Effects of preimplantation genetic testing for aneuploidy on embryo transfer outcomes in women of advanced reproductive age with no more than three retrieved oocytes.

Objective: To evaluate whether preimplantation genetic testing for aneuploidy (PGT-A) benefits women of advanced reproductive age (≥38 years old) with a diminished ovarian reserve (DOR; not more than three retrieved oocytes).

Design: A retrospective analysis comparing two groups: (a) PGT-A group: women who chose PGT-A and subsequent single re-warmed embryo transfers (ETs) and (b) non-PGT-A group: women who chose not to genetically test their embryos and underwent subsequent fresh or re-warmed ETs of one to two embryos on days 3 or 5.

Subjects: Two hundred and thirty patients underwent PGT-A therapy, with 49 of these individuals undergoing more than one PGT-A cycle. Meanwhile, 309 patients received non-PGT-A treatment, among whom 89 underwent more than one cycle of this type. Collectively, this study encompassed a total of 298 PGT-A cycles and 429 non-PGT-A cycles from a single center (April 2019-June 2023). All women had a DOR and advanced reproductive age.

Exposure: The exposure variable was the use of PGT-A.

Main outcome measures: The primary outcome was live birth rates (per cycle and retrieval). Secondary outcomes were clinical pregnancy rates (per cycle and retrieval), miscarriage rates (per pregnancy and retrieval).

Results: While PGT-A cycles had lower transfer rates (14.1% vs. 73.2%), they achieved significantly higher pregnancy (66.7% vs. 12.4%) (adjusted odds ratio [aOR] = 11.474; 95% confidence interval [95% CI], 5.462, 24.102; p < 0.001) and live birth rates (57.1% vs. 7.5%) per transfer (aOR = 13.065; 95% CI, 5.987, 28.510; p < 0.001). The PGT-A group also had lower miscarriage rates (14.3% vs. 40.0%) (aOR = 0.142; 95% CI, 0.030, 0.661; p = 0.013). However, overall pregnancy and live birth rates were similar, and the PGT-A group required fewer cycles for live birth (p = 0.023).

Conclusion: While PGT-A improved clinical pregnancy and live birth rates per transfer cycle in women of advanced reproductive age with a low oocyte yield, it did not impact these rates per retrieval.