Live birth rates with and without preimplantation genetic testing: a single-center retrospective study

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However, it remains uncertain whether different PGT techniques improve the live birth rate in patients compared to conventional in vitro fertilization (IVF). Methods In this single-center retrospective cohort study, we included couples undergoing their first IVF-assisted conception cycle with only their first single frozen embryo transfer. All couples were fertilized by intracytoplasmic sperm injection (ICSI) and had three or more high-quality blastocysts on the fifth day of embryo culture. The PGT group screened the optimal blastocysts for transfer by their counterpart technique, while the conventional IVF group selected blastocysts based on morphological criteria. The primary outcome was to observe the live birth rate in each group. Results A total of 409 couples were enrolled in the study, of which 219 were in the PGT group, 87 were PGT-A, 22 were PGT-M, 110 were PGT-SR, and 190 were in the IVF group. The live birth rate was higher in the PGT group (46.12%) compared to that of the conventional IVF group (34.74%) ( p = 0.0195, OR 0.6218, 95% CI 0.4161–0.9189). The live birth rate in the PGT-A subgroup (48.28%) was also higher than that in the IVF group ( p = 0.032, OR 0.5703, 95% CI 0.3380–0.9610). Different controlled ovarian hyperstimulation protocols and endometrial preparation protocols had no effect on the live birth rate of PGT. Conclusion Compared to conventional IVF, PGT, especially PGT-A, has the ability to increase the live birth rate in patients. Different controlled ovarian hyperstimulation protocols and endometrial preparation protocols had no effect on the live birth rate of PGT. Preimplantation genetic testing Live birth rate In vitro fertilization Figures Figure 1 What does this study adds to the clinical work We analyzed the effect of different types of PGT and different controlled ovarian hyperstimulation protocols and endometrial preparation protocols on live birth rates, respectively, using conventional IVF as a control. Introduction In vitro fertilization (IVF) is an important assisted reproductive technology (ART), and the transfer of high-quality embryos in receptive endometrium is crucial for IVF (Greco et al., 2020 ). Selection of the best embryos for transfer is a major challenge in the IVF process, especially in single embryo transfer strategies. The most common method of embryo selection is still based on morphological grading criteria (Abeyta and Behr, 2014 , Minasi et al., 2016 ). However, there has been substantial evidence that abnormalities in embryonic genetic material are also a significant cause of IVF failure, and therefore preimplantation genetic testing (PGT) has been employed in the process of embryo selection (Committee et al., 2020 , Practice Committees of the American Society for Reproductive et al., 2018 , Ben-Nagi et al., 2019 ). PGT is a diagnostic procedure that analyses the embryonic genetic material in order to reduce the risk of abnormalities of the genetic material and to increase the likelihood of a successful pregnancy (Giuliano et al., 2023 ). Until today, PGT has been developed in three ways: preimplantation genetic testing for aneuploidy (PGT-A), preimplantation genetic testing for monogenic disorders (PGT-M), and preimplantation genetic testing for structural rearrangements (PGT-SR), in order to improve the selection of embryos in different situations. As the combination of morphological criteria and PGT evaluates the embryos to be transferred from different latitudes, it has led to an elevated likelihood of successful pregnancies and a reduction in spontaneous abortions and genetically abnormal fetuses. However, it has been shown that invasive PGT manipulations may have a slight impact on embryo viability, and limitations in testing techniques can lead to false positives or false negatives (Giuliano et al., 2023 ); PGT-A may miss the diagnosis of mosaic embryos and incorrectly assess the embryo's reproductive potential (Viotti et al., 2021 b); PGT-M is unable to diagnose mutations that are not recorded in the current analysis strategy (Vanneste et al., 2011 ); and the variability of chromosomal rearrangements significantly influences the complexity and accuracy of PGT-SR (Garcia-Pascual et al., 2020 ). Each of these challenges has the potential to have an impact on the final assisted reproduction treatment outcome. In order to assess the impact of PGT on IVF treatment outcomes in different patients, as well as to provide additional clinical data for PGT prognostic studies, this study reviewed the live birth rate of IVF combining morphological criteria and PGT at our center, and compared it with the live birth rate of conventional IVF based on morphological criteria only. Material and Methods Patients All couples presented to Chengdu Women's and Children's Central Hospital from 2021.01.01-2023.12.31 with a diagnosis of infertility and were scheduled for their first IVF cycle. Intracytoplasmic sperm injection (ICSI) is used for all fertilization procedures. Couples with three or more good quality blastocysts will be included in the study. Exclusion criteria included known uterine anomalies (e.g., congenital malformations of the uterus; untreated uterine septum, adenomyosis, or submucosal fibroids; endometrial polyps; or intrauterine adhesions), the presence of contraindications to pregnancy, or the use of donor oocytes or sperm to achieve pregnancy. All couples provided written informed consent on the day of oocyte retrieval. The study was approved by the Ethics Committee of Chengdu Women's and Children's Central Hospital (2020.5 IEC-C-V2.0 2020(12)). Procedures Controlled ovarian hyperstimulation protocols mainly consist of agonist long protocol, antagonist protocol or progestin-primed ovarian stimulation (PPOS) protocol (Shi et al., 2018 ). The long protocol is a gonadotropin-releasing hormone (GnRH) agonist administered on the day 2 to day 4 of menstruation or in the mid-luteal phase of the previous cycle, and gonadotropins are started after satisfactory pituitary desensitization has been achieved; the antagonist protocol is gonadotropins from day 2 to 3 of the menstrual cycle, with concomitant GnRH antagonists when the follicle reaches 14 mm in diameter or when estrogen is more than 300 pg/ml; PPOS is the administration of exogenous progesterone from days 2 to 3 of the menstrual cycle, together with gonadotropins. When at least two follicles have an average diameter of 18 mm or more, clinicians use human chorionic gonadotropin (hCG), GnRH agonists, or both, to bring about the final maturation of the oocytes, which are then retrieved by transvaginal ultrasound after about 36 hours. All IVF procedures were performed using ICSI and all embryos were cultured to the blastocyst stage. According to the Gardner Morphological Criteria (Gardner et al., 2000 ), the blastocyst morphological score is based on three components: blastocyst expansion, inner cell mass and trophectoderm development, and blastocysts rated 4BC or higher on day 5 of embryo culture are considered to be high-quality blastocysts. Patients with three or more good quality blastocysts will be included in the study. In the PGT group, high-quality blastocysts screened by morphological criteria underwent trophoblast biopsy. All the embryos obtained were cryopreserved. All patients underwent a single frozen embryo transfer. The endometrial preparation protocols included down-regulation combined with hormone replacement cycles, hormone replacement cycles, ovulation induction cycles and natural ovulation cycles. An optimal blastocyst was selected for transfer in the PGT group by combining morphological criteria and biopsy results, and blastocysts were selected in the conventional IVF group only on the basis of morphological criteria. Pregnancy and live births were recorded in all patients. Outcomes The primary outcome was the live birth rate. Secondary outcomes included biochemical pregnancy rate, clinical pregnancy rate, miscarriage rate and multiple pregnancy rate. Subgroup analyses were performed according to controlled ovarian hyperstimulation protocols, endothelial preparation protocols and age of the woman. Statistical analysis Continuous baseline characteristics of patients were expressed as mean ± standard deviation (SD), and differences between groups were compared by the Wilcoxon rank sum test owing to the non-normality of the variables. Categorical variables