Dados do Trabalho

Title

How ICSI with PGT-A impact success pregnancy rates across women age groups?

Objective

Preimplantation genetic testing for aneuploidy (PGT-A) is a largely used tool in embryo selection on the grounds of euploidy. Formally, PGT-A has only few indications, such as recurrent implantation failure (RIF), recurrent miscarriage, couples with karyotype alterations or personal history of sex related hereditary diseases. However, it’s use has been routinely expanded for a wide group of patients, such as advanced maternal age (AMA), cases of severe male infertility and even for women at all ages with no formal indication, followed by an elective single embryo transfer as an attempt of increasing the pregnancy success rates in a shorter time and reduce the abortion incidence. This study aims to evaluate the ongoing pregnancy success of ICSI cycles with PGT-A and euploid blastocyst transfer, according to maternal age, using real world data.

Methods

Retrospective cohort including 226 ICSI cycles with PGT-A conducted at a private fertility center in São Paulo, Brazil, between 2019 and 2022 were included. The inclusion criteria were ICSI cycles using own oocytes, with embryos until blastocyst development followed by blastocyst biopsy for PGT-A on Day 5 of development. The frozen-thawed euploid D5 blastocyst transfers were performed in a subsequent hormone replacement cycle. Women included were 29 to 45 years old (yo) and the clinical outcomes are presented according to women ages ranges: <35 yo (n=44); 35-37 yo (n=61); 38-40 yo (n=78); 41-42 yo (n=33); >42 yo (n=10).

Results

The average age for each group were: <35 (32.6±1.8); 35-37 (36.1±0.9); 38-40 (38.9±0.8); 41-42 (41.3±0.5); >42 (43.2±0.6); p<0.001. The mean number of cycles per couple (1.3±0.7; 1.5±0.7; 1.9±1.6; 2.0±1.8; 1.7±1.0; p=0.298) and the number of blastocysts transferred were similar in all groups (1.2±0.4; 1.1±0.3; 1.1±0.3; 1.0±0.0; 1.2±0.6; p=0.085), respectively. Clinical outcomes evaluated included total pregnancy (bhCG+) (<35: 59%; 35-37: 39%; 38-40: 65%; 41-42: 61%; >42: 70%, p=0.369), miscarriage (<35: 35%; 35-37: 33%; 38-40: 36%; 41-42: 26%; >42: 17%, p=0.854) and ongoing pregnancy rates (<35: 39%; 35-37: 33%; 38-40: 42%; 41-42: 44%; >42: 56%, p=0.629). The multivariate logistic regression analysis confirmed that the ongoing pregnancy is not associated to women age: <35 (reference); 35-37 (OR 0.88; p=0.767; 38-40 (OR 1.35; p=0.461); 41-42 (OR 1.57; p=0.362); >42 (2.07; p=0.346), adjusted for confounders (number of cycles and number of embryos transferred).

Conclusion

This study based on real-world data demonstrated that the woman age has no impact on clinical pregnancy rates when a D5 euploid blastocyst transfer is placed. Those outcomes are similar to SART National Report Summary, which also shows similar live birth rates per transfer when PGT-A is placed, for all women ages rages. It is important to note the limitation of our study, as we presented clinical outcomes per blastocyst transfer, while cumulative outcomes per started cycle were not available. It is known that the number of oocytes obtained and the rate of euploid blastocysts decrease as the woman's age increases. Thus, the woman age can had been an impact on the availability of euploid embryos for transfer. On the other hand, we have shown here, once a euploid blastocyst is available and transferred, the success chances are similar at all women ages.

Keywords

Euploid blastocysts transfer, preimplantation genetic testing for aneuploidy (PGT-A), maternal age