The Efficacy of PGT-A versus Conventional IVF/ICSI in Infertile Women of Advanced Maternal Age (≥38 Years): A Comparative Analysis of Cumulative Live Birth Rates per Oocyte Retrieval Cycle

Background As advanced maternal age is associated with decreased ovarian reserve and higher embryo aneuploidy rates, preimplantation genetic testing for aneuploidies (PGT-A) intends to select chromosomally normal embryos but remains clinically controversial due to frequently limited retrievable oocytes and blastocyst formation. This study compares the efficacy of PGT-A versus conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in infertile women aged 38 years or older, and aims to assess the feasibility and clinical value of PGT-A in improving reproductive outcomes for this population. Methods A retrospective cohort study was conducted including women who underwent their first PGT-A or conventional IVF/ICSI cycle between January 2019 and June 2025. Propensity score matching (PSM) was applied to balance baseline characteristics. Ovarian stimulation, embryo culture, biopsy (for PGT-A), and embryo transfer protocols followed standardized clinical procedures. The primary outcome measures were the cumulative live birth rates (CLBRs) following a single stimulation cycle and subsequent embryo transfers and live birth rates per transfer. Secondary outcomes included fertilization rate, clinical pregnancy rate, miscarriage rate, and cycle cancellation rate. Statistical analyses employed generalized estimating equations (GEE) and binary logistic regression to account for confounding variables. Results After PSM, 352 patients remained in each group. The euploidy rate significantly declined with advancing maternal age (57.94% at 38 ≤ age < 40 years, 34.18% at 40 ≤ age < 42 years, and 21.21% at 42 ≤ age ≤ 45 years). Compared to the IVF/ICSI group, the PGT-A group showed significantly lower cumulative live birth and clinical pregnancy rates per retrieval (P < 0.05). In contrast, when analyzed per embryo transfer, biochemical pregnancy, clinical pregnancy, implantation, ongoing pregnancy, and live birth rates were all significantly higher in the PGT-A group (all P < 0.001). Subgroup analyses indicated that the benefits of PGT-A were most pronounced in women under 41 and those with higher ovarian reserve (AMH > 1 ng/ml or AFC ≥ 10). Conclusions PGT-A may not improve cumulative live birth outcomes in women aged 38–45 compared to conventional IVF/ICSI, though its clinical applicability depends on individual ovarian response and embryo availability. These findings support personalized treatment strategies for this patient population.