Comparative clinical and reproductive outcomes following non-invasive versus biopsy-based preimplantation genetic testing for aneuploidy: a multicentric cohort study

Abstract Non-invasive preimplantation genetic testing for aneuploidy (niPGT-A) is emerging as a newer technology alongside conventional trophectoderm biopsy-based PGT-A, aiming to avoid embryo biopsy while enabling genetic assessment through analysis of cell-free DNA. However, its clinical utility in improving reproductive outcomes remains uncertain, particularly in real-world settings. This retrospective multicentric cohort study evaluated reproductive outcomes following niPGT-A and conventional PGT-A in 6,215 patients underwent intracytoplasmic sperm injection across 48 centres of our organisation between January 2023 and July 2024, comprising 15,635 tested blastocysts. Clinical outcomes were analysed in 3,179 frozen embryo transfer (FET) cycles, and multivariable logistic regression was performed to adjust for confounding factors. Across both the overall cohort and euploid FETs, PGT-A was associated with improved reproductive outcomes compared with niPGT-A. Live birth rates were significantly higher following PGT-A in the overall cohort (46.2% vs. 34.5%) and among euploid embryo transfers (46.5% vs. 34.4%), accompanied by significantly higher clinical and ongoing pregnancy rates. These findings remained consistent across single- and double embryo transfers reproductive outcomes. Additionally, after confounders adjustment, PGT-A was still significantly associated with approximately twofold higher odds of clinical pregnancy and live birth. Collectively, these findings suggest that niPGT-A needs further refinement to improve its reliability and clinical efficacy for embryo selection.