United States racial/ethnic disparities in PGT-A use: an analysis of 2014-2020 SART CORS database.

Background: The use of preimplantation genetic testing for aneuploidy (PGT-A) allows for the selection of euploid embryos and has been thought to improve outcomes in ART, particularly in women ≥ 35 years old. However, little is known regarding PGT-A utilization among minority women in the United States (US). The objective of this study was to determine the trend of utilization of PGT-A in the US among minority women.

Methods: We conducted a retrospective cohort study using the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database. We included initial autologous ART cycles performed between 2014 and 2020. We assessed the rate of PGT-A utilization by race/ethnicity.

Results: This study included 150,604 PGT-A and 287,979 non-PGT-A initial autologous cycles. The overall trend of PGT-A utilization, regardless of race/ethnicity, increased from 11.5 to 49.0% (p < 0.001) over seven years. Of all ART cycles, 33% of White women used PGT-A, in comparison to 24% of Black women, 31% of Hispanic women, and 44% of Asian women (p < 0.001). Multiple Logistic Regression (MLR) determined race/ethnicity as an independent predictor of PGT-A utilization when adjusting for age, BMI, and AMH (p < 0.001). Compared to White women, MLR showed that Black and Hispanic women were 35% and 16% less likely to use PGT-A (aOR = 0.65, 95% CI 0.63-0.67, and aOR = 0.86, 95% CI 0.84-0.88, respectively, p < 0.001). In contrast, Asian women were 41% (aOR = 1.41, 95% CI 1.39-1.44) more likely to use PGT-A (p < 0.001). Overall, regardless of race/ethnicity, women 35 and older were 71% (aOR = 1.71, 95% CI 1.69-1.74) more likely to use PGT-A compared to women younger than 35 (p < 0.001).

Conclusion: Despite a significant increase in overall PGT-A utilization in the US over 7 years, utilization has been consistently less in ART cycles for Black and Hispanic women, in comparison to White women. This is in marked contrast to an increase in PGT-A utilization in cycles for Asian women.