Background PGT-A has been widely used for RPL couples to help improve pregnancy outcomes by selecting euploid embryos. However, there is still insufficient evidence to determine the effectiveness of PGT-A in RPL couples, especially on the cumulative live birth rate. This study aims to investigate whether preimplantation genetic testing for aneuploidy (PGT-A) could improve the cumulative live birth rate in patients with recurrent pregnancy loss (RPL). Methods A retrospective large cohort study with 1003 RPL couples (799 in the PGT-A group, and 204 in the conventional IVF/ICSI group) was conducted in a university-affiliated reproductive center. Stratified analysis was performed according to female age (< 35 years and ≥ 35 years). The associations between embryo selection with PGT-A and cumulative pregnancy outcomes were further analyzed by a binary logistic regression model. Results The cumulative live birth rates were similar between the PGT-A group and the conventional IVF/ICSI group both in women under 35 years old [53.32% vs. 61.97%, adjusted OR (95%CI): 0.853(0.547–1.330), P = 0.483] and in women aged ≥ 35 years [28.75% vs. 30.65%, adjusted OR (95%CI): 1.314(0.671–2.574), P = 0.426]. Whereas, a significantly lower cumulative rates of biochemical pregnancy loss (10.13% vs. 32.56%, P < 0.05) and clinical pregnancy loss [20.89% vs. 37.21%, adjusted OR (95%CI): 0.408(0.173–0.966), P = 0.042] were found in the PGT-A group compared with the control group, only among women aged ≥ 35 years. The numbers of embryo transfers were significant less in PGT-A women with < 35 years old [1(1;2) vs. 1(1;2), P < 0.05] and with ≥ 35 years old [1(1;1) vs. 1(1;2), P < 0.05]. Conclusions PGT-A could not improve cumulative live birth rate in RPL couples regardless maternal age.

ObjectiveTo explore the prognostic impact of a previous late miscarriage (LM) on the subsequent pregnancy outcomes of women with infertility.MethodThis retrospective cohort study included couples who had experienced LM following their first embryo transfer during an in vitro fertilization (IVF) cycle from January 2008 to December 2020. Subgroup analysis and binary logistic regression were performed to evaluate the associations between LM due to different causes and subsequent pregnancy outcomes.ResultsA total of 1072 women who had experienced LM were included in this study, comprising 458, 146, 412, and 56 women with LM due to unexplained factors (unLM), fetal factors (feLM), cervical factors (ceLM; i.e. cervical incompetence), and trauma factors (trLM), respectively. Compared with the general IVF (gIVF) population, the early miscarriage rate was significantly higher in the unLM group (8.28% vs. 13.47%, adjusted odds ratio [OR] 1.60, 95% confidence interval [95% CI] 1.12–2.28; P = 0.01). Furthermore, women in the unLM and ceLM groups had a dramatically increased risk of recurrent LM (unLM: 4.24% vs. 9.43%, aOR 1.91, 95% CI 1.24–2.94; P = 0.003; ceLM: 4.24% vs.15.53%, aOR 2.68, 95% CI 1.82–3.95; P < 0.001) and consequently a reduced frequency of live birth (unLM: 49.96% vs. 43.01%, aOR 0.75, 95% CI 0.61–0.91; P = 0.004; ceLM: 49.96% vs. 38.59%, aOR 0.61, 95% CI 0.49–0.77; P < 0.001) compared with the gIVF population.ConclusionA previous LM due to an unexplained factor or cervical incompetence was significantly associated with a higher risk of miscarriage and a lower live birth rate after subsequent embryo transfer.

Objectives: To evaluate whether preimplantation genetic testing for aneuploidy (PGT-A) can improve pregnancy and neonatal outcomes for patients with limited good-quality embryos. Design: Retrospective cohort study. Setting: University hospital. Population: A total of 1,553 patients who intended to pursue PGT-A for the first time but obtained only two or less good-quality embryos on day 3 after oocyte retrieval were divided into two groups: 997 in the PGT-A group and 556 in the drop-out group of withdrawing PGT-A due to poor embryological outcome. Results: After adjusting for potential confounding factors, PGT-A group exhibited significantly lower cumulative rates of biochemical pregnancy (19.96% vs. 30.22%, P-adj < 0.001), clinical pregnancy (17.55% vs. 23.38%, P-adj < 0.001) and live birth (14.14% vs. 16.19%, P-adj = 0.005) per oocyte retrieval and longer median time to pregnancy and live birth compared with drop-out group. However, significant increases in rates of biochemical pregnancy (72.16% vs. 35.50%, P-adj < 0.001), clinical pregnancy (61.86% vs. 26.98%, P-adj < 0.001), and live birth (48.45 vs. 18.26%, P-adj < 0.001) per transfer were found in the PGT-A group. No significant differences were observed in cumulative miscarriage and ectopic pregnancy rates, number of ETs needed per live birth and neonatal outcomes. Conclusion: PGT-A failed to improve cumulative live birth rate or shorten time to pregnancy, but optimized pregnancy outcomes per transfer for patients with limited good-quality embryos. Keywords: preimplantation genetic testing for aneuploidy, cumulative live birth rate, live birth rate per transfer, neonatal outcomes