ArticleReproductive sciences (Thousand Oaks, Calif.)2025
How Many Blastocysts Are Needed for PGT-A to Benefit RPL Patients? A 7-Year Retrospective Cohort Study.
Article in Reproductive sciences (Thousand Oaks, Calif.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The efficacy of preimplantation genetic testing for aneuploidy (PGT-A) in couples with unexplained recurrent pregnancy loss (uRPL) may vary according to the number of good-quality blastocysts available. This study is to determine whether PGT-A could improve the cumulative live birth rate (CLBR) among couples experiencing uRPL as the number of high-quality blastocysts increases. A retrospective study involving 1073 couples with uRPL was conducted at a university-affiliated reproductive center. Patients were divided into two groups: 813 participants who underwent PGT-A and 260 participants who underwent conventional in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). A stratified analysis was conducted, which categorized the female participants into three subgroups based on the number of high-quality blastocysts: 1-3, 4-6, and ≥ 7. A binary logistic regression model was used to evaluate the associations between the number of high-quality blastocysts and the cumulative pregnancy outcomes. Among uRPL patients undergoing PGT-A or IVF/ICSI, there were respectively 421 vs. 129 with 1-3 blastocysts, 252 vs. 69 with 4-6 blastocysts, and 140 vs. 62 with ≥ 7 blastocysts. In 1-3 blastocysts subgroup, CLBR was 23.52% after PGT-A vs. 33.33% after IVF/ICSI (adjusted OR 1.005, 95% CI 0.604-1.674, p = 0.984). In 4-6 blastocysts subgroup, CLBR was 53.17% after PGT-A vs. 75.36% after IVF/ICSI (adjusted OR 0.398, 95% CI 0.197-0.802, p = 0.010). In ≥ 7 blastocysts subgroup, CLBR was 73.57% after PGT-A vs. 66.13% after IVF/ICSI (adjusted OR 1.660, 95% CI 0.729-3.799, p = 0.227). In these three subgroups, clinical pregnancy loss rates were all similar between the two treatment methods. In women with uRPL, PGT-A did not improve CLBR, irrespective of the number of high-quality blastocysts available. Routine use of PGT-A in this population is therefore not recommended. Future high-quality randomized controlled trials may better define its appropriate indications.
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