PGT-A in Advanced Maternal Age: The probability of pregnancy is increased?

To determine the probability of achieving a successful pregnancy transferring a euploid embryo per follicular aspiration in women of advanced reproductive age and based on these results to provide an additional clinical tool to support patient counseling in assisted reproductive treatments.

All patients undergoing follicular aspiration and requiring PGT-A from January 2016 to March 2023 were included. Patients were divided into 4 groups based on age: <35, 35-37, 38-40, and 41 or older. It was calculated for each group the percentage of aspirated cycles with at least one blastocyst for biopsy and the percentage of these cycles with at least one euploid embryo. Ongoing pregnancy rate was calculated for the first euploid embryo transfer. The probability of achieving a successful pregnancy per aspirated cycle was finally determined and it was compared between age groups with Chi-square analysis (significance level of 5%).

There were no significant differences in pregnancy rate per transfer across age groups when euploids embryos were transferred (p=0.61). As patient age increases, the chance of obtaining a blastocyst suitable for biopsy per PGT-A aspirated cycle, and the chance of this embryo being euploid and transferred decrease. Finally, the probability of achieving a successful pregnancy per PGT-A aspirated cycle decreases from 29% in patients younger than 35 years old, to 5% in patients over 40 years old.

Only 5% of women aged 41 or older would achieve pregnancy by transferring a euploid embryo per follicular aspiration. Providing accurate counseling that aligns with the perspective and expectations of these patients will be a challenge for healthcare professionals, even when utilizing the PGT-A technique.