FAVORABLE OUTCOMES IN A SUBSEQUENT PGT-A CYCLE FOLLOWING ALL ANEUPLOID BLASTOCYST COHORT

Preimplantation genetic testing for aneuploidy (PGT-A) has been shown to improve the likelihood of live birth per embryo transfer. However, oocyte aneuploidy is significantly associated with reproductive aging, and the probability of an IVF cycle resulting in a lack of euploid embryos becomes more significant for women of advanced maternal age (>38 years). The aim of this study was to review patient’s treatment decisions following an all aneuploid PGT-A cycle to assist in future clinical management and counseling practices. Retrospective cohort analysis. Consecutive, autologous PGT-A cycles that resulted in all aneuploid blastocysts between January 2016 and December 2019 (n=550) were included in this analysis. Individual variable analysis was performed using Wilcoxon rank sum test. Step-wise logistic regression models evaluated whether 12 clinical parameters were predictive of patient treatment decisions including parental ages, prior live birth, BMI, ovarian reserve variables and IVF cycle characteristics. Significance determined at p<0.05. Nearly half of the couples (47.6%) decided to terminate treatment following an all aneuploid IVF cycle. Only a small number of couples pursued donor oocytes for future treatment (7.6%) and a handful naturally conceived (1.5%). The remaining couples (43.3%) pursued a second autologous PGT-A cycle, with 50.4% obtaining ≥1 euploid blastocyst. Interestingly, women who chose to stop treatment had significantly more oocytes retrieved (p<0.05) but trended towards being less likely to have had prior live births (p = 0.07) than women who continued infertility treatment. Other variables, including maternal age, AMH and resting antral follicle count (AFC), were not significantly different. Women with euploid blastocysts following their second IVF cycle were significantly younger (p<0.001, OR = 0.84) and had higher AMH (p<0.05, OR = 1.25) than women with a consecutive second all aneuploid cycle. Stratification of subsequent euploid frozen blastocyst transfers demonstrated the trend of lower maternal age (p = 0.06, OR=0.89), higher AFC (p<0.05, OR = 1.06) and more mature autologous oocytes (p<0.05, OR = 1.12) in association with a positive pregnancy outcome. Following a PGT-A cycle resulting in all aneuploid blastocysts, nearly half of all couples chose to cease pursing infertility treatment. Maternal age, ovarian reserve and other clinical parameters were not significantly associated with this decision. This indicates that external variables such as, stresses of the procedure and financial burden, may be more significant in patient treatment decisions. For those couples that did pursue further treatment over half went on to have a euploid embryo transfer. This encouraging information will be useful during patient counseling for future clinical decisions following an all-aneuploid PGT-A cycle.