Impact of aneuploidy on reproductive success in a population of younger infertile women: prospective intent to treat analysis

Oocyte aneuploidy is a common, natural occurrence that is associated with implantation failure, miscarriage and birth defects. The incidence of oocyte aneuploidy significantly increases with maternal age, raising a debate in the literature if preimplantation genetic testing for aneuploidy (PGT-A) should be offered to young infertile women (<37 years). This prospective, intent to treat (ITT) analysis, beginning at initial physician consult, investigated live birth outcomes with and without PGT-A for embryo selection in a population of young infertile women. Female infertility patients were prospectively, maternally age-matched (mean 32.6 ±3.6 years; n=100 per group) during their initial physician consult as ITT: (A) IVF cycle with embryo selection based on blastocyst morphology or (B) an IVF cycle with PGT-A for embryo selection. For all IVF cycles, blastocysts were vitrified using the Cryotop method and standard protocols for a hormone replacement frozen embryo transfer (FET) were utilized. PGT-A for Group B was determined from a trophectoderm biopsy using the VeriSeq™ platform (Vitrolife). An equivalent mean number of 1.1 blastocysts were transferred in both groups. Outcome measures included implantation with fetal heart tone (FHT), miscarriage, and live birth. Statistical analysis was performed by Fisher’s exact test and two-sided T-test of base 10 log-transformed data, significance at P < 0.05. The upfront clinical decision to include PGT-A for embryo selection (Group B) resulted in 23 additional women reaching live birth from initial physician consult, in this maternally age-matched young population (Group B = 72.0% vs Group A = 49.0% ITT live birth; p=0.0014). Implantation rate with FHT was significantly improved with the first FET of a euploid blastocyst (Group B = 76.8% vs Group A = 50.8%; P < 0.0001), while a trend towards a lower miscarriage rate was observed in Group B (4.0% vs 10.9%; P = 0.07). There were no significant differences in any ovarian reserve or IVF cycle parameters between the two groups of maternally age-matched, young infertile patients. Women who didn’t achieve an embryo transfer included: one IVF cycle per group with zero oocytes fertilized, 6 IVF cycles in Group A and 4 IVF cycles in Group B with arrested embryos, as well as 3 IVF cycles in Group B with only aneuploid blastocysts. Additionally, the live birth rate calculated from first FET was significantly improved with the selection of a euploid blastocyst in this younger infertile population (Group B = 78.3% vs Group A = 52.7%; P = 0.0003). For infertility patients of all ages, the goal of IVF is to achieve a healthy live birth in the shortest treatment time. Selecting the most competent embryo of the patient’s available cohort is critical to maximize reproductive success. This prospective, intent to treat analysis from initial physician consult clearly revealed that even young infertile women receive significantly improved live birth potential with embryo selection using PGT-A.