Evaluating PGT-A in patients with limited good-quality embryos: A retrospective cohort study.

BACKGROUND

Preimplantation genetic testing for aneuploidy (PGT-A) is widely used to screen for aneuploidy with the aim of improving the live birth rate. Remarkably, previous studies have focused on the effect of PGT-A on cumulative clinical outcomes in women with a good pregnancy prognosis. However, it is still unclear whether PGT-A is superior for cumulative pregnancy outcomes in patients with limited good-quality embryos.

METHODS

In total, 1553 patients who intended to pursue PGT-A for the first time but only obtained two or fewer good-quality embryos on day 3 after oocyte retrieval were divided into two groups: 997 in the PGT-A group and 556 in the drop-out group (i.e., decided not to undergo PGT-A due to poor embryological outcome). The main outcome measures were cumulative live birth rate per oocyte retrieval cycle and live birth rate per embryo transfer (ET) cycle.

RESULTS

After adjustment for potential confounders, the PGT-A group exhibited significantly lower cumulative rates of biochemical pregnancy [19.96 % vs. 30.22 %, p-adjusted (p-adj) < 0.001], clinical pregnancy (17.55 % vs. 23.38 %, p-adj < 0.001) and live birth (14.14 % vs. 16.19 %, p-adj = 0.005) per oocyte retrieval compared with the drop-out group. In contrast, when analysed per ET procedure, the PGT-A group showed marked improvements in rates of biochemical pregnancy (72.16 % vs. 35.50 %, p-adj < 0.001), clinical pregnancy (61.86 % vs. 26.98 %, p-adj < 0.001) and live birth (48.45 % vs. 18.26 %, p-adj < 0.001) compared with the drop-out group. No significant differences were observed in cumulative miscarriage and ectopic pregnancy rates, number of ETs per live birth, and neonatal outcomes between the groups.

CONCLUSIONS

This retrospective study of patients with limited good-quality embryos found that the PGT-A group had a lower cumulative live birth rate per oocyte retrieval, but superior pregnancy outcomes per ET compared with the drop-out group.