PGT-A versus expectant management for fertile patients with recurrent pregnancy loss and prior aneuploidy: a dual-center, real-world study of 5-year cumulative pregnancy outcomes.

INTRODUCTION: This study evaluated the effectiveness and cost-effectiveness of preimplantation genetic testing for aneuploidy (PGT-A) versus expectant management (EM) for achieving live birth among fertile patients with recurrent pregnancy loss (RPL) and prior aneuploid pregnancy loss. METHODS: This dual-center retrospective cohort study included 216 fertile patients with RPL and at least one previous aneuploid pregnancy loss. Seventy-one patients chose EM and 145 chose PGT-A. Propensity score matching (PSM), multivariable logistic regression, and subgroup analyses were performed. The primary outcome was conception leading to live birth (CLLB) within 12 months. Secondary outcomes included CLLB at 24 and 36 months, cumulative live birth (CLB) at 5 years, time to pregnancy leading to live birth (TPLB), early miscarriage per clinical pregnancy, and incremental cost-effectiveness ratios (ICERs). RESULTS: After PSM, 71 matched pairs were analyzed. CLLB within 12 months was lower in the PGT-A group than in the EM group (52.1% vs. 81.7%; adjusted odds ratio 0.27, 95% confidence interval 0.13-0.53; P < 0.001). Five-year CLB rates were similar (94.4% vs. 87.3%; P = 0.15), whereas TPLB was longer with PGT-A (median 8.6 vs. 3.0 months; P < 0.001). Early miscarriage rates per clinical pregnancy did not differ significantly (7.4% vs. 12.4%; adjusted odds ratio 0.42; P = 0.09). The ICERs per additional live birth and per miscarriage prevented were ¥1,203,800 and ¥1,504,800, respectively. DISCUSSION: In fertile patients with RPL and prior aneuploidy, PGT-A and EM were associated with similar 5-year cumulative live birth rates, whereas EM was associated with a higher probability of CLLB within 12 months and a shorter TPLB. A possible reduction in miscarriage with PGT-A remains uncertain and warrants further investigation.