The Ethics of Predictive Genetic Screening in Preimplantation Embryos

Abstract

Preimplantation genetic testing has expanded from screening for single, well-characterized mutations to polygenic risk scoring, which estimates an embryo's probabilistic risk of complex disease and, more controversially, its predicted standing on non-disease traits.
This review surveys the ethical case for conventional monogenic testing and examines how that case weakens as screening moves toward polygenic disease-risk prediction and further still toward trait selection, where predictive power is modest and reference data are skewed toward limited ancestries. It draws on recent professional guidance, including a 2026 ASRM Ethics Committee opinion counseling against clinical use of polygenic embryo screening, alongside qualitative work on how clinicians and patients
actually experience the technology. It also revisits the long-standing expressivist objection to genetic testing and its recent reformulation around relational equality, arguing that this critique applies with particular force to polygenic trait selection.
We conclude that the field needs a graduated ethical and regulatory framework that treats monogenic testing, polygenic disease-risk testing, and non-disease trait selection as distinct categories, rather than governing all three under one undifferentiated policy.