P-699 A clinical predictive model for live birth in women of advanced age undergoing PGT cycles

Abstract

Abstract Study question In 37–45-year-old women undergoing preimplantation genetic testing, who will benefit from repeated cycles until birth? Summary answer The chance of delivering after repeated cycles is higher in those with at least one top-quality unaffected embryo in their first preimplantation genetic testing cycle. What is known already PGT for monogenic disease or structural chromosomal rearrangement (PGT-M and PGT-SR) is offered to couples when one or both carry a monogenic mutation or chromosomal rearrangement that put their future offspring at risk of having a genetic disorder so they can select an unaffected embryo for uterine transfer. The tendency to delay childbirth has led to an increase in advanced-aged women seeking PGT treatments. This poses a major challenge to PGT treatments. Study design, size, duration A retrospective cohort study was conducted at a university hospital reproductive center. The computerized database of 158 women aged 37–45 undergoing 753 PGT-M/SR cycles between 2010 and 2021 was analyzed. Participants/materials, setting, methods The reproductive outcomes of women who were 37–45 years of age, starting a PGT-M/SR cycle, were analyzed until the first live birth or until the patient reached the age of 45. Data were analyzed using univariate analysis, multivariable stepwise logistic regression, Kaplan–Meier method, and decision tree analysis. The cumulative live birth rate was calculated in a conservative manner because the assumption that patients who did not return for subsequent cycles had negative results was made. Main results and the role of chance The analysis included 158 women undergoing 753 preimplantation genetic testing cycles. The cumulative live birth rate was 37.342% (59/158). Decision tree analysis revealed that women aged ≤ 40.1 or women > 40.1 with one or more top-quality embryos in their first cycle had the best chance for a live baby (41% and 56%, respectively). Those older than 40.1 without top-quality embryos and seven or fewer dominant follicles had no live births. A Kaplan–Meier curve showed that for autosomal dominant diseases, there was a negligible increase in live birth rate after three cycles, compared to six cycles in autosomal recessive inheritance. Limitations, reasons for caution This study is limited by its retrospective design and the low birth rate in this age group, which reduces its power to detect differences in birth rates between different modes of inheritance. Wider implications of the findings The predictive model for live births in women aged 37-45 developed in this study can be used for clinical decision making and patient consultation. Additional PGT cycles after three in carriers of an autosomal dominant disorder and six in those with an autosomal recessive disorder should be considered prudently. Trial registration number Not applicable