Juniper Genomics | Frequently Asked Questions

What does Juniper Genomics do?

Where can I get Juniper’s test?

How does Juniper’s technology work?

We have developed a proprietary approach that uses the latest in whole genome and transcriptome sequencing, bioinformatics, and data that will give patients and clinicians as much certainty as possible that the first embryo they choose to transfer will succeed.

We use the same clinical workflow as all existing embryo testing. Once embryos grow in the lab to the “blastocyst” stage (around day 5 or 6), the embryologist takes a biopsy of a few cells from the outside of the embryo and sends it to our lab. We also use a regular blood draw from the biological parents to help analyze the embryo.

We provide genetic counseling before the test as well as after we return our reports to patients and clinicians. Genetic counseling is personalised to the couple/individual, their goals, and the results of their embryo to ensure that everyone understands both the value and the limitations of our data.

How is your technology different from existing technologies for embryo screening?

Juniper Genomics uses “Whole Genome Sequencing” to accurately read the billions of letters of each embryo’s DNA genetic code individually. This allows us to look for single genetic changes that cause specific outcomes like implantation failure, embryo arrest, pregnancy loss or genetic disease. We also read the embryo’s RNA transcriptome at the same time to confirm and extend our findings from the genome.

At best, current testing technologies (“PGT-A”) find embryo errors that account for 50% of IVF failures and pregnancy losses. This is why only about half of current embryo transfers result in a live birth (SART 2022 data).

Juniper’s technology finds embryo errors that account for over 85% of IVF failures and pregnancy losses. This means patients will need far fewer embryo transfers to achieve a live birth. Put simply, this translates to a shorter journey to parenthood.

Juniper PGT Trio Whole Genome plus Transcriptome	PGT-WGS GenEmbryomics, Orchid Health	PGT-P (Polygenic Risk Scores) Genomic Prediction, Orchid Health	PGT-A (Aneuploidy) Cooper Genomics, iGenomix, Juno Genetics, MyOme	AI analysis of embryo images or data AIVF, ALife, etc.
>9,000,000,000 data points	3,000,000,000 data points	<1,000 data points	46 data points (23 chromosome pairs)	Not a genetic test
Looks for individual genetic changes that directly cause pregnancy loss and ~6,000 genetic diseases. As well as all PGT-A and PGT-M findings	Looks for individual genetic changes that cause ~1,000 genetic diseases plus PGT-A findings	Looks for patterns of changes that are associated with relative risk of ~600 traits, including some diseases	Looks for whether the embryo has the correct number of chromosomes	Looks at the shape of the embryo or the course of treatment and matches observed patterns with outcomes
Using parental (trio) data helps ensure consistency regardless of patient ancestry	Developed primarily from people with European ancestry	Developed primarily from people with European ancestry	Consistent data regardless of patient ancestry	May have training set bias
Identifies causes for at least 85% of adverse pregnancy outcomes	Identifies causes for ~50% of adverse pregnancy outcomes	Does not identify causes of pregnancy outcomes	Identifies causes for ~50% of adverse pregnancy outcomes	Pregnancy outcomes tbc
Identifies causes for over 6,000 genetic diseases	Identifies causes for ~1,000 genetic diseases	Does not identify causes of diseases	PGT-M can only identify the cause of 1 disease at a time and only if parents are affected or carriers	Does not identify causal events
Studies individual embryo cells separately to ensure consistent data and minimize false-positive mosaicism	Tests embryo biopsies in bulk, so is unable to distinguish true mosaicism from assay or biopsy errors	Does not address mosaicism	Tests embryo biopsies in bulk, so is unable to distinguish true mosaicism from assay or biopsy errors	Does not address mosaicism

How does whole genome sequencing increase the chances of IVF transfer success?

When a transfer doesn’t succeed, it’s natural to wonder, “Why did this happen?” or “Could I have done something differently?” But the truth is, it’s not the parents’ fault. We know from studying pregnancy loss, that at least 85% of pregnancy losses are due to the genetics of the embryo itself.

Juniper Genomics uses whole genome sequencing to accurately read the billions of letters of each embryo’s DNA genetic code individually. This allows us to look for single genetic changes that cause specific outcomes like implantation failure, embryo arrest, pregnancy loss or genetic disease. We also read the embryo’s RNA transcriptome at the same time to confirm and extend our findings from the genome.

At best, current testing technologies (PGT-A) find embryo errors that account for 50% of IVF failures and pregnancy losses. This is why only about half of current embryo transfers result in a live birth.

Juniper’s technology finds embryo errors that account for over 85% of IVF failures and pregnancy losses. This means patients will need far fewer embryo transfers to achieve a live birth. Put simply, this translates to a shorter journey to parenthood.

