Trends in Use of Preimplantation Genetic Testing for Aneuploidy Before Dobbs, After Dobbs Leak, and After Dobbs Final Ruling.

Abstract

Objective: To determine if utilization of preimplantation genetic testing for aneuploidy (PGT-A) increased following the Dobbs decision leak on May 2^nd, 2022, and after the Dobbs final ruling on June 24^th, 2022, compared to prior to the Dobbs decision.

Design: Retrospective cohort study SUBJECTS: Patients that underwent in vitro fertilization (IVF) within a large fertility network geographically distributed across six states from June 2021 through June 2023. PGT-A cycles were defined as cycles with at least one embryo biopsied.

Exposure: IVF cycles were grouped by cycle start date. Cycles starting between May 3^rd, 2022 and June 24^th, 2022 were considered Post-Dobbs leak. These were compared to cycles starting within the year leading up to the leak and those starting within the year following the final ruling.

Main outcome measures: Percentage of cycles utilizing PGT-A, defined as number of IVF cycles utilizing PGT-A divided by total number of IVF cycles during the study period. We stratified by age, socioeconomic status, and state abortion access legislation.

Results: We analyzed 9,371 IVF cycles prior to Dobbs, 1,581 IVF cycles after Dobbs leak, and 11,536 IVF cycles after Dobbs final ruling, totaling 22,488 IVF cycles. Age, BMI, AMH, parity, and number of embryos obtained per cycle were similar across time periods, but differences existed among race and infertility diagnoses. There were no differences in the primary outcome of percentage of cycles utilizing PGT-A between study time periods (57.2% pre-Dobbs, 56.8% post-Dobbs leak, 56.2% post-Dobbs final ruling); a finding which remained when adjusting for confounders. There was no association between the Dobbs decision and PGT-A use in subgroups stratified by age and socioeconomic status. A slight decrease in PGT-A use was noted in states with protective abortion legislation after the Dobbs final ruling (RR 0.96, 95% CI 0.93-0.99), with overall PGT-A use higher in states with restrictive policies (66.8%) than protective states (52.4%) across all time periods using Guttmacher's institute's protective vs. restrictive classifications.

Conclusions: There is no association between Dobbs decision timing and patients' pursuit of PGT-A, but PGT-A use was more common in restrictive states across all included time periods.