were expressed in the form of percentages and compared by the chi-square test. Effect sizes for differences in categorical variables were reported using odds ratios (ORs), and 95% confidence intervals (CIs) for ORs were calculated using the Baptista-Pike method. Couples lost to follow-up were not included in the final statistics. Statistical significance was defined as two-sided p < 0.05. All statistical analyses were performed using SPSS 19.0 software. Results 1. Baseline characteristics of included patients Initially, 422 couples who met the criteria and were willing to participate in the study were screened, 230 couples underwent PGT cycles and 192 couples underwent conventional IVF cycles. In the PGT group, 11 (4.78%) couples withdrew from the study due to failure to undergo implantation or loss to follow-up, whereas, in the IVF group, 2 (1.04%) couples withdrew from the study due to loss to follow-up. Ultimately, 219 couples were included in the PGT group, of which 87 were PGT-A, 22 were PGT-M, and 110 were PGT-SR, and 190 couples were included in the IVF group (Fig. 1 ). Couples in the PGT group had higher age and years of infertility than in the IVF group, while endometrial thickness on the day of transplantation was lower than in the IVF group. The weeks of pregnancy were similar in both groups. During the controlled ovarian hyperstimulation phase, more women (62.56%) in the PGT group preferred the PPOS protocol, whereas more women (56.32%) in the IVF group chose the antagonist protocol. During endometrial preparation, both groups underwent down-regulation combined with hormone replacement cycle in the highest number of women (77.63% and 61.58% in the PGT and IVF groups, respectively) (Table 1 ). Table 1 Baseline characteristics of included patients. “a” means p < 0.05 vs. IVF, “b” means p < 0.05 vs. PGT-SR, “c” means p < 0.05vs. PGT-M. PGT Conventional IVF PGT-A PGT-M PGT-SR Number of cases 219 190 87 22 110 Age of women (years) 32.90 ± 4.61 a 31.53 ± 4.15 35.71 ± 4.36 abc 32.36 ± 4.70 30.78 ± 3.52 Age of men (years) 35.08 ± 5.64 a 33.81 ± 5.48 37.76 ± 6.03 abc 34.05 ± 6.09 33.16 ± 4.26 Years of infertility (years) 3.038 ± 2.91 a 4.16 ± 2.64 2.53 ± 2.65 ab 1.81 ± 2.82 ab 3.69 ± 2.99 Controlled ovarian hyperstimulation protocols agonist long protocol 46 64 17 4 25 antagonist protocol 36 107 14 2 20 PPOS protocol 137 19 56 16 65 Endometrial preparation protocols down-regulation combined with hormone replacement cycle 170 117 72 18 80 hormone replacement cycle 6 2 4 0 2 ovulation induction cycle 3 4 1 0 2 natural ovulation cycle 40 67 10 4 26 Endometrial thickness (mm) 9.32 ± 1.71 a 10.46 ± 5.49 8.99 ± 1.67 ab 9.50 ± 1.85 9.56 ± 1.68 a Weeks of pregnancy (weeks) 37.71 ± 1.40 37.85 ± 1.18 37.50 ± 1.69 38.10 ± 1.20 37.82 ± 1.13 2. Primary and secondary outcomes The results and their corresponding odds ratios and p-values are displayed in Tables 2 and 3 . The live birth rate in the PGT group (46.12%) was significantly higher than that in the conventional IVF group (34.74%) (p = 0.0195, OR 0.6218, 95% CI 0.4161–0.9189). Among them, the live birth rate in the PGT-A subgroup (48.28%) was significantly higher than that in the IVF group (p = 0.032, OR 0.5703, 95% CI 0.3380–0.9610); and the live birth rates in the PGT-M and PGT-SR subgroups (45.45% and 44.55%, respectively), although higher than that in the IVF group, were not statistically different (p = 0.321, OR 0.6387, 95% CI 0.2776–1.577 and p = 0.0922, OR 0.6626, 95% CI 0.4096–1.074, respectively); live birth rates did not differ between the three PGT subgroups. In addition, the PGT group and PGT-A subgroups (30.82% and 25.00%, respectively) had lower miscarriage rates compared to the IVF group (42.61%) (p = 0.0489, OR 1.666, 95% CI 1.005–2.787 and p = 0.0251, OR 2.227, 95% CI 1.077–4.648, respectively); the PGT-M and PGT-SR subgroups (37.50% and 33.78%, respectively) had lower miscarriage rates than the IVF group, but were still not statistically different (p = 0.6981, OR 1.237, 95% CI 0.4491–3.697 and p = 0.225, OR 1.455, 95% CI 0.7929–2.647, respectively); miscarriage rates did not differ between the three PGT subgroups. Biochemical, clinical and multiple pregnancy rates did not differ significantly between groups and subgroups (Table 2 and Table 3 ). Table 2 Primary and secondary outcomes. “a” means p < 0.05 vs. IVF. PGT Conventional IVF PGT-A PGT-M PGT-SR Live birth rate % (n) 46.12%(101/219) a 34.74%(66/190) 48.28%(42/87) a 45.45%(10/22) 44.55%(49/110) Biochemical pregnancy rate % (n) 79.91%(175/219) 74.21%(141/190) 75.86%(66/87) 90.91%(20/22) 80.91%(89/110) Clinical pregnancy rate % (n) 66.67%(146/219) 60.53%(115/190) 64.37%(56/87) 72.73%(16/22) 67.27%(74/110) Miscarriage rate % (n) 30.82%(45/146) a 42.61%(49/115) 25.00%(14/56) a 37.50%(6/16) 33.78%(25/74) Multiple pregnancy rate % (n) 4.11%(6/146) 2.61%(3/115) 5.36%(3/56) 6.25%(1/16) 2.70%(2/74) Table 3 Odds ratios and p-values for comparisons between groups. A PGT vs. IVF PGT-A vs. IVF PGT-M vs. IVF PGT-SR vs. IVF OR p OR p OR p OR p Live birth rate 0.6218(0.4161–0.9189) 0.0195 0.5703(0.3380–0.9610) 0.032 0.6387(0.2776–1.577) 0.321 0.6626(0.4096–1.074) 0.0922 Biochemical pregnancy rate 0.7235(0.4594–1.164) 0.1703 0.9156(0.5100–1.667) 0.7691 0.2878(0.06474-1.187) 0.0828 0.6790(0.3870–1.201) 0.1862 Clinical pregnancy rate 0.7667(0.5104–1.149) 0.1975 0.8488(0.5017–1.438) 0.5415 0.5750(0.2209–1.542) 0.2649 0.7459(0.4559–1.223) 0.2435 Miscarriage rate 1.666(1.005–2.787) 0.0489 2.227(1.077–4.648) 0.0251 1.237(0.4491–3.697) 0.6981 1.455(0.7929–2.647) 0.225 Multiple pregnancy rate 0.6250(0.1685–2.404) 0.5094 0.4732(0.1082-2.090) 0.3593 0.4018(0.05726-5.539) 0.4277 0.9643(0.1931–5.539) 0.9686 B PGT-A vs. PGT-SR PGT-M vs. PGT-SR PGT-A vs. PGT-M OR p OR p OR p Live birth rate 1.162(0.6498–2.026) 0.602 1.037(0.3986–2.522) 0.9376 0.8929(0.3308–2.253) 0.8129 Biochemical pregnancy rate 1.348(0.6824–2.665) 0.3904 2.360(0.5759–10.82 0.259 3.182(0.7652-14.60) 0.1223 Clinical pregnancy rate 0.8788(0.4850–1.605) 0.6691 1.297(0.4956–3.582) 0.6161 1.476(0.5437–4.181) 0.4594 Miscarriage rate 0.6533(0.3091–1.383) 0.2792 1.176(0.3652–3.535) 0.7767 1.800(0.5066–6.214) 0.3249 Multiple pregnancy rate 2.038(0.4024–11.73) 0.4358 2.400(0.1560–21.40) 0.4735 1.178(0.08549-8.382) 0.8906 3. Subgroup analysis We categorized all patients into three subgroups according to different controlled ovarian hyperstimulation protocols: agonist long protocol, antagonist protocol, and PPOS protocol. Similarly, we categorized all patients into four subgroups according to different endometrial preparation protocols: down-regulation combined with hormone replacement cycle, hormone replacement cycle, ovulation induction cycle and natural ovulation cycle four subgroups. We then analyzed the live birth rates among the subgroups (Table 4 , Supplementary Table 1 and Supplementary Table 2). Table 4 Live birth rate in subgroup analysis. “a” means p < 0.05 vs. IVF, “*” means p < 0.05 vs. agonist long protocol, “#” means p < 0.05 vs. down-regulation combined with hormone replacement cycle. PGT Conventional IVF PGT-A PGT-M PGT-SR Controlled ovarian hyperstimulation protocols agonist long protocol 50.00%(23/46) 40.63%(26/64) 52.94%(9/17) 50.00%(2/4) 48.00%(12/25) antagonist protocol 52.78%(19/36) 34.58%(37/107) 42.86%(6/14) 50.00%(1/2) 60.00%(12/20) a PPOS protocol 43.07%(59/137) a 15.79%(3/19) * 48.21%(27/56) a 43.75%(7/16) 38.46%(25/65) Endometrial preparation protocols down-regulation combined with hormone replacement cycle 47.65%(81/170) a 29.06%(34/117) 51.39%(37/72) a 50.00%(9/18) 43.75%(35/80) a hormone replacement cycle 33.33%(2/6) 0%(0/2) 25.00%(1/4) 0%(0/0) 50.00%(1/2) ovulation induction cycle 0%(0/3) 50.00%(2/4) 0%(0/1) 0%(0/0) 0%(0/2) natural ovulation cycle 45.00%(18/40) 44.78%(30/67) # 40.00%(4/10) 25.00%(1/4) 50.00%(13/26) In the patients of down-regulation combined with hormone replacement cycle, the live birth rate was significantly higher in the PGT group (47.65%) than in the IVF group (29.06%) (p = 0.0016, OR 0.4501, 95% CI 0.2701–0.7443); the PGT-A and PGT-SR subgroups (51.39% and 43.75%, respectively) also had significantly higher live birth rates than the IVF group (p = 0.0021, OR 0.3875, 95% CI 0.2137–0.7217 and p = 0.0338, OR 0.5267, 95% CI 0.2863–0.9575, respectively). In the patients undergoing conventional IVF, the live birth rate was significantly higher in the natural ovulation cycle (44.78%) than in the down-regulation combined with hormone replacement cycle (29.06%) (p = 0.0313, OR 0.5052, and 95% CI 0.2726–0.9318). The other significant results should be