Retrospective cohort study of preimplantation genetic testing for aneuploidy with comprehensive chromosome screening versus nonpreimplantation genetic testing in normal karyotype, secondary infertility patients with recurrent pregnancy loss

Abstract

Objective: To evaluate whether preimplantation genetic testing for aneuploidy (PGT-A) with comprehensive chromosome screening increases live birth rate (LBR) in normal karyotype couples with recurrent pregnancy loss (RPL). Methods: A retrospective cohort follow-up study of 506 couples with RPL was conducted between April 2014 and March 2017. Couples were allocated to two groups according to their decision to choose PGT-A or not. The primary outcome was LBR per start/transfer cycle; secondary outcomes were ongoing pregnancy rate and miscarriage rate. Statistical analyses were conducted using univariate and multivariate logistic regression models adjusted for maternal age. Results: LBR per start (26.6% vs. 15.4%, relative risk [RR]: 2.66, 95% confidence interval [CI] [1.69–4.20], P < 0.0001; adjusted RR [aRR]: 2.40, 95% CI [1.49–3.86], P = 0.0004) and per transfer (44.9% vs. 25.1%, RR: 3.00, 95% CI [1.96–4.60], P < 0.0001; aRR: 2.64, 95% CI [1.68–4.14], P < 0.0001) was significantly higher in the PGT-A group than in the non-PGT-A group. The miscarriage rate was significantly lower in the PGT-A group compared to the non-PGT-A group (15.7% vs. 34.6%, RR: 0.27, 95% CI [0.13–0.57], P = 0.00005; aRR: 0.26, 95% CI [0.12–0.57], P = 0.0007). Conclusions: LBR per start cycle following PGT-A is significantly higher, and risk of miscarriage is significantly lower among infertile couples with RPL, irrespective of maternal age. PGT-A should be recommended to infertile couples with RPL.

Keywords

• comprehensive chromosome screening; preimplantation genetic testing for aneuploidy; recurrent pregnancy loss