09/09/2026
Preimplantation Genetic Testing in Kenya: Why Medically Indicated IVF-PGT Deserves a Place in Universal Health Coverage
TABLE OF CONTENTS
1. Introduction
1.1 Background to Infertility and Genetic Disease
1.2 Why Preimplantation Genetic Testing Matters
1.3 The Case for Equitable Access in Kenya
2. Understanding IVF and Preimplantation Genetic Testing
2.1 In Vitro Fertilisation (IVF)
2.2 What is Preimplantation Genetic Testing (PGT)?
2.3 Types of PGT
2.3.1 PGT for Monogenic Disorders (PGT-M)
2.3.2 PGT for Aneuploidy (PGT-A)
2.3.3 PGT for Structural Chromosomal Rearrangements (PGT-SR)
3. The Scientific Process of PGT
3.1 Genetic Counselling and Patient Assessment
3.2 Development of a Patient-Specific Genetic Test
3.3 Ovarian Stimulation
3.4 Egg Retrieval and Intracytoplasmic S***m Injection (ICSI)
3.5 Embryo Culture to the Blastocyst Stage
3.6 Trophectoderm Biopsy
3.7 DNA Extraction and Whole-Genome Amplification
3.8 Molecular Testing for PGT-M
3.9 Chromosomal Testing for PGT-A
3.10 Testing for Structural Rearrangements (PGT-SR)
3.11 Interpretation and Reporting of Results
3.12 Embryo Selection and Transfer
3.13 Prenatal Confirmation Following PGT
4. Key Scientific Considerations in PGT
4.1 Allele Dropout and the Risk of Misdiagnosis
4.2 Linkage Analysis and Haplotyping
4.3 Next-Generation Sequencing (NGS)
4.4 Embryonic Mosaicism
4.5 Limitations and Sources of Diagnostic Error
5. Why Medically Indicated IVF-PGT Should Be Considered in Kenya
5.1 Burden of Genetic Disease
5.2 Reproductive Risk for Couples with Genetic Conditions
5.3 PGT as a Reproductive and Diagnostic Intervention
5.4 Improving Reproductive Choice and Family Well-Being
6. The Kenyan Health Insurance and Universal Health Coverage Context
6.1 Current Access to IVF Services in Kenya
6.2 Financing of Assisted Reproductive Services
6.3 The Role of the Social Health Authority (SHA)
6.4 Financial Barriers to IVF and PGT
6.5 Equity and Access to Fertility Care
7. A Proposed Framework for PGT Coverage in Kenya
7.1 Coverage of Medically Indicated PGT-M
7.2 Coverage of PGT-SR for Chromosomal Rearrangements
7.3 Appropriate Use of PGT-A
7.4 Eligibility and Clinical Criteria
7.5 Pre-authorization and Multidisciplinary Assessment
7.6 Monitoring Outcomes and Cost-Effectiveness
8. Ethical Considerations
8.1 Embryo Selection and Disposition
8.2 Prevention of Serious Genetic Disease
8.3 S*x Selection and Non-Medical Use of PGT
8.4 Disability and Ethical Concerns
8.5 Informed Consent and Genetic Counselling
9. Health Economic and Social Implications
9.1 The Cost of IVF and PGT
9.2 Potential Long-Term Healthcare Savings
9.3 Reducing Financial Inequality in Fertility Care
9.4 Improving Family and Community Well-Being
10. Policy Recommendations for Kenya
10.1 Development of National PGT Guidelines
10.2 Inclusion of Medically Indicated PGT in Health Insurance
10.3 Strengthening Genetic Counselling Services
10.4 Building Laboratory and Embryology Capacity
10.5 Regulation, Quality Assurance and Accreditation
10.6 Public Awareness and Patient Education
11. Conclusion
12. References
1. Introduction
For many couples, having a child is one of life's most deeply personal aspirations. For some families, however, pregnancy comes with an additional and frightening question: What if our child inherits the genetic condition that runs in our family?
Modern reproductive medicine has provided an answer that was unimaginable a few decades ago. Through in vitro fertilisation (IVF) and preimplantation genetic testing (PGT), embryos can be created in the laboratory and tested for particular genetic or chromosomal abnormalities before an embryo is transferred into the uterus.