referred to with caution in our opinion because the sample size was too low. Discussion Until today, selecting the best embryos for transfer remains a major challenge for IVF, especially when clinicians choose the single embryo transfer (SET) protocol for a variety of different reasons (Greco et al., 2020 ). There have been randomized controlled trials and Meta-analyses confirming the poor clinical outcomes of SET (Kamath et al., 2020 , Gelbaya et al., 2010 ); whereas multiple embryo transfer is often used to increase embryo implantation rates in clinical practice, but this regimen increases the risk of multiple pregnancies (Fragouli et al., 2008 , Alfarawati et al., 2011 ). It is still widely recognized that the morphology of the embryo is closely related to its ability to survive and develop during conventional IVF (Abeyta and Behr, 2014 , Minasi et al., 2016 ). Although culturing embryos to the blastocyst stage has been proven to improve clinical outcomes in SET (Papanikolaou et al., 2006 ), morphologically normal blastocysts are still at risk of abnormal genetic material (Minasi et al., 2017 , Forman et al., 2014, Fragouli et al., 2013 ). Therefore, three PGT techniques have been introduced for assisted embryo selection with the expectation that they improve assisted reproductive outcomes (Mastenbroek et al., 2011 ). In our single-center retrospective cohort study, a total of 409 couples were included in the statistics, all women underwent a single frozen embryo transfer, and we only counted the clinical outcomes of the first embryo transfer. The results showed that the live birth rate of PGT was higher than that of conventional IVF, in which the live birth rate of PGT- A was also higher than that of conventional IVF, although the live birth rates of PGT-M and PGT-SR did not differ from those of conventional IVF, but were numerically higher. In addition, PGT and PGT-A had lower miscarriage rates compared to conventional IVF. However, biochemical pregnancy rate, clinical pregnancy rate and multiple pregnancy rate did not differ between groups. Whether PGT-A can improve the live birth rate of patients is still a controversial topic until now. At first, PGT-A was thought to increase the live birth rate of embryos in a single transfer (Scott et al., 2013 ), reduce the risk of multiple births (Practice Committee of the American Society for Reproductive and the Practice Committee for the Society for Assisted Reproductive Technologies. Electronic address, 2021), decrease the risk of early pregnancy and shorten the duration of pregnancy (Neal et al., 2018 ). Early clinical trials and meta-analyses also support this view (Dahdouh et al., 2015, Natsuaki and Dimler, 2018 ). However, in recent years, more and more counter-arguments have begun to emerge. Early studies often analyzed live birth rates on the basis of a single embryo transfer when patients had high-quality blastocysts (Scott et al., 2013 , Neal et al., 2018 , Sacchi et al., 2019 ), and these studies are considered to have subjectively excluded from the analysis cycles with fewer embryos, poorer embryo quality, no blastocysts, and no transferable embryos, invisibly overstating the effect of PGT-A on the live birth rate (Kemper et al., 2020 ). More and more studies have begun to report that the cumulative live birth rate is the reasonable metric to assess the utility of PGT-A (Kemper et al., 2020 , Doyle et al., 2020 , Yan et al., 2021 ), and that PGT-A did not improve the cumulative live birth rate in patients (Rubio et al., 2017 , Verpoest et al., 2018 , Munne et al., 2019 , Ozgur et al., 2019 ). In our study, both the PGT group and the conventional IVF group included only patients with excellent blastocyst quality in an attempt to reduce selection bias, but the results still favored PGT-A. There are two main possible reasons. First, because of the short period of time that PGT has been conducted in our center, it resulted in our inability to count the cumulative live birth rate, and we still used the live birth rate of a single transfer as the outcome indicator. Second, we did not transfer mosaic embryos, which may have had an impact on the final outcome. Some studies have shown that transferring mosaic embryos increases the rate of implantation failure and miscarriage despite the chance of a healthy delivery (Capalbo et al., 2021 , Munne et al., 2017 , Lin et al., 2020 , Viotti et al., 2021 a). For safety reasons, no mosaic embryos were transferred in our study. There are very few studies on the effect of PGT-M and PGT-SR on live birth rates; after all, their own purpose is to avoid the transmission of abnormal genetic material, not to improve the live birth rates of patients. A few studies have shown that PGT-M and PGT-SR do not have a significant effect on the live birth rate; rather, the live birth rate of patients with PGT-M or PGT-SR is more closely related to the patient's own age, endocrine status, oocyte quality and embryo quality (Shetty et al., 2022 , Insogna et al., 2021 , Ben-Nagi et al., 2019 , Van Der Kelen et al., 2024 ). In our study, due to the small number of patients in the PGT-M subgroup, the statistical results are not representative of the patient population and thus need to be considered with caution. However, it is reasonable that patients with PGT-SR did not have a significant profit in live birth rate. In our secondary outcomes, PGT-A significantly reduced the miscarriage rate in patients, which seems to be in line with the current aim of using PGT-A technique (Scott et al., 2013 , Practice Committee of the American Society for Reproductive and the Practice Committee for the Society for Assisted Reproductive Technologies. Electronic address, 2021, Neal et al., 2018 ). However, biochemical pregnancy rates, clinical pregnancy rates, and multiple pregnancy rates did not differ between PGT and conventional IVF, and perhaps the effect of PGT on pregnancy is not limited to early pregnancies (Yan et al., 2021 ), but is also reflected in ongoing pregnancies. We also subgrouped patients by different controlled ovarian hyperstimulation protocols and endometrial preparation protocols. Our results showed that when the PPOS protocol was used, the live birth rate in the PGT group and PGT-A subgroup would be higher than that in the conventional IVF group, and among patients undergoing conventional IVF, a higher live birth rate would be obtained with the agonist long protocol than with the PPOS protocol. Unfortunately, however, too few patients in the conventional IVF group used the PPOS protocol, resulting in these results having to be taken into account very carefully. It has been reported in the literature that in fresh transplantation cycles, the agonist long protocol can indeed be advantageous in terms of live birth rate (Li et al., 2021 ), and that a low GN dose is more favorable to improve the live birth rate of patients (Gerber et al., 2020 ), but in frozen transplantation cycles, the effect of different controlled ovarian hyperstimulation protocols do not seem to have as pronounced an effect on the live birth rate (Gerber et al., 2020 ). The effect of the endometrial preparation protocol on the live birth rate of patients appears to be more pronounced for frozen transplantation cycles. Previous studies have shown that down-regulation combined with hormone replacement cycle and hormone replacement cycle are associated with significantly lower live birth rates and patients are at a higher risk of gestational hypertension, postpartum hemorrhage, and preterm labor; in contrast, the natural ovulation cycle resulted in optimal pregnancy outcomes (Wu et al., 2021 ). This is also consistent with our results, but the number of patients who chose the ovulation induction cycle was too small for the current study to give constructive conclusions. However, it is interesting to note that in the group of patients who chose down-regulation combined with hormone replacement cycle, the live birth rate of PGT was significantly higher than that of the conventional IVF group, which has not been reported before. We believe that this is likely to be related to male factors. There are certain limitations to our study. The first and foremost is the insufficient sample size. The small sample size resulted in a restrictive interpretation of many of the results in the subgroup analyses. Similarly, because of the small sample size, this study did not further differentiate between age groups for subgroup analysis. Second, due to the relatively short period of time that PGT has been conducted