Comparative Analysis of PGT-A and Expectant Management in RPL

Overview

This study compares preimplantation genetic testing for aneuploidy (PGT-A) with expectant management (EM) in fertile patients experiencing recurrent pregnancy loss (RPL) and previous aneuploidy. Findings indicate that while EM leads to higher live birth rates within 12 months, both strategies show comparable cumulative live birth rates over five years.

Background

Recurrent pregnancy loss (RPL) is a significant clinical challenge, particularly in patients with a history of aneuploidy. Preimplantation genetic testing for aneuploidy (PGT-A) is often considered for these patients, yet its efficacy compared to expectant management remains debated. Understanding the outcomes associated with these approaches is crucial for guiding clinical decisions in this population.

Data Highlights

Key Findings

• CLLB within 12 months was significantly lower in the PGT-A group (52.1%) compared to EM (81.7%).
• 5-year cumulative live birth rates were comparable between PGT-A (94.4%) and EM (87.3%).
• PGT-A was associated with a longer median time to pregnancy leading to live birth (8.6 months) compared to EM (3.0 months).
• Early miscarriage rates were not significantly different between the two groups (7.4% for PGT-A vs. 12.4% for EM).
• Incremental cost-effectiveness ratios for PGT-A were ¥1,203,800 for each additional live birth and ¥1,504,800 for each miscarriage prevented.

Clinical Implications

The study results indicate a higher likelihood of achieving live birth within 12 months with expectant management compared to PGT-A in fertile patients with recurrent pregnancy loss and previous aneuploidy.

Conclusion

The study presents findings on management strategies for recurrent pregnancy loss, indicating that PGT-A does not demonstrate clear advantages over expectant management in terms of immediate live birth outcomes.

Related Resources & Content

1. American Society for Reproductive Medicine, ASRM, 2026 -- Recurrent pregnancy loss: a committee opinion
2. European Society of Human Reproduction and Embryology, ESHRE, 2023 -- Recurrent Pregnancy Loss
3. Frontiers in Endocrinology — Factors associated with de novo aneuploidy across different preimplantation genetic testing cycles: a retrospective cohort study
4. The Journal of Clinical Endocrinology & Metabolism — Evaluation of Cumulative Live Birth Rates in Preimplantation Genetic Testing Cycles: Progestin Versus GnRH Analogues
5. The Journal of Clinical Endocrinology & Metabolism — Effects of Negative Pregnancy Experiences in the First IVF Cycle on Future Pregnancy Results
6. The Journal of Clinical Endocrinology & Metabolism — Metabolic Outcomes in Children Born from Biopsied Embryos from Early Childhood to Preschool Years
7. Factors associated with de novo aneuploidy across different preimplantation genetic testing cycles
8. Evaluation of Cumulative Live Birth Rates in Preimplantation Genetic Testing Cycles
9. Effects of Negative Pregnancy Experiences in the First IVF Cycle on Future Pregnancy Results
10. Recurrent pregnancy loss: a committee opinion (2026) | American Society for Reproductive Medicine | ASRM
11. Recurrent Pregnancy Loss
12. The use of preimplantation genetic testing for aneuploidy: a committee opinion (2024) | American Society for Reproductive Medicine | ASRM
13. Live Birth with or without Preimplantation Genetic Testing for Aneuploidy | New England Journal of Medicine
14. Preimplantation genetic testing for aneuploidy versus no genetic testing in couples undergoing intracytoplasmic sperm injection for severe male infertility: multicentre, open label, randomised controlled trial | The BMJ
15. Preimplantation genetic testing for aneuploidy versus no genetic testing in couples undergoing intracytoplasmic sperm injection for severe male infertility: multicentre, open label, randomised controlled trial