This does not mean creating a "perfect" child, nor does PGT eliminate all genetic or developmental risks. Rather, when used appropriately, it gives couples with a known genetic risk an opportunity to reduce the likelihood of passing a specific inherited disorder to their child.
This distinction is particularly important for Kenya. The country is undergoing major changes in healthcare financing through the Social Health Authority (SHA), while access to assisted reproductive technology remains largely dependent on a person's ability to pay or on specific employment-based medical schemes. The 2026 SHA tariff framework continues to list assisted fertility treatments such as IVF among exclusions from the general healthcare tariff package. At the same time, Kenya has begun to demonstrate that IVF can be incorporated into selected medical schemes: the Ministry of Health reported in 2026 that IVF services were being made available to teachers through contracted facilities under the Public Officers Medical Scheme Fund.
This creates an important policy opportunity. If Kenya is willing to recognise IVF as a legitimate healthcare benefit for some insured populations, should medically indicated PGT also be covered when a couple has a clearly established risk of transmitting a serious inherited disease?
• There is a strong argument that it should.
• Understanding the difference between IVF and PGT
• IVF and PGT are related but they are not the same procedure.
• IVF is a method of fertilising an egg with s***m outside the body and subsequently transferring an embryo into the uterus.
• PGT is a genetic testing procedure performed on cells obtained from an IVF embryo before embryo transfer.
Therefore, PGT cannot ordinarily be performed independently of an IVF process. A couple needs embryos first, and those embryos have to be created through assisted reproduction before they can be biopsied and genetically analysed.
PGT is currently divided into three major categories:
• PGT-M – testing for specific monogenic or single-gene disorders.
• PGT-A – testing for chromosome-number abnormalities, known as aneuploidies.
• PGT-SR – testing embryos for structural chromosomal rearrangements such as translocations and inversions.
Professional guidance describes PGT as a group of genetic assays used to evaluate embryos before transfer, with the different forms targeting different genetic problems.
For health-insurance policy, however, these categories should not necessarily be treated identically. The argument for public coverage is particularly strong when PGT is being used to prevent transmission of a known serious inherited disorder, such as a well-characterised single-gene disease.
How PGT is performed: from genetic counselling to embryo transfer
PGT may appear simple from the outside—"test the embryo and select the normal one"—but the science behind it is considerably more sophisticated.
The process can be divided into several stages.
1. Genetic counselling and assessment
The process begins before IVF.
The couple is assessed by a reproductive specialist and, where appropriate, a clinical geneticist or genetic counsellor. The family history is carefully reviewed and genetic testing is performed to establish the precise genetic problem.
For PGT-M, the laboratory needs to know the disease-causing variant and how it is inherited.
For example, suppose both partners are carriers of a pathogenic variant responsible for sickle-cell disease. A naturally conceived pregnancy has approximately:
• 25% probability of being affected;
• 50% probability of being a carrier;
• 25% probability of being unaffected and not carrying the familial combination.
PGT-M can be used to identify embryos according to their genotype before transfer.
The laboratory must first determine that the genetic diagnosis is technically feasible and develop an appropriate testing strategy. Good-practice recommendations emphasise genetic counselling, informed consent, laboratory quality management and multidisciplinary assessment before PGT is undertaken.
2. Development of a patient-specific genetic test
One of the most technically demanding parts of PGT-M occurs before the embryos are created.
An embryo biopsy contains only a very small number of cells. Modern blastocyst biopsy generally removes approximately 5–10 cells from the trophectoderm, the layer that contributes primarily to the placenta. The inner cell mass, which gives rise to the fetus, is not intentionally biopsied.
Because there are so few cells, there is very little DNA available for analysis.
The laboratory therefore develops a highly specific testing strategy, often using the known familial mutation together with genetic markers surrounding the gene.
This can involve relatives' DNA samples to establish haplotypes—patterns of genetic markers that travel together with the disease-causing variant.
This additional information is important because a major technical challenge in PGT-M is allele dropout, where one copy of a gene may fail to amplify during laboratory testing.
For example, an embryo could actually carry:
Normal allele + pathogenic allele
but if only the normal allele is successfully amplified, the embryo could incorrectly appear unaffected.
For this reason, direct mutation analysis may be combined with linkage analysis to improve diagnostic reliability.
3. Ovarian stimulation
The woman undergoes controlled ovarian stimulation using fertility medications.
