Preimplantation Genetic Testing for Aneuploidy Improves Cumulative Live Birth Rate and Reduces Miscarriage in Recurrent Pregnancy Loss

Objective To evaluate whether preimplantation genetic testing for aneuploidy to deselect aneuploid embryos improves cumulative live birth rate and reduces miscarriage risk in normal karyotype couples with recurrent pregnancy loss undergoing assisted reproductive technology. Design: Retrospective cohort study. Subjects: A total of 1,039 couples with recurrent pregnancy loss who underwent assisted reproductive treatment between January 2013 and December 2023. Exposure: Patients were stratified into two groups based on their decision to undergo preimplantation genetic testing for aneuploidy. Results Among women with recurrent pregnancy loss, preimplantation genetic testing for aneuploidy increased the cumulative live birth rate to 70% compared to 51% in women ≤ 35 years (adjusted risk ratio, 1.38; 95% confidence interval, 1.05–1.82; P  = 0.025) and to 35% compared to 21% in women > 35 years (adjusted risk ratio, 1.69; 95% confidence interval, 1.03–2.77; P  = 0.037). Preimplantation genetic testing reduced the early miscarriage rate to 7% vs. 13%, ( P  = 0.030) and the late miscarriage rate to 0% vs. 3% ( P  = 0.016) in women ≤ 35 years. Subgroup analysis revealed that the significant benefit of preimplantation genetic testing diminished in patients undergoing fresh embryo transfers. Conclusion Preimplantation genetic testing for aneuploidy significantly increased the cumulative live birth rate in couples with recurrent pregnancy loss across both age groups (≤ 35 years and > 35 years) and reduced early and late miscarriage rates in those ≤ 35 years. However, its benefits diminished in patients undergoing fresh embryo transfers, suggesting that the embryo transfer strategy may influence its effectiveness.