diff --git a/src/pytest_sphinx.py b/src/pytest_sphinx.py
index d232118..27622b6 100644
--- a/src/pytest_sphinx.py
+++ b/src/pytest_sphinx.py
@@ -47,6 +47,11 @@ class SphinxDoctestDirectives(enum.Enum):
     DOCTEST = 5
 
 
+class DirectiveSyntax(enum.Enum):
+    RST = 1
+    MYST = 2
+
+
 _DIRECTIVES_W_OPTIONS = (
     SphinxDoctestDirectives.TESTOUTPUT,
     SphinxDoctestDirectives.DOCTEST,
@@ -79,7 +84,7 @@ def pytest_collect_file(
 
 
 def _is_doctest(config: Config, path: Path, parent: Union[Session, Package]) -> bool:
-    if path.suffix in (".txt", ".rst") and parent.session.isinitpath(path):
+    if path.suffix in (".txt", ".rst", ".md") and parent.session.isinitpath(path):
         return True
     globs = config.getoption("doctestglob") or ["test*.txt"]
     assert isinstance(globs, list)
@@ -95,7 +100,7 @@ def _is_doctest(config: Config, path: Path, parent: Union[Session, Package]) ->
 _OPTION_DIRECTIVE_RE = re.compile(r':options:\s*([^\n\'"]*)$')
 _OPTION_SKIPIF_RE = re.compile(r':skipif:\s*([^\n\'"]*)$')
 
-_DIRECTIVE_RE = re.compile(
+_RST_DIRECTIVE_RE = re.compile(
     r"""
     \s*\.\.\s
     (?P<directive>(testcode|testoutput|testsetup|testcleanup|doctest))
@@ -106,6 +111,28 @@ def _is_doctest(config: Config, path: Path, parent: Union[Session, Package]) ->
     re.VERBOSE,
 )
 
+_MYST_DIRECTIVE_RE = re.compile(
+    r"""
+    \s*```
+    {(?P<directive>(testcode|testoutput|testsetup|testcleanup|doctest))}
+    \s*
+    (?P<argument>([^\n'"]*))
+    $
+    """,
+    re.VERBOSE,
+)
+
+_SYNTAX_TO_DIRECTIVE_RE = {
+    DirectiveSyntax.RST: _RST_DIRECTIVE_RE,
+    DirectiveSyntax.MYST: _MYST_DIRECTIVE_RE,
+}
+
+_FILE_EXTENSION_TO_SYNTAX = {
+    ".rst": DirectiveSyntax.RST,
+    ".md": DirectiveSyntax.MYST,
+    ".py": DirectiveSyntax.RST,
+}
+
 
 def _split_into_body_and_options(
     section_content: str,
@@ -222,7 +249,7 @@ def __init__(
         self.options = options
 
 
-def get_sections(docstring: str) -> List[Union[Any, Section]]:
+def get_sections(docstring: str, syntax: DirectiveSyntax) -> List[Union[Any, Section]]:
     lines = textwrap.dedent(docstring).splitlines()
     sections = []
 
@@ -248,7 +275,7 @@ def add_match(
         except IndexError:
             break
 
-        match = _DIRECTIVE_RE.match(line)
+        match = _SYNTAX_TO_DIRECTIVE_RE[syntax].match(line)
         if match:
             group = match.groupdict()
             directive = getattr(SphinxDoctestDirectives, group["directive"].upper())
@@ -263,7 +290,11 @@ def add_match(
                 except IndexError:
                     add_match(directive, i, j, groups)
                     break
-                if block_line.lstrip() and _get_indentation(block_line) <= indentation:
+                if (
+                    syntax is DirectiveSyntax.RST
+                    and block_line.lstrip()
+                    and _get_indentation(block_line) <= indentation
+                ) or (syntax is DirectiveSyntax.MYST and block_line.lstrip() == "```"):
                     add_match(directive, i, j, groups)
                     i = j - 1
                     break
@@ -272,7 +303,9 @@ def add_match(
 
 
 def docstring2examples(
-    docstring: str, globs: Optional[GlobDict] = None
+    docstring: str,
+    syntax: DirectiveSyntax = DirectiveSyntax.RST,
+    globs: Optional[GlobDict] = None,
 ) -> List[Union[Any, doctest.Example]]:
     """
     Parse all sphinx test directives in the docstring and create a
@@ -283,7 +316,7 @@ def docstring2examples(
     if globs is None:
         globs = {}
 
-    sections = get_sections(docstring)
+    sections = get_sections(docstring, syntax)
 
     def get_testoutput_section_data(
         section: "Section",
@@ -527,6 +560,7 @@ def collect(self) -> Iterator[_pytest.doctest.DoctestItem]:
         encoding = self.config.getini("doctest_encoding")
         text = self.fspath.read_text(encoding)
         name = self.fspath.basename
+        file_extension = Path(self.fspath).suffix
 
         optionflags = _pytest.doctest.get_optionflags(self)  # type:ignore
         runner = SphinxDocTestRunner(
@@ -535,8 +569,11 @@ def collect(self) -> Iterator[_pytest.doctest.DoctestItem]:
             checker=_pytest.doctest._get_checker(),
         )
 
+        syntax = _FILE_EXTENSION_TO_SYNTAX[file_extension]
+        examples = docstring2examples(text, syntax=syntax)
+
         test = doctest.DocTest(
-            examples=docstring2examples(text),
+            examples=examples,
             globs={},
             name=name,
             filename=name,