PGT-A is associated with a reduced live birth rate in routine practice: evidence from the UK ART register

RESEARCH QUESTION: Does the use of preimplantation genetic testing for aneuploidy (PGT-A) improve the treatment success rate in routine IVF practice? DESIGN: A bespoke dataset from the UK Human Fertilisation and Embryology Authority (HFEA) register was used to analyse a cohort of all available treatment episodes (oocyte retrieval and all associated transfers) in the UK which started between 2014 and 2018. The data included whether PGT-A or preimplantation testing for monogenic diseases (PGT-M) was employed in any cycle. The 111,975 treatment episodes included 2243 patients who received PGT-A and 2078 patients who received PGT-M at any point in the episode. Logistic regression models compared PGT-A and PGT-M with standard IVF cycles without PGT with careful adjustment for age, cause of infertility, previous IVF treatment, ovarian stimulation, intracytoplasmic sperm injection, number of oocytes, number of embryos, and treatment centre. Live birth events, multiple births and pregnancy loss were considered for both the first transfer following oocyte retrieval and cumulatively for all transfers from the initial oocyte retrieval. RESULTS: PGT-A was associated with a decrease in the live birth rate in the first transfer (OR 0.86 95% CI 0.77-0.97) and cumulatively (OR 0.74, 95% CI 0.67-0.82) compared with standard IVF cycles. Pregnancy loss was reduced per pregnancy in the first cycle (OR 0.47, 95% CI 0.36-0.61) and cumulatively (OR 0.64, 95% CI 0.52-0.78). In 48% of PGT-A treatments, no embryos were transferred in the first cycle, compared with 5% of standard IVF cycles. CONCLUSIONS: HFEA register data from 2014 to 2018 show that PGT-A as used in routine care was associated with a reduced live birth rate and reduced pregnancy loss compared with standard IVF cycles.