Analysis of pregnancy outcomes in patients with unexplained recurrent miscarriage assisted by IVF/ICSI with or without PGT-A.

Abstract

Purpose: The objective of this study was to evaluate the efficacy of preimplantation genetic testing for aneuploidy (PGT-A) in reducing the incidence of early miscarriage among patients diagnosed with unexplained recurrent spontaneous abortion (URSA).

Methods: This investigation was designed as a retrospective cohort study, examining patients who underwent freeze-thaw embryo transfer (FET) of single blastocysts from January 2018 to August 2023. A total of 675 FET cycles involving patients with URSA were included in the study. The primary outcome measure was the early miscarriage rate, while secondary outcome measures included the clinical pregnancy rate, ongoing pregnancy rate, and live birth rate.

Results: A total of 316 patients with URSA who underwent PGT-A utilizing next-generation sequencing (NGS) technology were designated as the PGT-A group. Additionally, 359 URSA patients who underwent in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) during the same time frame were selected as the control group. Following comprehensive embryo cryopreservation, the blastocyst exhibiting the highest morphological score was chosen for the initial FET cycle in both groups. The pregnancy outcomes between the two groups were subsequently compared. In patients with URSA, the application of PGT-A was associated with improved clinical pregnancy rates (64.2% vs. 45.7%; aOR, 2.012; 95% CI, 1.303 to 3.108; P = 0.002), ongoing pregnancy rates (53.2% vs. 34.0%; aOR, 2.121; 95% CI, 1.379 to 3.260; P = 0.001), and live birth rates (51.3% vs. 32.9%; aOR, 2.019; 95% CI, 1.316 to 3.097; P = 0.001). In patients aged 38 years and older with unexplained recurrent miscarriages, PGT-A not only increased the rate of ongoing pregnancies (50.0% vs. 17.5%; aOR, 4.325; 95% CI, 1.31 to 14.281; P = 0.016) and live birth rates (46.7% vs. 17.5%; aOR, 3.684; 95% CI, 1.141 to 11.893; P = 0.029), but also significantly reduced the rate of early miscarriage (16.7% vs. 40.0%; aOR, 0.098; 95% CI, 0.01 to 0.956; P = 0.046).

Conclusions: PGT-A has been demonstrated to enhance clinical pregnancy rates, ongoing pregnancy rates, and live birth rates in patients experiencing unexplained recurrent miscarriages. Furthermore, the implementation of PGT-A significantly reduced the rate of early miscarriage among older patients aged 38 years and above.