Does the testing harm the embryo?

The biopsy comes from the outside of the embryo - how do you know it’s an accurate test for the genetics of the part that becomes the fetus?

What are the benefits of Juniper’s test?

We help IVF patients have babies faster because our test will help ensure that the first embryo chosen for transfer is the most likely to succeed.

Our test replaces all existing preimplantation genetic tests, giving patients and doctors all of the data they would get from aneuploidy testing (PGT-A) and monogenic testing (PGT-M). Additionally, our test provides data on thousands of genetic changes that cause IVF failure or pregnancy loss, as well as thousands of genetic changes that cause serious medical conditions after birth.

Having this additional data means that patients and clinicians will be able to prioritize embryos more accurately so that fewer transfers are needed to achieve a live birth.

You’re talking about success rates per embryo transfer. What about success rates per cycle?

Measuring any embryo selection technology over a whole cycle is misleading - neither Juniper’s technology nor any other approach to choosing embryos will cause more embryos to be made from an IVF cycle. So if a patient has produced at least one viable embryo, and all embryos are transferred, that patient will have a baby regardless of whether they test those embryos or not.

However, there is a huge difference in timing and experience. Imagine that 10 embryos are produced in a cycle, and 2 of them pass Juniper’s most stringent screening. A patient who uses Juniper would be likely to have a live birth from the first transfer - with their baby arriving just a year after starting IVF. But a patient who doesn’t use Juniper’s test might try 8 transfers before “finding” a successful embryo - delaying their baby by 16 months or more.

Juniper’s test would also have benefits for an older patient with fewer embryos. If only 3 embryos are produced in a cycle, and none of which are deemed viable by Juniper’s testing, that patient can start a new cycle immediately; whereas without Juniper’s testing, they would lose a minimum of 6 months trying each embryo, waiting for a pregnancy test, waiting for a heartbeat and hoping for a live birth that would never come. For older patients that time is critical and it impacts their overall likelihood of success.

Giving patients and clinicians increased confidence that an embryo selected through Juniper’s testing will succeed will also allow more transfers in which only one embryo is selected (“single embryo transfers”). Clinical practice is moving towards this anyway because transferring multiple embryos creates risk for the fetuses and the mother, but better data will mean more confident decisions and fewer complications from multiple pregnancies.

Does Juniper’s testing look at polygenic risk scores or “genetic risk scores”?

No. We agree with the American College of Medical Genetics and Genomics and with the authors of this report in the New England Journal of Medicine that polygenic risk scores should not be used for embryo selection.

Juniper’s testing looks for specific genetic changes that cause adverse pregnancy and health outcomes. Polygenic risk scores (aka genetic risk scores) are about correlation, not causation. They use fewer than 1000 data points across the genome to look for patterns of genetic changes that are associated with an increased risk of disease outcomes across populations, but are not shown to cause, much less guarantee, the outcome of any individual embryo. Most importantly, PGT-P does not even claim to improve IVF outcomes, so if your main goal is IVF success, polygenic risk scores can’t help.

Tell me more about the scientific and clinical validity of Juniper?

We have tested our technology on hundreds of donated embryo samples and reference cell lines. Our sequencing is clinically accurate, and we know that the sequence data we get from an embryo biopsy is 99% identical to every other sample from that embryo. This gives us a very high degree of confidence that the biopsy data accurately reflects the genome of the part of the embryo that develops into the baby.

We have peer reviewed abstracts of our data being presented at upcoming major industry conferences.

How accurate is the testing?

How is the biopsy performed and when?

How will this impact my current PGT practices and/or workflow?

Your current workflow stays the same, with one addition: a single blood draw from both parents. This can happen any time prior to shipping the biopsies. Our biopsy and shipping processes are identical to current PGT-A. We provide the biopsy and phlebotomy kits along with shipping labels and materials. Clear reports with straightforward and comprehensive answers are available within a few weeks. We offer genetic counseling at no additional cost and we share consultation notes with your clinic in whatever way you prefer.

What is the turnaround time on the testing and reporting?

How are results delivered?

What kind of post-testing support do you offer for patients?

Is Juniper’s test ethical?

We strongly believe that it is. Juniper is providing more comprehensive data to patients and doctors to help them do a better job answering a question they already have to answer every day: which embryo among a set of IVF embryos should be transferred for pregnancy? Juniper’s approach to embryo screening adheres to three core ethical commitments:

Autonomy: We empower those who bear the emotional, physical and financial burden of pregnancy and parenting to make fully informed decisions.
Beneficence: We report findings that directly and reliably cause specific medical and IVF outcomes, including embryo transfer success, and pregnancy loss. We do not report findings that do not independently predict outcomes such as polygenic risk scores.
Justice: We are committed to reducing the financial, mental, and physical health costs associated with IVF and parenthood. We do not study or report on things like height or eye color.

