LIVE BIRTH RATES IN TRANSFERS FROM IVF CYCLES UTILIZING PGT-A VERSUS FRESH AND FROZEN TRANSFERS FROM IVF CYCLES NOT UTILIZING PGT

BACKGROUNDPreimplantation genetic testing for aneuploidy (PGT-A) has been employed as a complement to assisted reproductive technology (ART) to identify euploid embryos for implantation1. While PGT-A provides more information, it has not consistently demonstrated clinical benefit and there is still concern that risks to the embryo outweigh the benefit2,3.OBJECTIVETo compare the live birth rate (LBR) of embryo transfers (ETs) from patients who utilized in vitro fertilization (IVF) with PGT-A to the patients who utilized IVF (both fresh and frozen transfers) without PGT during the same time period from a single institution.MATERIALS AND METHODSWomen who underwent IVF with PGT-A and women who underwent IVF without PGT-A who had a transfer between January 1, 2016 and January 31, 2019 were included. Only euploid embryos were transferred in the PGT-A group. Women were excluded if they had undergone IVF in the setting of fertility preservation or utilized third party reproduction. The LBR of ETs in the PGT-A group was compared to fresh and frozen transfers not involving PGT, by fitting generalized regression models for a binary outcome with a logit link function and using generalized estimating equation methodology to account for the correlation between ETs involving the same patient. Additional models were fit using inverse-probability of treatment weighting (IPTW) derived from propensity scores to adjust for differences in patient characteristics between those with versus without PGT.RESULTSThe study included 107 ETs from 74 women with PGT-A; 321 fresh ETs from 297 women and 286 frozen ETs from 193 women without PGT. Patient characteristics are summarized in Table 1. The mean age of the women in the PGT-A group was significantly older compared to non-PGT fresh and frozen groups (p<0.001). The infertility etiologies were significantly different between the groups; in particular the women in the PGT-A group were more likely to have unexplained infertility (41.3%), compared to both non-PGT fresh ETs (24.9%) and non-PGT frozen ETs (28.0%) and less likely to have male factor infertility (17.6%), compared to both non-PGT fresh ETs (29.3%) and non-PGT frozen ETs (29%). Compared to women in the non-PGT frozen group, women who underwent PGT-A had a significantly lower median AMH, higher median FSH, and lower median AFC.Tabled 1Table 1. Characteristics at the time of the first cycle for women with ETs using PGT-A versus non-PGT fresh and frozenCharacteristicGroupP-value†PGT-A (N=74)Non-PGT, Fresh (N=297)Non-PGT, Frozen (N=193)PGT vs. Non-PGT, FreshPGT vs. Non-PGT FrozenAge (years), Mean (SD)35.3 (3.9)33.4 (4.0)32.5 (4.0)<0.001<0.001AMH (ng/ml), Median (IQR)2.7 (1.5, 5.8)2.7 (1.4, 5.4)4.3 (2.0, 8.5)0.690.014FSH (IU/L), Mean (SD)7.7 (2.9)7.3 (2.4)6.9 (2.0)0.230.019AFC, Median (IQR)16 (13, 25)17 (11, 28)24 (14, 38)0.550.009Infertility etiology, N (%)0.0140.042 Uterine factor7 (9.5%)16 (5.4%)8 (4.1%) Ovarian factor19 (25.7%)90 (30.3%)66 (34.2%) Male factor13 (17.6%)87 (29.3%)56 (29.0%) Tubal factor4 (5.4%)30 (10.1%)9 (4.7%) Unexplained31 (41.9%)74 (24.9%)54 (28.0%)†Comparisons between groups were evaluated using the two-sample t-test for age and FSH, the Wilcoxon rank sum test for AMH and AFC, and the chi-square test for infertility etiology. Open table in a new tab Tabled 1Table 2. Comparison of the LBR between ETs that did versus did not undergo PGT-AGroupUnadjusted analysisAdjusted rates using IPTWLive birth rateP-valueLive birth rateP-valuePGT-A48.6% (52/107)0.04649.5% (52.96/107)0.036Non-PGT, Fresh38.9% (125/321)38.6% (123.99/321)PGT-A48.6% (52/107)0.04950.6% (54.14/107)0.016Non-PGT, Frozen36.7% (105/286)35.8% (102.31/286) Open table in a new tab CONCLUSIONSWhen compared to both fresh and frozen ETs not utilizing PGT, utilizing PGT-A had significantly higher LBR based on analyses performed with and without adjustment for patient characteristics. This is significant for providers counseling patients on the use of PGT-A in IVF.SUPPORTNoneReferences:1. Penzias A, Bendikson K, Butts S, et al. The use of preimplantation genetic testing for aneuploidy (PGT-A): a committee opinion. Fertil Steril. 