in our center, the cumulative live birth rate was not adopted as the primary outcome in this study, which may have potentially inflated the contribution of PGT to the live birth rate. In addition, the baseline characteristics of the patients were not consistent, and it is good to note that we do not believe this had a significant impact on our results. These issues are expected to be improved in future large studies. Abbreviations ART assisted reproductive technology CI confidence interval GnRH gonadotropin-releasing hormone hCG human chorionic gonadotropin ICSI intracytoplasmic sperm injection IVF in vitro fertilization OR odds ratio PGT preimplantation genetic testing PGT-A preimplantation genetic testing for aneuploidy PGT-M preimplantation genetic testing for monogenic disorders PGT-SR preimplantation genetic testing for structural rearrangements PPOS progestin-primed ovarian stimulation SET single embryo transfer SD standard deviation Declarations Author contributions Yicheng Wang and Xinting Yu contributed equally to this research. Yicheng Wang and Xinting Yu participated in Data curation, Formal analysis, Funding acquisition, Roles/Writing - original draft, and Writing - review & editing. Yacong Wang, Wending Teng and Hong Xian participated in Investigation, Methodology, Resources, and Software. Fang Wang participated in Conceptualization, Investigation, and Resources. Competing interests All authors declare no competing interests. Acknowledgements The authors gratefully acknowledge support from the National Natural Science Foundation of China (82401912) and Natural Science Foundation of Sichuan Province (2024NSFSC1677). Data Availability Statement The data that support the findings of this study are openly available at https://pan.quark.cn/s/343d7cac932a. References ABEYTA, M. & BEHR, B. 2014. Morphological assessment of embryo viability. Semin Reprod Med, 32 , 114-26. ALFARAWATI, S., FRAGOULI, E., COLLS, P., STEVENS, J., GUTIERREZ-MATEO, C., SCHOOLCRAFT, W. B., KATZ-JAFFE, M. G. & WELLS, D. 2011. The relationship between blastocyst morphology, chromosomal abnormality, and embryo gender. Fertil Steril, 95 , 520-4. BEN-NAGI, J., JONES, B., NAJA, R., AMER, A., SUNKARA, S., SENGUPTA, S. & SERHAL, P. 2019. Live birth rate is associated with oocyte yield and number of biopsied and suitable blastocysts to transfer in preimplantation genetic testing (PGT) cycles for monogenic disorders and chromosomal structural rearrangements. Eur J Obstet Gynecol Reprod Biol X, 4 , 100055. CAPALBO, A., POLI, M., RIENZI, L., GIRARDI, L., PATASSINI, C., FABIANI, M., CIMADOMO, D., BENINI, F., FARCOMENI, A., CUZZI, J., RUBIO, C., ALBANI, E., SACCHI, L., VAIARELLI, A., FIGLIUZZI, M., FINDIKLI, N., COBAN, O., BOYNUKALIN, F. K., VOGEL, I., HOFFMANN, E., LIVI, C., LEVI-SETTI, P. E., UBALDI, F. M. & SIMON, C. 2021. Mosaic human preimplantation embryos and their developmental potential in a prospective, non-selection clinical trial. Am J Hum Genet, 108 , 2238-2247. COMMITTEE, E. P. C. S., CARVALHO, F., COONEN, E., GOOSSENS, V., KOKKALI, G., RUBIO, C., MEIJER-HOOGEVEEN, M., MOUTOU, C., VERMEULEN, N. & DE RYCKE, M. 2020. ESHRE PGT Consortium good practice recommendations for the organisation of PGT. Hum Reprod Open, 2020 , hoaa021. DAHDOUH, E. M., BALAYLA, J. & GARCIA-VELASCO, J. A. 2015. Impact of blastocyst biopsy and comprehensive chromosome screening technology on preimplantation genetic screening: a systematic review of randomized controlled trials. Reprod Biomed Online, 30 , 281-9. DOYLE, N., GAINTY, M., EUBANKS, A., DOYLE, J., HAYES, H., TUCKER, M., DEVINE, K., DECHERNEY, A., LEVY, M., JAHANDIDEH, S. & HILL, M. 2020. Donor oocyte recipients do not benefit from preimplantation genetic testing for aneuploidy to improve pregnancy outcomes. Hum Reprod, 35 , 2548-2555. FORMAN, E. J., HONG, K. H., FRANASIAK, J. M. & SCOTT, R. T., JR. 2014. Obstetrical and neonatal outcomes from the BEST Trial: single embryo transfer with aneuploidy screening improves outcomes after in vitro fertilization without compromising delivery rates. Am J Obstet Gynecol, 210 , 157 e1-6. FRAGOULI, E., ALFARAWATI, S., SPATH, K., JAROUDI, S., SARASA, J., ENCISO, M. & WELLS, D. 2013. The origin and impact of embryonic aneuploidy. Hum Genet, 132 , 1001-13. FRAGOULI, E., LENZI, M., ROSS, R., KATZ-JAFFE, M., SCHOOLCRAFT, W. B. & WELLS, D. 2008. Comprehensive molecular cytogenetic analysis of the human blastocyst stage. Hum Reprod, 23 , 2596-608. GARCIA-PASCUAL, C. M., NAVARRO-SANCHEZ, L., NAVARRO, R., MARTINEZ, L., JIMENEZ, J., RODRIGO, L., SIMON, C. & RUBIO, C. 2020. Optimized NGS Approach for Detection of Aneuploidies and Mosaicism in PGT-A and Imbalances in PGT-SR. Genes (Basel), 11. GARDNER, D. K., LANE, M., STEVENS, J., SCHLENKER, T. & SCHOOLCRAFT, W. B. 2000. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril, 73 , 1155-8. GELBAYA, T. A., TSOUMPOU, I. & NARDO, L. G. 2010. The likelihood of live birth and multiple birth after single versus double embryo transfer at the cleavage stage: a systematic review and meta-analysis. Fertil Steril, 94 , 936-45. GERBER, R. 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A., CORTI, L., FIORENTINO, F., SPINELLA, F., MINASI, M. G., GRECO, E. & MUNNE, S. 2021b. Using outcome data from one thousand mosaic embryo transfers to formulate an embryo ranking system for clinical use. Fertil Steril, 115 , 1212-1224. WU, H., ZHOU, P., LIN, X., WANG, S. & ZHANG, S. 2021. Endometrial preparation for frozen-thawed embryo transfer cycles: a systematic review and network meta-analysis. J Assist Reprod Genet, 38 , 1913-1926. YAN, J., QIN, Y., ZHAO, H., SUN, Y., GONG, F., LI, R., SUN, X., LING, X., LI, H., HAO, C., TAN, J., YANG, J., ZHU, Y., LIU, F., CHEN, D., WEI, D., LU, J., NI, T., ZHOU, W., WU, K., GAO, Y., SHI, Y., LU, Y., ZHANG, T., WU, W., MA, X., MA, H., FU, J., ZHANG, J., MENG, Q., ZHANG, H., LEGRO, R. S. & CHEN, Z. J. 2021. Live Birth with or without Preimplantation Genetic Testing for Aneuploidy. N Engl J Med, 385 , 2047-2058. ABEYTA, M. & BEHR, B. 2014. Morphological assessment of embryo viability. Semin Reprod Med, 32 , 114-26. ALFARAWATI, S., FRAGOULI, E., COLLS, P., STEVENS, J., GUTIERREZ-MATEO, C., SCHOOLCRAFT, W. B., KATZ-JAFFE, M. G. & WELLS, D. 2011. The relationship between blastocyst morphology, chromosomal abnormality, and embryo gender. Fertil Steril, 95 , 520-4. BEN-NAGI, J., JONES, B., NAJA, R., AMER, A., SUNKARA, S., SENGUPTA, S. & SERHAL, P. 2019. Live birth rate is associated with oocyte yield and number of biopsied and suitable blastocysts to transfer in preimplantation genetic testing (PGT) cycles for monogenic disorders and chromosomal structural rearrangements. Eur J Obstet Gynecol Reprod Biol X, 4 , 100055. COMMITTEE, E. P. C. S., CARVALHO, F., COONEN, E., GOOSSENS, V., KOKKALI, G., RUBIO, C., MEIJER-HOOGEVEEN, M., MOUTOU, C., VERMEULEN, N. & DE RYCKE, M. 2020. ESHRE PGT Consortium good practice recommendations for the organisation of PGT. Hum Reprod Open, 2020 , hoaa021. DAHDOUH, E. M., BALAYLA, J. & GARCIA-VELASCO, J. A. 2015. Impact of blastocyst biopsy and comprehensive chromosome screening technology on preimplantation genetic screening: a systematic review of randomized controlled trials. Reprod Biomed Online, 30 , 281-9. DOYLE, N., GAINTY, M., EUBANKS, A., DOYLE, J., HAYES, H., TUCKER, M., DEVINE, K., DECHERNEY, A., LEVY, M., JAHANDIDEH, S. & HILL, M. 2020. Donor oocyte recipients do not benefit from preimplantation genetic testing for aneuploidy to improve pregnancy outcomes. Hum Reprod, 35 , 2548-2555. FORMAN, E. J., HONG, K. H., FRANASIAK, J. M. & SCOTT, R. T., JR. 2014. Obstetrical and neonatal outcomes from the BEST Trial: single embryo transfer with aneuploidy screening improves outcomes after in vitro fertilization without compromising delivery rates. Am J Obstet Gynecol, 210 , 157 e1-6. FRAGOULI, E., ALFARAWATI, S., SPATH, K., JAROUDI, S., SARASA, J., ENCISO, M. & WELLS, D. 2013. The origin and impact of embryonic aneuploidy. Hum Genet, 132 , 1001-13. FRAGOULI, E., LENZI, M., ROSS, R., KATZ-JAFFE, M., SCHOOLCRAFT, W. B. & WELLS, D. 2008. Comprehensive molecular cytogenetic analysis of the human blastocyst stage. Hum Reprod, 23 , 2596-608. GARCIA-PASCUAL, C. M., NAVARRO-SANCHEZ, L., NAVARRO, R., MARTINEZ, L., JIMENEZ, J., RODRIGO, L., SIMON, C. & RUBIO, C. 2020. Optimized NGS Approach for Detection of Aneuploidies and Mosaicism in PGT-A and Imbalances in PGT-SR. Genes (Basel), 11. GARDNER, D. K., LANE, M., STEVENS, J., SCHLENKER, T. & SCHOOLCRAFT, W. B. 2000. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril, 73 , 1155-8. GELBAYA, T. A., TSOUMPOU, I. & NARDO, L. G. 2010. The likelihood of live birth and multiple birth after single versus double embryo transfer at the cleavage stage: a systematic review and meta-analysis. Fertil Steril, 94 , 936-45. GIULIANO, R., MAIONE, A., VALLEFUOCO, A., SORRENTINO, U. & ZUCCARELLO, D. 2023. Preimplantation Genetic Testing for Genetic Diseases: Limits and Review of Current Literature. Genes (Basel), 14. GRECO, E., LITWICKA, K., MINASI, M. G., CURSIO, E., GRECO, P. F. & BARILLARI, P. 2020. Preimplantation Genetic Testing: Where We Are Today. Int J Mol Sci, 21. KAMATH, M. S., MASCARENHAS, M., KIRUBAKARAN, R. & BHATTACHARYA, S. 2020. Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev, 8 , CD003416. KEMPER, J. M., WANG, R., ROLNIK, D. L. & MOL, B. W. 2020. Preimplantation genetic testing for aneuploidy: are we examining the correct outcomes? Hum Reprod, 35 , 2408-2412. MASTENBROEK, S., TWISK, M., VAN DER VEEN, F. & REPPING, S. 2011. Preimplantation genetic screening: a systematic review and meta-analysis of RCTs. Hum Reprod Update, 17 , 454-66. MINASI, M. G., COLASANTE, A., RICCIO, T., RUBERTI, A., CASCIANI, V., SCARSELLI, F., SPINELLA, F., FIORENTINO, F., VARRICCHIO, M. T. & GRECO, E. 2016. Correlation between aneuploidy, standard morphology evaluation and morphokinetic development in 1730 biopsied blastocysts: a consecutive case series study. Hum Reprod, 31 , 2245-54. MINASI, M. G., FIORENTINO, F., RUBERTI, A., BIRICIK, A., CURSIO, E., COTRONEO, E., VARRICCHIO, M. T., SURDO, M., SPINELLA, F. & GRECO, E. 2017. Genetic diseases and aneuploidies can be detected with a single blastocyst biopsy: a successful clinical approach. Hum Reprod, 32 , 1770-1777. NATSUAKI, M. N. & DIMLER, L. M. 2018. Pregnancy and child developmental outcomes after preimplantation genetic screening: a meta-analytic and systematic review. World J Pediatr, 14 , 555-569. NEAL, S. A., MORIN, S. J., FRANASIAK, J. M., GOODMAN, L. R., JUNEAU, C. R., FORMAN, E. J., WERNER, M. D. & SCOTT, R. T., JR. 2018. Preimplantation genetic testing for aneuploidy is cost-effective, shortens treatment time, and reduces the risk of failed embryo transfer and clinical miscarriage. Fertil Steril, 110 , 896-904. PAPANIKOLAOU, E. G., CAMUS, M., KOLIBIANAKIS, E. M., VAN LANDUYT, L., VAN STEIRTEGHEM, A. & DEVROEY, P. 2006. In vitro fertilization with single blastocyst-stage versus single cleavage-stage embryos. N Engl J Med, 354 , 1139-46. PRACTICE COMMITTEE OF THE AMERICAN SOCIETY FOR REPRODUCTIVE, M. & THE PRACTICE COMMITTEE FOR THE SOCIETY FOR ASSISTED REPRODUCTIVE TECHNOLOGIES. ELECTRONIC ADDRESS, A. A. O. 2021. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril, 116 , 651-654. PRACTICE COMMITTEES OF THE AMERICAN SOCIETY FOR REPRODUCTIVE, M., THE SOCIETY FOR ASSISTED REPRODUCTIVE TECHNOLOGY. ELECTRONIC ADDRESS, A. A. O., PRACTICE COMMITTEES OF THE AMERICAN SOCIETY FOR REPRODUCTIVE, M. & THE SOCIETY FOR ASSISTED REPRODUCTIVE, T. 2018. The use of preimplantation genetic testing for aneuploidy (PGT-A): a committee opinion. Fertil Steril, 109 , 429-436. SACCHI, L., ALBANI, E., CESANA, A., SMERALDI, A., PARINI, V., FABIANI, M., POLI, M., CAPALBO, A. & LEVI-SETTI, P. E. 2019. Preimplantation Genetic Testing for Aneuploidy Improves Clinical, Gestational, and Neonatal Outcomes in Advanced Maternal Age Patients Without Compromising Cumulative Live-Birth Rate. J Assist Reprod Genet, 36 , 2493-2504. SCOTT, R. T., JR., UPHAM, K. M., FORMAN, E. J., HONG, K. H., SCOTT, K. L., TAYLOR, D., TAO, X. & TREFF, N. R. 2013. Blastocyst biopsy with comprehensive chromosome screening and fresh embryo transfer significantly increases in vitro fertilization implantation and delivery rates: a randomized controlled trial. Fertil Steril, 100 , 697-703. SHI, Y., SUN, Y., HAO, C., ZHANG, H., WEI, D., ZHANG, Y., ZHU, Y., DENG, X., QI, X., LI, H., MA, X., REN, H., WANG, Y., ZHANG, D., WANG, B., LIU, F., WU, Q., WANG, Z., BAI, H., LI, Y., ZHOU, Y., SUN, M., LIU, H., LI, J., ZHANG, L., CHEN, X., ZHANG, S., SUN, X., LEGRO, R. S. & CHEN, Z. J. 2018. Transfer of Fresh versus Frozen Embryos in Ovulatory Women. N Engl J Med, 378 , 126-136. VANNESTE, E., MELOTTE, C., VOET, T., ROBBERECHT, C., DEBROCK, S., PEXSTERS, A., STAESSEN, C., TOMASSETTI, C., LEGIUS, E., D'HOOGHE, T. & VERMEESCH, J. R. 2011. PGD for a complex chromosomal rearrangement by array comparative genomic hybridization. Hum Reprod, 26 , 941-9. VIOTTI, M., VICTOR, A. R., BARNES, F. L., ZOUVES, C. G., BESSER, A. G., GRIFO, J. A., CHENG, E. H., LEE, M. S., HORCAJADAS, J. A., CORTI, L., FIORENTINO, F., SPINELLA, F., MINASI, M. G., GRECO, E. & MUNNE, S. 2021. Using outcome data from one thousand mosaic embryo transfers to formulate an embryo ranking system for clinical use. Fertil Steril, 115 , 1212-1224. YAN, J., QIN, Y., ZHAO, H., SUN, Y., GONG, F., LI, R., SUN, X., LING, X., LI, H., HAO, C., TAN, J., YANG, J., ZHU, Y., LIU, F., CHEN, D., WEI, D., LU, J., NI, T., ZHOU, W., WU, K., GAO, Y., SHI, Y., LU, Y., ZHANG, T., WU, W., MA, X., MA, H., FU, J., ZHANG, J., MENG, Q., ZHANG, H., LEGRO, R. S. & CHEN, Z. J. 2021. Live Birth with or without Preimplantation Genetic Testing for Aneuploidy. N Engl J Med, 385 , 2047-2058. Additional Declarations No competing interests reported. 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Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIie2PMQrCQBBFV1Y2zQ9pVyPmChsCQUHwIDaCkCqCYJNCxGqrYO0x9AaB4FbBOp2FYG0lVmpMZ5OkFNxXDcM8/h9CNJofhT6iFyyafGbea6aQjPY6cloqaKa0JB0JVSqkXnEm6dVeZAyeoqqbrwYgRnrcVynuKfDtXQT4is28UBXFEAR5pRITnyPj8M+xewlZoRRzjWLcuSkFPAmRhs8GilNUsk05hWBwL3PZQBHAcrjLEvDPL/MtB6v7xYmNQ36LkrElqbLD+7pvGamqTklIm39tWNV5mbIh9FZ3pNFoNH/OG6mNP+ZAomIZAAAAAElFTkSuQmCC","orcid":"","institution":"Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":true,"prefix":"","firstName":"Yicheng","middleName":"","lastName":"Wang","suffix":""},{"id":494850238,"identity":"acd78f94-50b9-4006-a63a-42678717771a","order_by":1,"name":"Xinting Yu","email":"","orcid":"","institution":"Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Xinting","middleName":"","lastName":"Yu","suffix":""},{"id":494850239,"identity":"2487136a-b55f-4346-a3c7-febba4f93eae","order_by":2,"name":"Yacong Wang","email":"","orcid":"","institution":"Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Yacong","middleName":"","lastName":"Wang","suffix":""},{"id":494850240,"identity":"0a49a957-aea6-4244-9aa2-5846315b3b4f","order_by":3,"name":"Wending Teng","email":"","orcid":"","institution":"Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Wending","middleName":"","lastName":"Teng","suffix":""},{"id":494850241,"identity":"ec6c570f-79b7-4842-8421-092f5a60aea9","order_by":4,"name":"Hong Xian","email":"","orcid":"","institution":"Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Xian","suffix":""},{"id":494850242,"identity":"34ccd3d7-aa99-44f3-ad64-11d735bf3153","order_by":5,"name":"Fang Wang","email":"","orcid":"","institution":"Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Fang","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-07-24 08:25:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7203090/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7203090/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00404-025-08225-x","type":"published","date":"2025-10-22T16:17:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88755751,"identity":"dc6e0790-a2f6-4940-8934-f9f9372088ad","added_by":"auto","created_at":"2025-08-11 07:13:18","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":257010,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy recruitment and results.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7203090/v1/752b95fb4c84c5b3daabf2ee.jpeg"},{"id":94490464,"identity":"101ffb6c-a51c-48e5-b44f-4728b0c68ca4","added_by":"auto","created_at":"2025-10-27 17:10:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1424793,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7203090/v1/6b8a6e15-ab1c-4742-b0b8-a935d9fca474.pdf"},{"id":88756574,"identity":"39b18810-d043-40ab-9dff-2c434d762250","added_by":"auto","created_at":"2025-08-11 07:21:18","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25512,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile.docx","url":"https://assets-eu.researchsquare.com/files/rs-7203090/v1/17a7701e04dadd06be2010eb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Live birth rates with and without preimplantation genetic testing: a single-center retrospective study","fulltext":[{"header":"What does this study adds to the clinical work","content":"\u003cp\u003eWe analyzed the effect of different types of PGT and different controlled ovarian hyperstimulation protocols and endometrial preparation protocols on live birth rates, respectively, using conventional IVF as a control.