The objective is to recruit multiple follicles rather than allowing only one egg to mature, as would normally occur during a natural menstrual cycle.
The response is monitored using:
• ultrasound;
• follicular measurements;
• hormone assessment where clinically indicated.
When the follicles have reached appropriate maturity, final oocyte maturation is triggered.
4. Egg retrieval and fertilisation
The mature oocytes are retrieved through an ultrasound-guided procedure.
For PGT cycles, intracytoplasmic s***m injection (ICSI) is frequently used because it can reduce the possibility of contamination from s***m or surrounding cells during subsequent genetic analysis.
The s***m is injected directly into the oocyte.
The fertilised eggs are then cultured in the embryology laboratory.
5. Embryo culture to the blastocyst stage
Following fertilisation, embryos undergo several developmental stages.
They progress from:
zygote → cleavage-stage embryo → morula → blastocyst
The blastocyst normally develops around day 5–7 after fertilisation.
At this stage, two major cell populations can be identified:
Inner cell mass: eventually develops into the fetus.
Trophectoderm: contributes predominantly to the placenta and extraembryonic tissues.
Modern PGT most commonly uses trophectoderm biopsy rather than removing a cell from the inner cell mass.
6. Embryo biopsy
Under microscopic guidance, the embryologist creates a small opening in the embryo's surrounding zona pellucida, commonly using a laser.
A biopsy pipette is then used to remove several trophectoderm cells.
These cells are transferred to a specialised tube and sent to the genetic laboratory.
The embryo itself is usually vitrified, meaning it is rapidly cryopreserved.
The embryo therefore remains safely stored while the laboratory performs the genetic analysis.
7. DNA amplification
The amount of DNA contained in 5–10 cells is far too small for many genetic tests to be performed directly.
The laboratory therefore amplifies the DNA.
Depending on the testing strategy, this may involve:
• targeted PCR-based amplification;
• multiplex amplification;
• whole-genome amplification;
• next-generation sequencing (NGS);
• SNP-based analysis.
Whole-genome amplification can provide sufficient genetic material for subsequent analysis, while targeted methods can focus specifically on the familial mutation and informative genetic markers.
This stage is critical because amplification errors can potentially influence the final diagnosis.
8. Molecular testing for PGT-M
PGT-M focuses on a specific genetic disorder.
Suppose a family carries a pathogenic variant in a particular gene.
The laboratory can determine whether each embryo:
• carries the pathogenic genotype;
• does not carry the pathogenic genotype;
• is a carrier, where relevant;
• or produces an inconclusive result.
The laboratory may analyse the mutation directly and simultaneously examine nearby genetic markers.
This combination provides a genetic "fingerprint" that helps determine whether the chromosome segment carrying the pathogenic variant has been inherited.
PGT-M is therefore much more sophisticated than simply asking whether one mutation is present or absent.
9. PGT-A and chromosome testing
PGT-A addresses a different problem.
Instead of asking whether an embryo carries a particular single-gene mutation, PGT-A assesses whether the embryo has the expected number of chromosomes.
A typical human embryo should contain 46 chromosomes:
• 22 pairs of autosomes + two s*x chromosomes.
• An embryo with an extra chromosome is described as having a trisomy.
For example:
Three copies of chromosome 21 → trisomy 21 → Down syndrome.
• An embryo missing one chromosome has a monosomy.
Modern PGT-A frequently uses NGS to estimate chromosome copy number by analysing the relative representation of DNA originating from different chromosomes.
However, PGT-A should not be confused with a universal "health test". It does not determine that an embryo is completely genetically normal.
10. PGT-SR
PGT-SR is used when one of the parents has a known structural chromosome rearrangement.
Examples include:
• balanced translocations;
• inversions;
• certain deletions;
• certain duplications.
A parent may be healthy despite carrying a balanced chromosomal rearrangement, but the rearrangement can produce embryos with an unbalanced chromosome complement.
PGT-SR can therefore help identify embryos that are suitable for transfer in appropriately selected cases.
11. What happens after genetic testing?
After the genetic laboratory completes its analysis, embryos are categorised according to the test performed.
For PGT-M, results may include:
• affected / unaffected / carrier / inconclusive
• For PGT-A, results may include: euploid / aneuploid / mosaic / no result
The reproductive team then considers the genetic result together with embryo morphology and other clinical factors when deciding which embryo should be transferred.
