Best laid plans: good perinatal outcome after ivf with pgt-a

While preimplantation genetic testing for aneuploidy (PGT-A) is intended to identify euploid embryos for single embryo transfer, many patients and providers cite a desire for a good perinatal outcome as rationale for PGT-A. Given this gap between patient perception and evidence-based practice, we investigated the likelihood to achieve a good perinatal outcome among individuals with a clinical intrauterine gestation (CIG) after in vitro fertilization (IVF) with and without PGT-A. We conducted a retrospective cohort analysis of all individuals with clinical intrauterine gestations (CIG) after IVF with and without PGT between 2013 and 2020 using institutional data from a high-volume academic center submitted to the Society for Assisted Reproductive Technology (SART). Individuals using donor oocytes and/or gestational carriers were excluded. The primary outcome of interest was good perinatal outcome, defined as a singleton live birth at 37+ weeks of gestation with birth weight between 2,500 g and 4,000 g (1). Secondary outcomes included live birth, clinically-detected early pregnancy loss (SAB), stillbirth, and route of delivery. Bivariate statistics were performed to identify important covariates followed by regression analyses to control for these covariates. P<0.05 was significant. A post-hoc power calculation was performed. 3,479 individuals met study criteria including 2,172 IVF cycles without PGT-A and 1307 cycles with PGT-A. In bivariate analyses, good perinatal outcomes were positively associated with single embryo transfer (SET) and PGT-A, but negatively associated with frozen embryo transfer (FET) and body mass index (BMI). In a regression analysis adjusting for SET, FET, and BMI, PGT-A remained associated with good perinatal outcome (OR 1.55, 95% CI 1.26-1.91). Limiting the analysis to individuals who underwent FET or SET, PGT-A remained associated with good perinatal outcome (OR 1.6, 95% CI 1.28-2.02 and OR 1.65, 95% CI 1.3-2.08 respectively). In regression analyses, PGT-A was also positively associated with live birth (OR 1.6 95% CI: 1.2-2.1), and negatively associated with SAB (OR 0.63, 95% CI 0.47-0.84). This large cohort study suggests use of PGT-A has favorable pregnancy outcomes, including a significantly higher rate of a good perinatal outcome, when compared to IVF without PGT-A. Subsequent analyses are planned to compare rates of prenatally diagnosed fetal anomalies and maternal outcomes between the cohorts.