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003e\u003cem\u003eIn vitro\u003c/em\u003e fertilization (IVF) is an important assisted reproductive technology (ART), and the transfer of high-quality embryos in receptive endometrium is crucial for IVF (Greco et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Selection of the best embryos for transfer is a major challenge in the IVF process, especially in single embryo transfer strategies. The most common method of embryo selection is still based on morphological grading criteria (Abeyta and Behr, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2014\u003c/span\u003e, Minasi et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). However, there has been substantial evidence that abnormalities in embryonic genetic material are also a significant cause of IVF failure, and therefore preimplantation genetic testing (PGT) has been employed in the process of embryo selection (Committee et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Practice Committees of the American Society for Reproductive et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Ben-Nagi et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). PGT is a diagnostic procedure that analyses the embryonic genetic material in order to reduce the risk of abnormalities of the genetic material and to increase the likelihood of a successful pregnancy (Giuliano et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Until today, PGT has been developed in three ways: preimplantation genetic testing for aneuploidy (PGT-A), preimplantation genetic testing for monogenic disorders (PGT-M), and preimplantation genetic testing for structural rearrangements (PGT-SR), in order to improve the selection of embryos in different situations.\u003c/p\u003e\u003cp\u003eAs the combination of morphological criteria and PGT evaluates the embryos to be transferred from different latitudes, it has led to an elevated likelihood of successful pregnancies and a reduction in spontaneous abortions and genetically abnormal fetuses. However, it has been shown that invasive PGT manipulations may have a slight impact on embryo viability, and limitations in testing techniques can lead to false positives or false negatives (Giuliano et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e); PGT-A may miss the diagnosis of mosaic embryos and incorrectly assess the embryo's reproductive potential (Viotti et al., \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2021\u003c/span\u003eb); PGT-M is unable to diagnose mutations that are not recorded in the current analysis strategy (Vanneste et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2011\u003c/span\u003e); and the variability of chromosomal rearrangements significantly influences the complexity and accuracy of PGT-SR (Garcia-Pascual et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Each of these challenges has the potential to have an impact on the final assisted reproduction treatment outcome.\u003c/p\u003e\u003cp\u003e In order to assess the impact of PGT on IVF treatment outcomes in different patients, as well as to provide additional clinical data for PGT prognostic studies, this study reviewed the live birth rate of IVF combining morphological criteria and PGT at our center, and compared it with the live birth rate of conventional IVF based on morphological criteria only.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003e\u003cb\u003ePatients\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll couples presented to Chengdu Women's and Children's Central Hospital from 2021.01.01-2023.12.31 with a diagnosis of infertility and were scheduled for their first IVF cycle. Intracytoplasmic sperm injection (ICSI) is used for all fertilization procedures. Couples with three or more good quality blastocysts will be included in the study. Exclusion criteria included known uterine anomalies (e.g., congenital malformations of the uterus; untreated uterine septum, adenomyosis, or submucosal fibroids; endometrial polyps; or intrauterine adhesions), the presence of contraindications to pregnancy, or the use of donor oocytes or sperm to achieve pregnancy. All couples provided written informed consent on the day of oocyte retrieval. The study was approved by the Ethics Committee of Chengdu Women's and Children's Central Hospital (2020.5 IEC-C-V2.0 2020(12)).\u003c/p\u003e\u003cp\u003e\u003cb\u003eProcedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eControlled ovarian hyperstimulation protocols mainly consist of agonist long protocol, antagonist protocol or progestin-primed ovarian stimulation (PPOS) protocol (Shi et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The long protocol is a gonadotropin-releasing hormone (GnRH) agonist administered on the day 2 to day 4 of menstruation or in the mid-luteal phase of the previous cycle, and gonadotropins are started after satisfactory pituitary desensitization has been achieved; the antagonist protocol is gonadotropins from day 2 to 3 of the menstrual cycle, with concomitant GnRH antagonists when the follicle reaches 14 mm in diameter or when estrogen is more than 300 pg/ml; PPOS is the administration of exogenous progesterone from days 2 to 3 of the menstrual cycle, together with gonadotropins. When at least two follicles have an average diameter of 18 mm or more, clinicians use human chorionic gonadotropin (hCG), GnRH agonists, or both, to bring about the final maturation of the oocytes, which are then retrieved by transvaginal ultrasound after about 36 hours.\u003c/p\u003e\u003cp\u003eAll IVF procedures were performed using ICSI and all embryos were cultured to the blastocyst stage. According to the Gardner Morphological Criteria (Gardner et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2000\u003c/span\u003e), the blastocyst morphological score is based on three components: blastocyst expansion, inner cell mass and trophectoderm development, and blastocysts rated 4BC or higher on day 5 of embryo culture are considered to be high-quality blastocysts. Patients with three or more good quality blastocysts will be included in the study. In the PGT group, high-quality blastocysts screened by morphological criteria underwent trophoblast biopsy. All the embryos obtained were cryopreserved.\u003c/p\u003e\u003cp\u003eAll patients underwent a single frozen embryo transfer. The endometrial preparation protocols included down-regulation combined with hormone replacement cycles, hormone replacement cycles, ovulation induction cycles and natural ovulation cycles. An optimal blastocyst was selected for transfer in the PGT group by combining morphological criteria and biopsy results, and blastocysts were selected in the conventional IVF group only on the basis of morphological criteria. Pregnancy and live births were recorded in all patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe primary outcome was the live birth rate. Secondary outcomes included biochemical pregnancy rate, clinical pregnancy rate, miscarriage rate and multiple pregnancy rate. Subgroup analyses were performed according to controlled ovarian hyperstimulation protocols, endothelial preparation protocols and age of the woman.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eContinuous baseline characteristics of patients were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), and differences between groups were compared by the Wilcoxon rank sum test owing to the non-normality of the variables. Categorical variables were expressed in the form of percentages and compared by the chi-square test. Effect sizes for differences in categorical variables were reported using odds ratios (ORs), and 95% confidence intervals (CIs) for ORs were calculated using the Baptista-Pike method. Couples lost to follow-up were not included in the final statistics. Statistical significance was defined as two-sided p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All statistical analyses were performed using SPSS 19.0 software.