Relationship Between Pgt-A & Cumulative Live Birth Rate In Autologous & Donor Cycles: An Analysis Of 178,511 Patients Reported To Sart Cors.

Cumulative live birth rate (CLBR) outcome prediction models may not account for patient intent at the start of the stimulation cycle, cycle cancellation, or elimination of cycles without transferable embryos. We evaluated & compared the CLBR per cycle start, oocyte retrieval (ER), & embryo transfer (ET) +/- PGT-A across maternal age groups, using autologous or donor oocytes. Retrospective cohort study. Autologous & donor oocyte IVF cycles from 2014-2016 reported to SART CORS were evaluated. Inclusion criteria were the first reported ovarian stimulation cycle per patient, combined with the first fresh ET or frozen-thawed embryo transfer (FET) & all subsequent linked FETs. For the PGT-A group, only day 5 & 6 FETs were included. PGT-A cycles without transferable embryos were included in the ‘all cycle starts’ group. PGT-A cycles without FET and no reason that could be clearly categorized were excluded. Comparisons were stratified by patient age categorically. The primary outcome measure was CLBR per stimulation cycle start. Secondary outcomes were CLBR per ER & per cumulative ET. Chi-square tests were used to assess the association between CLBR across groups. Two-sided p-values <0.05 were considered statistically significant. 178,511 stimulation cycle starts were analyzed. Increasing age was associated with decreasing CLBR for all stimulation cycle starts (including planned PGT-A cycles) using autologous oocytes. Similarly, the subgroup of cycles which resulted in ER with intention for fresh ET without PGT-A showed inverse CLBR with increasing age (p <0.001 for both analyses). A subgroup of patients was analyzed per cumulative ET, not per cycle start. In this subgroup, PGT-A FET had higher CLBR vs. fresh ET stratified by age (71.5% vs. 64.2% age <30; 69.7% vs. 59.6% age 30-34; 66.0% vs. 45.5% age 35-39; 57.5% vs. 16.7% age ≥40). FET without PGT-A also had a higher CLBR vs. fresh ET stratified by age (72.3%, 67.9%, 53.9%, & 23.7% for ages ≤30, 30-34, 35-39, ≥40, respectively) (p<0.001 for all comparisons). PGT-A FET had a higher CLBR vs. FET without PGT-A at age >30 (p<0.05), but not at age <30 (p>0.5). Donor oocyte cycles had higher CLBR per stimulation cycle start for all age groups compared with autologous oocytes (p<0.001). Donor oocyte PGT-A FET resulted in a higher CLBR vs. fresh ET at age 35-39 (p = 0.04) & vs. FET without PGT-A at age ≥40 (p < 0.001), but not at other ages. Increasing age is associated with decreasing CLBR in all cycles. For the subset of patients undergoing ET, PGT-A is beneficial at age >30; this improvement is minimal at ages 30-34 & most pronounced at age ≥40. However, it should not be concluded that PGT-A improves CLBR per cycle overall, but rather just in the subset in which ET is done. Under age 30, PGT-A is superior to fresh ET, but not to FET without PGT-A, suggesting limited utility in this age group. Donor oocytes produced the highest CLBR per cycle start & after ET at all ages, but there is no benefit to PGT-A if the recipient is age <35. Patient counseling regarding use of PGT-A & donor oocytes should be age dependent & individualized.