12. Embryo transfer
Once an embryo has been selected, it is warmed from vitrification and transferred into the uterus.
A thin catheter is passed through the cervix and the embryo is placed into the uterine cavity.
If implantation occurs, pregnancy develops in the normal way.
The pregnancy is subsequently monitored using serum β-hCG and ultrasound.
Importantly, the genetic testing does not end with the embryo transfer.
13. Why prenatal testing is still important after PGT
One of the most important points for patients—and policymakers—is that PGT is not a guarantee of a genetically normal baby.
The biopsy analyses a small number of cells from the embryo.
Those cells may not perfectly represent every cell in the embryo because of embryonic mosaicism.
There can also be technical problems such as:
• allele dropout;
• amplification errors;
• contamination;
• laboratory error;
• mosaicism;
• limitations of the particular genetic test.
Professional guidance therefore recommends that appropriate prenatal screening or diagnostic testing should still be offered after PGT. A negative PGT result should not be presented as a guarantee that a newborn will have no genetic abnormality.
This is an important distinction between risk reduction and risk elimination.
IVF-PGT and the Kenyan context
The scientific ability to perform PGT is no longer simply a question for high-income countries.
Kenya has fertility centres with advanced IVF laboratories and access to genetic testing technologies. The more difficult question is equitable access.
At present, the cost of IVF and genetic testing can place these services beyond the reach of many Kenyan families.
This raises a fundamental question about Universal Health Coverage:
• Should access to medically indicated reproductive genetic technology depend primarily on whether a family can afford it?
Kenya's health-financing reforms provide an opportunity to reconsider this question.
The Ministry of Health's current SHA tariff framework explicitly lists assisted fertility treatments such as IVF among exclusions from the general healthcare tariffs.
At the same time, the government has demonstrated a willingness to finance IVF in selected settings. In April 2026, the Ministry reported that IVF services would be available through contracted facilities under the Public Officers Medical Scheme Fund, including the medical cover serving teachers.
This creates an important precedent.
Kenya has begun asking not simply whether infertility treatment is desirable, but whether it should be incorporated into organised health financing.
The logical next discussion is whether medically indicated PGT should accompany IVF when there is a substantial and documented genetic risk.
Why PGT-M may be particularly important in Kenya
Consider a Kenyan couple who have previously had a child with a severe inherited disorder, or who have both been confirmed as carriers of the same autosomal-recessive condition.
• Their reproductive choices may be extremely difficult.
• They could conceive naturally and undergo prenatal testing.
If the fetus is found to be affected, they may then face an emotionally and medically difficult decision concerning the pregnancy.
• Alternatively, they could decide not to have biological children.
• Or, where clinically appropriate and accessible, they could undergo IVF with PGT-M and attempt to select an embryo that does not have the familial disease-causing genotype.
• The third option does not guarantee a pregnancy or a healthy child. IVF itself may not produce enough embryos, some embryos may be affected, some may be unsuitable for transfer, and pregnancy may still fail.
Nevertheless, it provides something that conventional prenatal diagnosis cannot provide:
the opportunity to make the genetic selection before an ongoing pregnancy is established.
For couples who strongly wish to have biological children, that difference can be profound.
The case for insurance coverage in Kenya
The argument for insurance coverage should not be based simply on the idea that everyone who wants IVF should receive unlimited treatment.
Kenya has limited healthcare resources and must make difficult decisions about what should be publicly financed.
Instead, the argument should focus on medical indication and fairness.
If a patient requires a medical intervention because of a documented health risk, the question should be whether that intervention is clinically effective, safe, appropriate and sufficiently cost-effective—not simply whether it is expensive.
This is where the argument developed in the original article becomes relevant to Kenya.
The article proposes that IVF-PGT can be understood in two ways: as a diagnostic intervention and as a treatment that compensates for an impaired reproductive function.
That reasoning can be adapted to the Kenyan health system.
PGT as prevention rather than "designer babies"
Public discussion of embryo genetic testing sometimes becomes dominated by fears of "designer babies."
That concern should not be ignored, but it should not obscure the legitimate medical applications of PGT.
There is a fundamental difference between: using PGT to avoid transmission of a serious inherited disease and using PGT for non-medical selection of preferred characteristics. A Kenyan insurance policy could therefore make this distinction explicit.