2018;109(3):429-436.2. Fritz M, Speroff L. Clinical Gynecologic Endocrinology and Infertility. 8th ed. Lippincott Williams & Wilkins; 2011.3. Schmutzler AG. Theory and practice of preimplantation genetic screening (PGS). Eur J Med Genet. 2019;62(8):103670. BACKGROUNDPreimplantation genetic testing for aneuploidy (PGT-A) has been employed as a complement to assisted reproductive technology (ART) to identify euploid embryos for implantation1. While PGT-A provides more information, it has not consistently demonstrated clinical benefit and there is still concern that risks to the embryo outweigh the benefit2,3. Preimplantation genetic testing for aneuploidy (PGT-A) has been employed as a complement to assisted reproductive technology (ART) to identify euploid embryos for implantation1. While PGT-A provides more information, it has not consistently demonstrated clinical benefit and there is still concern that risks to the embryo outweigh the benefit2,3. OBJECTIVETo compare the live birth rate (LBR) of embryo transfers (ETs) from patients who utilized in vitro fertilization (IVF) with PGT-A to the patients who utilized IVF (both fresh and frozen transfers) without PGT during the same time period from a single institution. To compare the live birth rate (LBR) of embryo transfers (ETs) from patients who utilized in vitro fertilization (IVF) with PGT-A to the patients who utilized IVF (both fresh and frozen transfers) without PGT during the same time period from a single institution. MATERIALS AND METHODSWomen who underwent IVF with PGT-A and women who underwent IVF without PGT-A who had a transfer between January 1, 2016 and January 31, 2019 were included. Only euploid embryos were transferred in the PGT-A group. Women were excluded if they had undergone IVF in the setting of fertility preservation or utilized third party reproduction. The LBR of ETs in the PGT-A group was compared to fresh and frozen transfers not involving PGT, by fitting generalized regression models for a binary outcome with a logit link function and using generalized estimating equation methodology to account for the correlation between ETs involving the same patient. Additional models were fit using inverse-probability of treatment weighting (IPTW) derived from propensity scores to adjust for differences in patient characteristics between those with versus without PGT. Women who underwent IVF with PGT-A and women who underwent IVF without PGT-A who had a transfer between January 1, 2016 and January 31, 2019 were included. Only euploid embryos were transferred in the PGT-A group. Women were excluded if they had undergone IVF in the setting of fertility preservation or utilized third party reproduction. The LBR of ETs in the PGT-A group was compared to fresh and frozen transfers not involving PGT, by fitting generalized regression models for a binary outcome with a logit link function and using generalized estimating equation methodology to account for the correlation between ETs involving the same patient. Additional models were fit using inverse-probability of treatment weighting (IPTW) derived from propensity scores to adjust for differences in patient characteristics between those with versus without PGT. RESULTSThe