Is Juniper's test eugenics?

No. Juniper is empowering and promoting reproductive autonomy, which is the opposite of what eugenics movements have done.

Eugenics movements denied individuals the right to make their own reproductive decisions in the name of creating a ‘better’ society. Segregation, arranged marriage, and sterilizations are some examples of state-mandated practices used to encourage those with “desirable” traits to have children, and to discourage or prevent those with “undesirable” traits from having children.

Eugenics responds to uncertainty with coercion and control.

Juniper is empowering people to navigate uncertainty on their own terms.

By providing people trying to conceive with data about their embryos, we are not promoting any goals beyond individual choice, or any one definition of health or a good life.

Is it “liberal eugenics”?

We believe the term ‘liberal eugenics’ is disrespectful and misrepresentative, and we strongly disagree with those who are intent on popularizing it. This term attempts to equate parents making difficult choices to protect the health, security, or well-being of their families with the evils of eugenics movements.

We understand concerns about the politicization of reproductive technologies. We do not report traits like height or eye color. Our mission is focused exclusively on fertility, health, and access.

Are there ethical concerns with your approach?

We believe the most important challenge in the long term is equity and access, commonly referred to as distributive justice. Most IVF right now is still paid for directly by patients, and because of the cost and burden, about 80% of people who need help getting pregnant cannot afford it. Although we believe that using our test will save families money throughout their IVF journey, it will initially provide benefits to an already privileged group of people.

To address this, our plan is to generate and use our data to improve insurance coverage for IVF. Because our testing will reduce the number of failed embryo transfers and pregnancy losses that occur in IVF, we expect to reduce the direct and indirect costs of IVF overall, and make IVF outcomes more certain. By using our resources to rigorously prove these benefits over time, we aim to convince insurers and payers to make IVF accessible to more people, regardless of their means.

Who owns the data? Will you sell it? How do you keep it safe?

You own your data. We will never sell it. We store it on secure cloud servers using clinical processes, coding and encryption. It is still possible that someone could access your data without authorization (through hacking or other malicious or criminal activity).

There are two ways in which we do plan to disclose data that we obtain, but it will never include any connection to your personal information:

If we learn about a specific genetic change that causes disease, pregnancy loss, or other bad outcomes, we will contribute that information to relevant databases that are accessible by other researchers so that they can learn about it and help other families who may be affected. We would not disclose any personal information or any other genetic data outside the minimum required by the data custodians.
Once we remove identifying information, we will combine all of the individual data into aggregate datasets. We will use these to improve our product for future customers and to learn more about what makes IVF succeed or fail so that we can try to improve more parts of the IVF process. We intend to sell insights from this analysis, but we will not sell copies of, or access to, any individual data about you.

If you want a copy of your own data, you can request it from us. There may be fees associated with producing a copy for you.

You have the option to request the deletion of your data, upon which we will erase all individual copies and discontinue its use in future datasets. However, your data may already have been incorporated into aggregate datasets. Removing it from these datasets might not be feasible, as any personal identifiers have been expunged and its removal could compromise completed analyses.

What about “mosaicism”?

With current embryo testing technologies, depending on the lab, up to 20% of embryos may be reported as “mosaic” - neither clearly euploid (correct number of chromosomes) nor clearly aneuploid (incorrect number of chromosomes), but somewhere in between.

However, “Mosaic” has a specific meaning - that different cells have different genetics - but NONE of the current tests actually separately look at the genetics of different cells. What they’re calling “mosaic” is actually any result in between fully euploid and fully aneuploid embryos. Those results could be caused by mosaicism, but they could also be caused by errors in the biopsy process or in the testing process.

Recent data from a paper in which embryos that had been given “mosaic” results from commercial tests were rebiopsied multiple times showed that 50% of these embryos were actually euploid (figure below ¹). The low confirmation rate of “mosaic” findings on rebiopsy strongly supports the view that assay or biopsy variability is causing intermediate copy number results.

Because patients interpret embryos with “mosaic” findings as inferior to those with euploid findings, the embryos called “mosaic” are deprioritized and often discarded, sometimes in favor of starting a whole new IVF cycle.

Juniper’s technology is the only embryo test based on research that examines separate cells individually. We expect that our test will report more euploid embryos than other NGS approaches, while leveraging the high resolution only available from NGS to identify small but critical genetic changes in the embryo.

1: Figure 1 from Cascante et. al. Fert. Ster. 2023, https://doi.org/10.1016/j.fertnstert.2023.08.010