P-762 Exploring the Efficacy and Beneficial Population of Preimplantation Genetic Testing for Aneuploidy Start from Oocyte Retrieval Cycle: A Real-World Study
Authors: Ma S , Liao J , Zhang S , Hocher B , Xie P , Lin G 
Published: June 2023

Abstract

Study question
Does preimplantation genetic testing for aneuploidy (PGT-A) increase chance of live birth among women undergoing IVF? What kind of women are most likely to benefit?

Summary answer
PGT-A is effective in people with specific indications, including maternal aged ≥38 years, diagnosed with recurrent pregnancy loss or intrauterine adhesions.

What is known already
As an embryo-selection technique, PGT-A is extensively used in in-vitro fertilization (IVF), but its efficacy and potential beneficial population is unclear.

Study design, size, duration
This was a retrospective cohort study. We analyzed data from women who underwent assisted reproduction treatment in the Reproductive and Genetic Hospital of CITIC-Xiangya. We included all first oocyte retrieval cycles from January 1, 2016, to November 31, 2019, and related fresh- and thawed-embryo transfer cycles up to November 31, 2020.

Participants/materials, setting, methods
The study cohort included 60,580 women. We used 1:3 propensity score matching to balance baseline data between women with PGT-A and without PGT-A. Stratified analyses according to age, body mass index, ovarian reserve/response, and potential indications were predesigned to explore benefits in sub-populations. The main outcome was cumulative live birth rate (CLBR) and the other observed outcomes including live birth rate (LBR), pregnancy loss, clinical pregnancy, pregnancy complications, newborn birth weight and neonatal malformation.

Main results and the role of chance
A total of 4,195 (95.1%) PGT-A users’ first oocyte retrieval cycles were matched to 10,140 non-users’ oocyte retrieval cycles. We found that women utilizing PGT-A had significantly lower CLBRs (27.5% vs. 31.1%; odds ratio (OR)=0.84, 95% confidence interval (CI), 0.78–0.91; P&lt;.001) following the first oocyte retrieval cycle than did women not utilizing it. However, first transfers among women utilizing PGT-A had significantly higher pregnancy (63.9% vs. 46.9%; OR = 2.01, 95% CI, 1.81–2.23; P&lt;.001) and live birth rates (LBR; 52.6% vs. 34.2%, OR = 2.13, 95% CI, 1.92–2.36; P&lt;.001), as well as lower early miscarriage (12.8% vs. 20.2%; OR = 0.58, 95% CI, 0.48–0.70; P&lt;.001), preterm birth (8.6% vs 17.3%; P&lt;.001), and low birth weight rates (4.9% vs. 19.3%; P&lt;.001). Moreover, subgroup analyses showed patients with maternal aged ≥38 years, diagnosed with recurrent pregnancy loss or intrauterine adhesions benefit from PGT-A, exhibiting significantly increasing LBRs following first transfer, without reducing CLBRs.

Limitations, reasons for caution
The retrospective design introduces inevitable bias. And the data originated from a single IVF center, thus, extrapolation of our findings may be limited, multi-center large data studies are needed to further confirm these findings.

Wider implications of the findings
Although PGT-A use does not increase and may decrease CLBR per oocyte retrieval cycle, it is effective in people with specific indications. Careful selection of suitable populations and proper clinical management for mosaic embryo transfer are important for effective PGT-A implementation.

Trial registration number
NA