23andMe vs. Orchid: what’s the difference? Consumer genetics explained by a genetic counselor

23andMe vs. Orchid: what’s the difference? Consumer genetics explained by a genetic counselor
As a genetic counselor, people often ask me what genetic test they should choose. It can feel daunting to unpack what each test is supposed to tell you and what you can learn. Choosing the right test for you hinges on your situation and needs. Here’s what you need to know about the difference between existing consumer DNA testing like 23andMe and Orchid.
Written by Christina Ren, Board-Certified Genetic Counselor
Orchid offers advanced genetic testing for couples who want their child to have the best shot of a healthy life. “Ask a Genetic Counselor” is where we unpack how genetics impacts our everyday lives and the latest tools to help you build a healthier family.

What information does 23andMe and Orchid each offer me?

23andMe and Orchid are genetic reports that analyze and interpret your genetic information that you might not have otherwise known. 23andMe focuses on providing ancestry and health wellness traits for personal curiosity, while Orchid specializes in modern genetics for smart couples before conceiving to have healthier families.

Many people use 23andMe to determine their ancestry and find their genetic relatives. It can also help answer questions like, “am I more likely to have alcohol flush based on my genetics?” by using a handful of genetic variants that can affect certain traits or health risks.

Orchid focuses on helping couples proactively build healthier families. The reports help answer questions like, “how likely is my future child going to develop common diseases such as heart disease, diabetes, and cancer, based on my partner and I’s combined genetics?” and, “what can I do to reduce my future child’s health risks?”

For a quick overview of the differences, here’s a comparison chart. I’ll do a deeper take below.

Difference #1 - personal use vs. reproductive family planning

The first question to ask yourself is: “why am I seeking DNA testing — what am I hoping to learn?”

23andMe can be a good option if you’re generally curious about how your genetics can explain certain aspects of yourself — ancestry, physical traits and preferences, certain health risks. You’ll get a little bit of everything from caffeine metabolism to predisposition to blood clots. It’s like a sampler plate of various things you can learn from your genetics.

On the other hand, if you’re planning on starting or growing your family, you may be looking for information tailored towards your future child’s health. Orchid offers such comprehensive genetic risk assessment through the Couple Report. It’s a saliva test that analyzes both you and your partner’s DNA to see how your combined genetics can influence your future child’s genetic predispositions to common diseases.

Conditions Orchid offers screening for include:

  • Breast Cancer
  • Prostate Cancer
  • Heart Disease
  • Atrial Fibrillation
  • Stroke
  • Type 2 Diabetes 
  • Type 1 Diabetes 
  • Inflammatory Bowel Disease 
  • Schizophrenia 
  • Alzheimer’s

You also get to see your individual genetic risks for these conditions, so the Couple Report is 3 reports in one — 1) your future child 2) you and 3) your partner.

Difference #2 - less vs. more genetic data analyzed

Another big difference between 23andMe and Orchid is the method used to analyze your DNA. 23andMe uses SNP genotyping (I’ll explain in a bit what this means) which only looks at less than 2% of your entire genome. Orchid uses whole genome sequencing which analyzes 100% of your genome — over three billion base pairs of DNA found in humans.

SNP genotyping array vs. whole genome sequencing

What that means is Orchid offers a full picture of your genetic information through DNA sequencing, whereas 23andMe “hand-picks” specific locations in the genome to analyze.

If represented visually, a chest X-ray would look something like this with whole genome sequencing:

And something like this with 23andMe’s SNP genotyping array: Why this matters for you


Why this matters for you

If you’ve seen 23andMe reports before, you may notice disclaimers that state although the reports cover many genetic variants, they don’t include all possible variants associated with each condition.

What this means is that you could still have genetic variants not covered by the SNP genotyping array. For example, for breast and ovarian cancer risk genes, BRCA1/2, only 3 out of over 1,000 genetic variants are reported through 23andMe.

Orchid is able to read your full genome to assess the whole genetic landscape. For each condition, a combination of many genes and genetic markers are analyzed. Most conditions have some genetic component to it — and modern genetics is one way of trying to see if this genetic component can be quantified using the latest available science.

Now — and here’s where I put my genetic counselor hat on — neither 23andMe nor Orchid can give you a medical diagnosis. What Orchid can tell you is whether you and your future child are more or less likely to develop a condition than average. So the reports help alert you ahead of time if there is a concern and if so, the chance of developing a certain condition.

If you do go with Orchid, interpreting your reports in a meaningful way will go better if you understand the nature of genetic risk for common conditions.

Difference #3 - direct-to-consumer vs physician-approved testing

23andMe is considered a true “direct-to-consumer” test. That means there is no physician oversight when you order a test from them. With Orchid, the purchase of the Couple Report is approved by independent physician review.

Orchid reports includes personalized expert support

23andMe does not offer genetic counseling, which some may find distressing, especially if you receive results you didn’t expect. If you want expert support, you’ll need to seek out a third-party service on your own.

Orchid reports come with a personalized video walking you through your results (not some sample report) from a board-certified genetic counselor. You also have the opportunity to ask questions and discuss one-on-one with a genetic counselor about your report.

Orchid offers actionable options to proactively reduce your future child’s health risks

23andMe gives you information about your genetic makeup, not what genetic predispositions you and your partner can pass on to your children.

In contrast, there are ways you can take action for your future child with Orchid.

If your Orchid Couple Report shows that your future child has an increased genetic predisposition to a condition, you have options about how you want to use this information. One option is to choose to lower your future child’s genetic risk through in vitro fertilization (IVF) and embryo screening. By determining each embryo’s genetic risk for certain conditions, you can elect to prioritize transferring embryos with the lowest genetic risk. You can learn more about how this is done at Orchid and potential benefits of embryo screening for your family in our guide here.

Knowing you and your future child’s genetic risks can also help you plan for the future through increased awareness, screening, and lifestyle modifications. These informed actions can help prevent or identify conditions early.

What about carrier screening? I thought that’s for reproductive planning and 23andMe has it?

Now, if you’re a discerning consumer with a sharp eye, you may have noticed that 23andMe has carrier screening for 40+ rare genetic disorders. Most of the time, being a carrier of a recessive genetic disorder doesn’t impact your health. While almost all of us are carriers of something, it’s rare for couples to be carriers of the same recessive genetic disorder.

What this means is that for the vast majority of couples, the most likely outcome from carrier screening is that there is nothing you need to do differently before pregnancy.

By contrast, every single Orchid test reveals something about you and your future child's health.

We go over more about these differences in our guide to preconception genetic testing and article explaining the differences between Orchid preconception and carrier screening.

Who are 23andMe and Orchid best for?

To sum things up:

Orchid is best for information-seeking couples before conceiving. Modern genetics can help couples better protect their future child’s health from the most common diseases. We do this by providing advanced tools for parents-to-be to measure their future child’s genetic predispositions through our Couple Report and, if desired, to mitigate genetic risks through our Embryo Report.

23andMe is better for individuals curious about their ancestry and select health traits. If you aren’t planning on starting or growing a family, 23andMe can be a good place to start if you don’t have any specific health or genetic concerns.

Orchid offers advanced genetic testing for couples planning on building their family. We use advanced tools and smart, caring humans to help you give your future children the best shot of a healthy life. Conceive with greater confidence and peace of mind
2/15/2021
Genetics
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