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003e1. Baseline characteristics of included patients\u003c/b\u003e\u003c/p\u003e\u003cp\u003eInitially, 422 couples who met the criteria and were willing to participate in the study were screened, 230 couples underwent PGT cycles and 192 couples underwent conventional IVF cycles. In the PGT group, 11 (4.78%) couples withdrew from the study due to failure to undergo implantation or loss to follow-up, whereas, in the IVF group, 2 (1.04%) couples withdrew from the study due to loss to follow-up. Ultimately, 219 couples were included in the PGT group, of which 87 were PGT-A, 22 were PGT-M, and 110 were PGT-SR, and 190 couples were included in the IVF group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eCouples in the PGT group had higher age and years of infertility than in the IVF group, while endometrial thickness on the day of transplantation was lower than in the IVF group. The weeks of pregnancy were similar in both groups. During the controlled ovarian hyperstimulation phase, more women (62.56%) in the PGT group preferred the PPOS protocol, whereas more women (56.32%) in the IVF group chose the antagonist protocol. During endometrial preparation, both groups underwent down-regulation combined with hormone replacement cycle in the highest number of women (77.63% and 61.58% in the PGT and IVF groups, respectively) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eBaseline characteristics of included patients.\u003c/b\u003e \u0026ldquo;a\u0026rdquo; means p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. IVF, \u0026ldquo;b\u0026rdquo; means p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. PGT-SR, \u0026ldquo;c\u0026rdquo; means p\u0026thinsp;\u0026lt;\u0026thinsp;0.05vs. PGT-M.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003ePGT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eConventional IVF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePGT-A\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePGT-M\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePGT-SR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eNumber of cases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e190\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAge of women (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e32.90\u0026thinsp;\u0026plusmn;\u0026thinsp;4.61\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e31.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.36\u0026thinsp;\u0026plusmn;\u0026thinsp;4.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAge of men (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e35.08\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e33.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.76\u0026thinsp;\u0026plusmn;\u0026thinsp;6.03\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.05\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eYears of infertility (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e3.038\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e4.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.81\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eControlled ovarian hyperstimulation protocols\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eagonist long protocol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eantagonist protocol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePPOS protocol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEndometrial preparation protocols\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003edown-regulation combined with hormone replacement cycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ehormone replacement cycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eovulation induction cycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003enatural ovulation cycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eEndometrial thickness (mm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e9.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e10.46\u0026thinsp;\u0026plusmn;\u0026thinsp;5.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eWeeks of pregnancy (weeks)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e37.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e37.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e2. Primary and secondary outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results and their corresponding odds ratios and p-values are displayed in Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The live birth rate in the PGT group (46.12%) was significantly higher than that in the conventional IVF group (34.74%) (p\u0026thinsp;=\u0026thinsp;0.0195, OR 0.6218, 95% CI 0.4161\u0026ndash;0.9189). Among them, the live birth rate in the PGT-A subgroup (48.28%) was significantly higher than that in the IVF group (p\u0026thinsp;=\u0026thinsp;0.032, OR 0.5703, 95% CI 0.3380\u0026ndash;0.9610); and the live birth rates in the PGT-M and PGT-SR subgroups (45.45% and 44.55%, respectively), although higher than that in the IVF group, were not statistically different (p\u0026thinsp;=\u0026thinsp;0.321, OR 0.6387, 95% CI 0.2776\u0026ndash;1.577 and p\u0026thinsp;=\u0026thinsp;0.0922, OR 0.6626, 95% CI 0.4096\u0026ndash;1.074, respectively); live birth rates did not differ between the three PGT subgroups. In addition, the PGT group and PGT-A subgroups (30.82% and 25.00%, respectively) had lower miscarriage rates compared to the IVF group (42.61%) (p\u0026thinsp;=\u0026thinsp;0.0489, OR 1.666, 95% CI 1.005\u0026ndash;2.787 and p\u0026thinsp;=\u0026thinsp;0.0251, OR 2.227, 95% CI 1.077\u0026ndash;4.648, respectively); the PGT-M and PGT-SR subgroups (37.50% and 33.78%, respectively) had lower miscarriage rates than the IVF group, but were still not statistically different (p\u0026thinsp;=\u0026thinsp;0.6981, OR 1.237, 95% CI 0.4491\u0026ndash;3.697 and p\u0026thinsp;=\u0026thinsp;0.225, OR 1.455, 95% CI 0.7929\u0026ndash;2.647, respectively); miscarriage rates did not differ between the three PGT subgroups. Biochemical, clinical and multiple pregnancy rates did not differ significantly between groups and subgroups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003ePrimary and secondary outcomes.\u003c/b\u003e \u0026ldquo;a\u0026rdquo; means p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. IVF.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003ePGT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eConventional IVF\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePGT-A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePGT-M\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePGT-SR\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eLive birth rate\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e% (n)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e46.12%(101/219)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e34.74%(66/190)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48.28%(42/87)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.45%(10/22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.55%(49/110)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eBiochemical pregnancy rate\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e% (n)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e79.91%(175/219)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e74.21%(141/190)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.86%(66/87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90.91%(20/22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80.91%(89/110)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eClinical pregnancy rate\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e% (n)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e66.67%(146/219)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e60.53%(115/190)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64.37%(56/87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.73%(16/22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67.27%(74/110)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMiscarriage rate\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e% (n)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e30.82%(45/146)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e42.61%(49/115)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.00%(14/56)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.50%(6/16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.78%(25/74)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMultiple pregnancy rate\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e% (n)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e4.11%(6/146)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e2.61%(3/115)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.36%(3/56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.25%(1/16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.70%(2/74)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOdds