AGE-RELATED PREGNANCY LOSS IS LARGELY OVERCOME WITH SINGLE EUPLOID EMBRYO TRANSFER

Abstract

Oocyte aneuploidy is significantly associated with increasing maternal age and is the primary cause of reproductive failure including pregnancy loss for women of advanced maternal age (AMA; ≥38 years). Preimplantation genetic testing for aneuploidy (PGT-A) has been shown to improve IVF live birth outcomes from embryo transfer for AMA infertility patients. The aim of this study was to evaluate the efficacy of single euploid embryo transfers to reduce the impact of AMA on pregnancy loss. Retrospective large cohort study A total of 3,773 single euploid transfers (SET) from 2010-2019 at a large IVF clinic, which underwent PGT-A at a single Genetics laboratory, were included in this cohort analysis. Donor oocyte and gestational carrier cycles were excluded. Groups were defined based on maternal age at the time of oocyte retrieval: <35 years (n=1,261 SETs), 35-37 years (n=1,074 SETs), 38-40 years (n=950 SETs), 41-42 years (n=397 SETs) and >43 years (n=91 SETs). Outcome measures included clinical pregnancy (visualized gestational sac and fetal pole), miscarriage (visualized fetal heart tone followed by loss) and live birth. Statistical analysis was performed where appropriate with Fisher’s exact, Kruskal-Wallis and Benjamini-Hochberg adjustment, significance at p < 0.05. Clinical pregnancy and live birth rates significantly decreased with AMA of ≥38 years (Table 1; *P<0.001). In contrast, miscarriage was not significantly different across the maternal age groups, including for AMA women (≥38 years). Only 2.4% of sustained implantations resulted in monozygotic twinning with monozygotic twinning 2.5x more likely to result in a pregnancy loss (p < 0.05). This large cohort analysis of SETs has revealed that the age-related increase in pregnancy loss associated with aneuploidy has been largely overcome with PGT-A and the selection of euploid embryos for transfer. A small but significant decrease in live birth outcomes still remains for AMA women undergoing infertility treatment and represents the additional embryonic and maternal factors associated with reproductive success.Tabled 1<35 Years35-37 Years38-40 Years41-42 Years43+ Yearsn=1,261 SETsn=1,074 SETsn=950 SETsn=397 SETsn=91 SETsClinical Pregnancy Rate68.0%70.0%63.3%*62.0%*61.0%*MAB Rate6.3%6.6%4.7%5.3%3.6%Live Birth Rate63.7%65.4%60.3%*58.7%*59.3%* Open table in a new tab