U.S. Racial and Ethnic Disparities in Outcomes Using Preimplantation Genetic Testing for Aneuploidies: An Analysis of...

To determine live birth, intrauterine pregnancy, and miscarriage rates in cycles using preimplantation genetic testing for aneuploidy (PGT-A) as a function of race and ethnicity.

This retrospective cohort analysis used data collected from the Society of Assisted Reproductive Technology Clinical Outcomes Reporting System (SART CORS). Women who underwent their first autologous cycle that resulted in a primary transfer from 2014 to 2020 with the intent of assisted reproductive technology (ART) with and without PGT-A were included in this study. We compared live birth, intrauterine pregnancy, and miscarriage rates by race and ethnicity (American Indian/Alaska Native, Asian, Black, Hispanic, Native Hawaiian/Other Pacific Islander, and White). Statistical analyses of live birth, intrauterine pregnancy, and miscarriage rates with t tests and multiple logistic regression were used to determine adjusted odds ratios (aORs).

A total of 438,583 ART cycles were included with 150,604 PGT-A and 287,979 non-PGT-A primary autologous cycles with a single blastocyst transfer. There was a decrease in live-birth rate in White women using PGT-A (37.4% vs 39.7%, P <.001, P adjusted>.05). Live-birth rates were similar in PGT-A cycles of Black and Hispanic women compared with non-PGT-A cycles. Asian women who used PGT-A had higher intrauterine pregnancy rate (34.7% vs 30.4%, P <.001) and live-birth rate (31.4% vs 27.3%, P <.001) compared with Asian women who did not. The intrauterine pregnancy rate for White women regardless of PGT-A use was the same (40.8% vs 40.8%, P >.05), whereas Black and Hispanic women had a slightly increased rate of intrauterine pregnancy rate with PGT-A. For all races and ethnicities, PGT-A use was associated with a lower miscarriage rate. In Black and Hispanic women using PGT-A, there were higher rates of miscarriage and lower rates of intrauterine pregnancy and live-birth rates compared with White women using PGT-A. After adjustment for demographic and clinical confounders, race and ethnicity remained independent predictors for live birth, intrauterine pregnancy, and miscarriage in women using PGT-A. Race and ethnicity, PGT-A use, age 35 years or older, high body mass index (BMI), and low anti-müllerian hormone levels were independent predictors of miscarriage. Despite PGT-A use, Black women were 13% (aOR 0.87, 95% CI, 0.86-0.91, P <.001) and 17% (aOR 0.83, 95% CI, 0.81-0.85, P <.001) less likely to have an intrauterine pregnancy and live birth, respectively, compared with White women who used PGT-A. Of note, the miscarriage rate in Black women using PGT-A was similar to that in White women not using PGT-A (16.7% and 16.5%).

Despite PGT-A use, Black and Hispanic women continue to have higher miscarriage rates and lower intrauterine pregnancy and live-birth rates compared with White women using PGT-A. However, the use of PGT-A is associated with lower miscarriage rate for women of each race and ethnic group compared with nonusers of PGT-A.