OBJECTIVE:To examine whether use of preimplantation genetic testing for aneuploidy (PGT-A) among donor oocyte recipients is associated with the number of embryo transfers (ETs) required to achieve a live birth, or time to live birth. DESIGN:Retrospective cohort study. SUBJECTS:Recipients at a large, academic-affiliated practice who underwent donor oocyte in vitro fertilization (IVF) from 2016-2024 and achieved at least one live birth were included. Cycles using fresh or frozen donor oocytes and resulting in fresh or frozen single ETs were eligible for analysis. EXPOSURE:Patients who did and did not use PGT-A were compared. MAIN OUTCOME MEASURES:The primary outcome was the number of ETs required to achieve first live birth. Secondary outcomes were days from first ET until first live birth, days from fertilization until first live birth, live birth rate after first ET, and rate of spontaneous abortion per patient and per ET. RESULTS:The study included 629 patients who underwent 927 ETs: 312 patients (479 ETs) used PGT-A and 317 patients (448 ETs) did not. On Cox proportional hazards model, no difference was found between study groups regarding number of ETs needed to achieve first live birth (hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.73-1.09). There also was no difference between groups regarding number of days from first ET to first live birth (HR, 0.93; 95% CI, 0.77-1.13) and number of days from fertilization to first live birth (HR, 1.07; 95% CI, 0.83-1.36). No association was found between PGT-A group and live birth rate for the first ET (adjusted odd ratio [aOR], 1.29, 95% CI, 0.91-1.84), or rate of spontaneous abortion per patient (aOR, 1.08, 95% CI, 0.52-2.27) or per ET (aOR, 1.23; 95% CI, 0.61-2.49). CONCLUSION:Donor oocyte recipients can be counseled that use of PGT-A does not appear to be associated with number of transfers needed to achieve live birth or with time to live birth.
We report a case of an exceedingly rare form of conjoined twinning in a 37-year-old patient who underwent a single euploid embryo transfer for severe male factor infertility. The male partner presented with congenital bilateral absence of the vas deferens, absence of the right seminal vesicle, and right renal agenesis. The sperm used to create the couple’s embryos were obtained by TESE and cryopreserved with subsequent thawing. The patient had an unremarkable IVF and medicated frozen embryo transfer cycle. The serum βHCG trend was unremarkable, and pregnancy ultrasound revealed a single fetal pole visualized until 8 weeks of gestation, when two fetal poles were noted. A comprehensive ultrasound evaluation at 9 weeks and 6 days revealed monochorionic, monoamniotic ischiopagus conjoined twins. Twin B demonstrated significant skin edema, a large pericardial effusion, and possible abnormal intracranial anatomy. The couple elected to terminate the pregnancy. Monoamniotic, monochorionic twinning is a rare complication after single embryo transfer, with conjoined twinning exceptionally rare. While several mechanisms underlying monochorionic, monoamniotic twinning after single embryo transfer has been proposed, the development of conjoined twins following embryo transfer is poorly understood. Further investigation is needed to understand the underlying pathophysiologic processes responsible for this phenomenon. These data will aid clinicians in counseling, risk-stratifying, and ultimately, managing rare occurrences of conjoined twinning after SET.
To evaluate the association between the method of sperm retrieval (ejaculated versus testicular sperm) and embryonic mosaicism in infertile couples with severe male factor infertility undergoing in vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A). This retrospective study analyzed 298 patients with severe male factor infertility undergoing IVF with PGT-A from 2019 to 2025. Patients were divided into two groups based on sperm source: ejaculated sperm (n = 229) and testicular sperm obtained via testicular sperm extraction (TESE) (n = 69). All cycles used fresh sperm collected on the day of oocyte retrieval. The primary outcome was the rate of embryonic mosaicism among biopsied blastocysts. Secondary outcomes included euploidy, aneuploidy, mosaicism level, inconclusive embryo count, clinical pregnancy and live birth rates. A total of 1124 embryos were biopsied (250 from testicular sperm extraction; 874 from ejaculate). Mosaicism rates were similar between testicular and ejaculated sperm groups (9.6