Coverage could initially focus on:
• PGT-M for well-established serious monogenic disorders;
• PGT-SR for appropriately diagnosed parental chromosomal rearrangements; genetic counselling and laboratory testing necessary to establish the indication.
• PGT-A should be considered separately because its role is broader and the evidence for routine use in every IVF patient is not equivalent to the evidence supporting PGT-M for a known familial disorder.
A possible model for Kenya
A realistic Kenyan policy could introduce PGT coverage gradually rather than attempting universal coverage immediately.
• First: cover genetic counselling-Couples with a significant family history of inherited disease should have access to genetic counselling and appropriate genetic testing.
• Second: establish clear eligibility criteria
Coverage could be considered where there is:
i. a documented pathogenic genetic variant;
ii. a significant risk of transmission;
iii. an established clinical indication for PGT;
iv. appropriate genetic counselling;
v. a technically validated laboratory test.
• Third: cover the complete treatment pathway-It would be ineffective to cover only the genetic test.
A meaningful PGT benefit would need to consider:
Genetic counselling → IVF/ICSI → embryo culture → biopsy → genetic analysis → embryo cryopreservation → embryo warming → embryo transfer → pregnancy monitoring.
If only one component is covered, patients may remain unable to access the treatment.
• Fourth: establish quality standards ; PGT requires highly specialised embryology and molecular genetics laboratories.
Kenya would therefore need strong requirements for:
a. laboratory accreditation;
b. embryologist competency;
c. molecular genetic testing quality;
d. external quality assurance;
e. documentation of diagnostic accuracy;
f. genetic counselling;
g. informed consent;
h. secure handling of genetic information.
International good-practice recommendations emphasise multidisciplinary teams, quality management, counselling and clear patient-selection criteria.
A proper Kenyan health-economic assessment should therefore compare the cost of medically indicated IVF-PGT with the expected healthcare costs and health outcomes associated with alternative reproductive pathways.
Conclusion
Preimplantation genetic testing represents one of the most important developments in reproductive medicine. It allows genetic information to be incorporated into reproductive decision-making before an embryo is transferred and before an ongoing pregnancy is established.
For couples with a known risk of transmitting a serious inherited disease, this can fundamentally change their reproductive choices.
The argument for PGT coverage in Kenya should not be that every couple undergoing IVF needs genetic testing, nor that PGT can guarantee a genetically normal child. It cannot.
The stronger argument is narrower and more defensible: When a couple has a clearly established and clinically significant risk of transmitting a serious inherited disorder, medically indicated IVF-PGT should be considered a legitimate component of reproductive healthcare rather than automatically being treated as an elective luxury.
Kenya has already begun testing new approaches to financing IVF within selected medical schemes. The next step could be a careful national discussion about whether PGT-M and selected PGT-SR indications should receive similar consideration.
Such a policy would need to be evidence-based, financially responsible and ethically grounded. It should include genetic counselling, appropriate patient selection, accredited laboratories, informed consent, quality assurance and continued prenatal testing.
Most importantly, the discussion should remain focused on the people behind the technology.
For a couple who has already watched a child suffer from a serious inherited disease, PGT is not simply another laboratory test. It may represent the possibility of entering another pregnancy with less fear and more choice.
That is the human face of reproductive genetics—and it is a conversation Kenya should increasingly be prepared to have.
Footnotes
1) Always recommend to your patients for Laser Assisted Hatching(LAH) and
Embryo glueing as extra services at NO extra Costs, this is a secrets to increase the chances
of implantation and pregnancy rates.
2) Not all IVF centers offers above services. Contacts us for information.
3) Where AMH levels are low(diminished/low ovarian reserve), you can recommend platelet rich plasma(PRP) for ovarian rejuvenation before making decision for egg donation program. Likewise for obstructive azoos***mia, recommended testicular s***m aspiration(TESA) before s***m donation program. We always try to give couples an opportunity to have their biological children.
4) insurances and corporate covering IVF treatment in Kenya ; Department of Defence, Kenya seeds, Safaricom, KRA, GDC(Geothermal devt corp), Kenya pipeline, Kengen, NIS, TSC, KPLC,Safaricom,Bupa global, Aetna, Judiciary,Nairobi bottlers, TSC secretariat, Kenya seeds, First Assurance, KCB. Other local insurance companies require pre-authorization for IVF treatment.
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