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How Many Blastocysts Are Needed for PGT-A to Benefit RPL Patients? A 7-Year Retrospective Cohort Study
Jia Liao1,2,3,4,5,6,7, Shiheng Zhu1,2,3,4,5,6,7, Jinghan Wang1,2,3,4,5,6,7
1State Key Laboratory of Rproductive Medicine and Offspring Health, Center for Reproductive Medicine, Institute of Women, Children and Reproductive Health, Shandong University, 157, Jingliu Road, Jinan, 250012, China.
Preimplantation genetic testing for aneuploidy (PGT-A) did not improve cumulative live birth rates in couples with unexplained recurrent pregnancy loss (uRPL). Routine PGT-A is not recommended for uRPL, regardless of blastocyst quality.
Area of Science:
- Reproductive Medicine
- Genetics
- Infertility Treatment
Background:
- Unexplained recurrent pregnancy loss (uRPL) affects couples' ability to achieve live births.
- The role of preimplantation genetic testing for aneuploidy (PGT-A) in improving outcomes for uRPL patients is debated.
- Blastocyst quality and quantity may influence PGT-A efficacy.
Purpose of the Study:
- To determine if PGT-A improves cumulative live birth rates (CLBR) in couples with uRPL.
- To assess the impact of the number of high-quality blastocysts on PGT-A effectiveness in uRPL.
- To evaluate PGT-A versus conventional in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) for uRPL patients.
Main Methods:
- Retrospective study of 1073 couples with uRPL.
- Comparison between PGT-A group (813 couples) and IVF/ICSI group (260 couples).
- Stratified analysis based on the number of high-quality blastocysts (1-3, 4-6, ≥7) and logistic regression.
Main Results:
- In the 1-3 blastocyst subgroup, CLBR was 23.52% with PGT-A vs. 33.33% with IVF/ICSI (p=0.984).
- In the 4-6 blastocyst subgroup, CLBR was 53.17% with PGT-A vs. 75.36% with IVF/ICSI (p=0.010).
- In the ≥7 blastocyst subgroup, CLBR was 73.57% with PGT-A vs. 66.13% with IVF/ICSI (p=0.227). Clinical pregnancy loss rates were similar.
Conclusions:
- PGT-A did not enhance CLBR in women with uRPL, irrespective of the number of available high-quality blastocysts.
- Routine PGT-A is not currently recommended for couples experiencing unexplained recurrent pregnancy loss.
- Further randomized controlled trials are needed to define PGT-A indications for uRPL.
