Association between ovarian reserve and utilization of preimplantation genetic testing for aneuploidy in autologous IVF cycles.

study questionDoes ovarian reserve, as measured by anti-Müllerian hormone (AMH), influence the utilization of preimplantation genetic testing for aneuploidy (PGT-A) in autologous IVF cycles across different age groups? SUMMARY ANSWER: Lower ovarian reserve, reflected by reduced AMH levels, was associated with a lower likelihood of undergoing PGT-A across all age strata. WHAT IS KNOWN ALREADY: PGT-A is widely used in IVF, particularly in older patients, but its utilization may be influenced not only by age but also by expected ovarian reserve and embryo yield. How ovarian reserve is associated with selection for PGT-A at a population level has not yet been well characterized. STUDY DESIGN SIZE DURATION: This cross-sectional analysis of the US Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database includes 258,532 patient-first autologous ovarian stimulation cycles performed between 2014 and 2021. PARTICIPANTS/MATERIALS SETTING

methodsThe study included the first autologous IVF cycles of women aged 21-46 years. Donor oocyte, donor embryo, and gestational carrier cycles were excluded, as were cycles using <150 IU/day of gonadotropins or with missing key data. Cycles were classified according to PGT-A use. Ovarian reserve was primarily assessed using the most recent AMH value measured within 1 year of treatment. Multivariable logistic regression models evaluated the association between AMH and PGT-A utilization, adjusting for age, calendar year, race, total gonadotropin dose, gravidity, and prior ART, with prespecified testing for the age-AMH interaction. MAIN RESULTS AND THE ROLE OF CHANCE: Across the study population, higher AMH levels were associated with significantly increased odds of undergoing PGT-A. This association persisted after multivariable adjustment and within each age group. AMH modelled as both a continuous variable and dichotomized at 1 ng/ml showed consistent results, indicating an independent relationship between ovarian reserve and PGT-A utilization that was unlikely due to chance. LIMITATIONS REASONS FOR CAUTION: The observational, cross-sectional design limits causal inference. Residual confounding is possible, and registry data do not capture treatment intent or all of the clinical reasons underlying use or non-use of PGT-A. Embryo-level genetic outcomes and clinical outcomes such as live birth were not evaluated. WIDER IMPLICATIONS OF THE

findingsThese findings suggest a systematic selection pattern in IVF practice, whereby patients with diminished ovarian reserve are less likely to undergo PGT-A. This population imbalance should be considered when interpreting observational studies of PGT-A and when counselling patients about the clinical context in which PGT-A is most commonly used. STUDY FUNDING/COMPETING INTERESTS: This work was supported by intramural funds from The Center for Human Reproduction and the not-for-profit research Foundation for Reproductive Medicine, both in New York, NY, USA.Drs. Barad and Gleicher are co-inventors on several US patents hold patents related to androgen treatment in females (DHEA) with numbers US8067400B2, US8501718B2, and US9375436B2 (listed in USPTO/public records and assigned to American Infertility of New York). They also receive royalties from Nutraceuticals LLC, which has helped commercialize DHEA as a nutritional supplement. Dr. Gleicher is also a shareholder in Fertility Nutraceuticals and the owner of the Center for Human Reproduction. Dr. Albertini receives a stipend as Editor-in- Chief of the TRIAL REGISTRATION NUMBER: N/A.