The short version
| Natural pearl | Cultured pearl | |
|---|---|---|
| How it starts | On its own, around a microscopic irritant | A person places a bead or tissue inside the mollusk |
| Is it a real pearl? | Yes | Yes |
| How common | Rare; natural beds were overharvested | Almost all pearls sold today |
| How to confirm | Lab X-ray testing | Lab X-ray testing |
Sources: FTC (16 CFR 23.19) and GIA.
More on each: natural pearls and cultured pearls.