Objective: Gynecologic oncologists should be aware of the option of conception through IVF/PGT-M for families with high BRCA related morbidity or mortality. Our objective was to investigate the cost-effectiveness of preimplantation genetic testing for selection and transfer of BRCA negative embryo in BRCA mutation carriers compared to natural conception. Design: Markovian process decision analysis model comparing two strategies, conception through IVF/PGT-M and BRCA negative embryo transfer and natural conception with a 50% chance of BRCA positive newborn. Setting: Not applicable Population: Theoretical couple, with either one parent carrying a BRCA germ line mutation. Intervention: None Methods: Costs of two strategies were compared using quality adjusted life years (QALYs’). All costs were discounted at 3%. Main outcome measure: Incremental cost effectiveness ratio (ICER) compared to willingness to pay threshold was used for cost-effectiveness analysis. Results: IVF/ PGT-M is cost-effective with an ICER of 150,219 new Israeli Shekels, per QALY gained (equivalent to 44,480 USD), at a 3% discount rate. Conclusion: IVF/ PGT-M and BRCA negative embryo transfer compared to natural conception among BRCA positive parents is cost effective and should be considered for selected couples with high BRCA mutation related morbidity. Funding: No funding of any kind was received for this article