Objective:

To assess the effectiveness and cost-effectiveness of preimplantation genetic testing for aneuploidy (PGT-A) compared to expectant management (EM) in achieving live births among fertile patients with recurrent pregnancy loss and prior aneuploid pregnancy loss.

Approach:

• Study Design: Retrospective cohort study conducted at two centers involving 216 fertile patients with recurrent pregnancy loss and a history of aneuploid pregnancy loss.
• Participants: Patients aged 25-40 years with at least two pregnancy losses, including one aneuploid loss, were included. 71 chose EM and 145 underwent PGT-A.
• Analysis Methods: Propensity score matching, multivariable logistic regression, and subgroup assessments were used to evaluate outcomes.

Key Findings:

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

Interpretation:

PGT-A and EM showed comparable five-year cumulative live birth rates, but EM was associated with a higher likelihood of achieving CLLB within 12 months and a shorter time to live birth.

Limitations:

• The study is retrospective, which may introduce selection bias.
• The sample size for the EM group was smaller than the PGT-A group.

Conclusion:

Further investigation is needed to determine whether PGT-A reduces miscarriage rates in this population.