Embryonic aneuploidy: overcoming molecular genetics challenges improves outcomes and changes practice patterns

•IVF relies on molecular technology to enhance the power of embryonic selection.•Challenges include genome amplification, embryonic mosaicism, and platform validation.•Secondary challenges include timing and type of cell removed for genetic analysis.•This strategy improves pregnancy rates and decreases multiple gestation morbidity.

Since its inception, in vitro fertilization (IVF) has pursued molecular technology to improve patient outcomes, leading to enhanced methods of embryo selection. Comprehensive chromosomal screening (CCS) is a powerful tool that decreases maternal and neonatal morbidity due to multiple gestations by allowing the transfer of fewer embryos while maintaining success rates. To optimize this genetic test, physiological principles limiting the timing and type of cells to be removed had to be realized. Molecular barriers involved in genome amplification and ensuring the accuracy and validity of the CCS platform required a multistep approach to ensure that this technology was not used prematurely. Only after ensuring that the potential for harm was minimized and benefit maximized could clinicians use this technology to improve patient care.