Obstet Gynecol. 2025 Aug 21. doi: 10.1097/AOG.0000000000006047. Online ahead of print.
ABSTRACT
OBJECTIVE: To investigate whether the perceived advantages of preimplantation genetic testing for aneuploidy (PGT-A) are attributable to genetic testing itself or to transferring a thawed frozen embryo into a receptive endometrium. We compared live-birth and cumulative live-birth outcomes across three groups: primary frozen embryo transfer (FET) with PGT-A, FET without PGT-A, and fresh transfers in initial autologous assisted reproductive technology (ART) cycles.
METHODS: We performed a retrospective analysis from the 2014-2020 Society for Assisted Reproductive Technology Clinic Outcome Reporting System database, comparing success rates of primary FET with PGT-A, FET without PGT-A, and fresh transfers. Live birth, cumulative live birth, and miscarriage rates were compared, with primary transfer defined as the first transfer after the index retrieval. Live-birth rate was defined as the likelihood of live birth from the first transfer; cumulative live-birth rate was the likelihood of a live birth from all transfers within 1 year of the initial retrieval. Multivariate logistic regression determined the association of live birth with FET with PGT-A, FET without PGT-A, and fresh transfers while controlling for various demographic and clinical factors.
RESULTS: We examined 263,521 first autologous ART cycles between 2014 and 2020 that resulted in primary embryo transfer. The live-birth rate was 56.0% for FET with PGT-A, 48.3% for FET without PGT-A, and 39.8% for fresh transfers (P<.001 cumulative="" live-birth="" rates="" were="" similar="" between="" the="" two="" frozen="" strategies="" with="" pgt-a="" vs="" without="" p=".66);" both="" higher="" than="" fresh="" transfers="" in="" patients="" younger="" age="" years="" for="" fets="" those="" and="" older="" was="" associated="" success="" regression="" analysis="" demonstrated="" that="" fet="" regardless="" of="" use="" odds="" live="" birth="" across="" all="" groups="" whereas="" conferred="" additional="" benefit="" only="" aged="" or="" increasing="" advantage="" advancing="" age.="">
CONCLUSION: Primary FETs were associated with better outcomes than fresh transfers. Although PGT-A use improved outcomes for older patients, no overall benefit was seen in younger patients. These findings bring into question the perceived advantage of PGT-A over FETs without PGT-A, particularly in those younger than age 38 years, in whom FET without PGT-A demonstrated a higher cumulative live-birth rate compared with cycles with PGT-A. These data highlight the need for cautious consideration of PGT-A utilization for initial transfer, especially in younger age groups.
PMID:40839881 | DOI:10.1097/AOG.0000000000006047