The impact of PGT-A on in vitro fertilization outcomes in advanced-age women: a retrospective cohort study of 1808 Non-PGT-A cycles and 329 PGT-A cycles

To evaluate the effects of preimplantation genetic testing for aneuploidy (PGT-A) on reproductive outcomes in infertile women of advanced maternal age (≥ 35 years). This single-center retrospective cohort study included frozen vitrified-warmed blastocyst transfer (FET) cycles performed from 2019 to 2024. Cycles were divided into a PGT-A group (329 cycles) and a Non-PGT-A group relying solely on morphological embryo screening (1808 cycles). Given the unbalanced sample sizes and baseline characteristics between groups, multivariate logistic regression was used to adjust key confounders and minimize intergroup bias. The primary outcome was live birth rate; secondary outcomes included biochemical pregnancy rate, clinical pregnancy rate, miscarriage rate, cumulative clinical pregnancy rate and cumulative live birth rate. Stratified subgroup analyses were conducted according to maternal age and history of prior spontaneous abortion. Compared with the Non-PGT-A group, the PGT-A group demonstrated significantly higher biochemical pregnancy rate (61.70% vs. 43.42%, P < 0.001), clinical pregnancy rate (53.50% vs. 35.56%, P < 0.001), live birth rate (43.47% vs. 25.17%, P < 0.001), cumulative clinical pregnancy rate (66.28% vs. 49.14%, P < 0.001) and cumulative live birth rate (55.94% vs. 37.06%, P < 0.001), alongside a markedly lower miscarriage rate (18.18% vs. 28.77%, P = 0.005). Age-stratified analysis showed significantly higher live birth rates in the PGT-A group among women aged 37–38, 39–40, 41–42 and ≥ 43 years (all P < 0.05). Subgroup stratification by spontaneous abortion history revealed superior live birth rates in the PGT-A arm across all miscarriage subgroups (all P < 0.05). For women aged ≥ 37 years, PGT-A is associated with better pregnancy outcomes and live birth rates regardless of prior miscarriage history, supporting its clinical value in optimizing embryo selection for advanced-age patients.