study included 107 ETs from 74 women with PGT-A; 321 fresh ETs from 297 women and 286 frozen ETs from 193 women without PGT. Patient characteristics are summarized in Table 1. The mean age of the women in the PGT-A group was significantly older compared to non-PGT fresh and frozen groups (p<0.001). The infertility etiologies were significantly different between the groups; in particular the women in the PGT-A group were more likely to have unexplained infertility (41.3%), compared to both non-PGT fresh ETs (24.9%) and non-PGT frozen ETs (28.0%) and less likely to have male factor infertility (17.6%), compared to both non-PGT fresh ETs (29.3%) and non-PGT frozen ETs (29%). Compared to women in the non-PGT frozen group, women who underwent PGT-A had a significantly lower median AMH, higher median FSH, and lower median AFC.Tabled 1Table 1. Characteristics at the time of the first cycle for women with ETs using PGT-A versus non-PGT fresh and frozenCharacteristicGroupP-value†PGT-A (N=74)Non-PGT, Fresh (N=297)Non-PGT, Frozen (N=193)PGT vs. Non-PGT, FreshPGT vs. Non-PGT FrozenAge (years), Mean (SD)35.3 (3.9)33.4 (4.0)32.5 (4.0)<0.001<0.001AMH (ng/ml), Median (IQR)2.7 (1.5, 5.8)2.7 (1.4, 5.4)4.3 (2.0, 8.5)0.690.014FSH (IU/L), Mean (SD)7.7 (2.9)7.3 (2.4)6.9 (2.0)0.230.019AFC, Median (IQR)16 (13, 25)17 (11, 28)24 (14, 38)0.550.009Infertility etiology, N (%)0.0140.042 Uterine factor7 (9.5%)16 (5.4%)8 (4.1%) Ovarian factor19 (25.7%)90 (30.3%)66 (34.2%) Male factor13 (17.6%)87 (29.3%)56 (29.0%) Tubal factor4 (5.4%)30 (10.1%)9 (4.7%) Unexplained31 (41.9%)74 (24.9%)54 (28.0%)†Comparisons between groups were evaluated using the two-sample t-test for age and FSH, the Wilcoxon rank sum test for AMH and AFC, and the chi-square test for infertility etiology. Open table in a new tab Tabled 1Table 2. Comparison of the LBR between ETs that did versus did not undergo PGT-AGroupUnadjusted analysisAdjusted rates using IPTWLive birth rateP-valueLive birth rateP-valuePGT-A48.6% (52/107)0.04649.5% (52.96/107)0.036Non-PGT, Fresh38.9% (125/321)38.6% (123.99/321)PGT-A48.6% (52/107)0.04950.6% (54.14/107)0.016Non-PGT, Frozen36.7% (105/286)35.8% (102.31/286) Open table in a new tab The study included 107 ETs from 74 women with PGT-A; 321 fresh ETs from 297 women and 286 frozen ETs from 193 women without PGT. Patient characteristics are summarized in Table 1. The mean age of the women in the PGT-A group was significantly older compared to non-PGT fresh and frozen groups (p<0.001). The infertility etiologies were significantly different between the groups; in particular the women in the PGT-A group were more likely to have unexplained infertility (41.3%), compared to both non-PGT fresh ETs (24.9%) and non-PGT frozen ETs (28.0%) and less likely to have male factor infertility (17.6%), compared to both non-PGT fresh ETs (29.3%) and non-PGT frozen ETs (29%). Compared to women in the non-PGT frozen group, women who underwent PGT-A had a significantly lower median AMH, higher median FSH, and lower median AFC. †Comparisons between groups were evaluated using the two-sample t-test for age and FSH, the Wilcoxon rank sum test for AMH and AFC, and the chi-square test for infertility etiology. CONCLUSIONSWhen compared to both fresh and frozen ETs not utilizing PGT, utilizing PGT-A had significantly higher LBR based on analyses performed with and without adjustment for patient characteristics. This is significant for providers counseling patients on the use of PGT-A in IVF. When compared to both fresh and frozen ETs not utilizing PGT, utilizing PGT-A had significantly higher LBR based on analyses performed with and without adjustment for patient characteristics. This is significant for providers counseling patients on the use of PGT-A in IVF.