ratios and p-values for comparisons between groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"13\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003ePGT vs. IVF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003ePGT-A vs. IVF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e\u003cp\u003ePGT-M vs. IVF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e\u003cp\u003ePGT-SR vs. IVF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLive birth rate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.6218(0.4161\u0026ndash;0.9189)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.0195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.5703(0.3380\u0026ndash;0.9610)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.6387(0.2776\u0026ndash;1.577)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.321\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e0.6626(0.4096\u0026ndash;1.074)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.0922\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBiochemical pregnancy rate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.7235(0.4594\u0026ndash;1.164)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.1703\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.9156(0.5100\u0026ndash;1.667)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.7691\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.2878(0.06474-1.187)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.0828\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e0.6790(0.3870\u0026ndash;1.201)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.1862\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eClinical pregnancy rate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.7667(0.5104\u0026ndash;1.149)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.1975\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.8488(0.5017\u0026ndash;1.438)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.5415\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.5750(0.2209\u0026ndash;1.542)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.2649\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e0.7459(0.4559\u0026ndash;1.223)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.2435\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMiscarriage rate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.666(1.005\u0026ndash;2.787)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.0489\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e2.227(1.077\u0026ndash;4.648)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.0251\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.237(0.4491\u0026ndash;3.697)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.6981\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e1.455(0.7929\u0026ndash;2.647)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.225\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMultiple pregnancy rate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.6250(0.1685\u0026ndash;2.404)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.5094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.4732(0.1082-2.090)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.3593\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.4018(0.05726-5.539)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.4277\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e0.9643(0.1931\u0026ndash;5.539)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.9686\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePGT-A vs. PGT-SR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003e\u003cb\u003ePGT-M vs. PGT-SR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c13\" namest=\"c10\"\u003e\u003cp\u003e\u003cb\u003ePGT-A vs. PGT-M\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLive birth rate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1.162(0.6498\u0026ndash;2.026)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.602\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1.037(0.3986\u0026ndash;2.522)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.9376\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.8929(0.3308\u0026ndash;2.253)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e0.8129\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBiochemical pregnancy rate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1.348(0.6824\u0026ndash;2.665)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.3904\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e2.360(0.5759\u0026ndash;10.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.259\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e3.182(0.7652-14.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e0.1223\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eClinical pregnancy rate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.8788(0.4850\u0026ndash;1.605)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.6691\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1.297(0.4956\u0026ndash;3.582)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.6161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e1.476(0.5437\u0026ndash;4.181)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e0.4594\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMiscarriage rate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.6533(0.3091\u0026ndash;1.383)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.2792\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1.176(0.3652\u0026ndash;3.535)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.7767\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e1.800(0.5066\u0026ndash;6.214)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e0.3249\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMultiple pregnancy rate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2.038(0.4024\u0026ndash;11.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.4358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e2.400(0.1560\u0026ndash;21.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.4735\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e1.178(0.08549-8.382)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e0.8906\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3. Subgroup analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe categorized all patients into three subgroups according to different controlled ovarian hyperstimulation protocols: agonist long protocol, antagonist protocol, and PPOS protocol. Similarly, we categorized all patients into four subgroups according to different endometrial preparation protocols: down-regulation combined with hormone replacement cycle, hormone replacement cycle, ovulation induction cycle and natural ovulation cycle four subgroups. We then analyzed the live birth rates among the subgroups (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Supplementary Table\u0026nbsp;1 and Supplementary Table\u0026nbsp;2).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eLive birth rate in subgroup analysis.\u003c/b\u003e \u0026ldquo;a\u0026rdquo; means p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. IVF, \u0026ldquo;*\u0026rdquo; means p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. agonist long protocol, \u0026ldquo;#\u0026rdquo; means p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. down-regulation combined with hormone replacement cycle.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003ePGT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eConventional IVF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePGT-A\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePGT-M\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePGT-SR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eControlled ovarian hyperstimulation protocols\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eagonist long protocol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e50.00%(23/46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e40.63%(26/64)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52.94%(9/17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.00%(2/4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.00%(12/25)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eantagonist protocol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e52.78%(19/36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e34.58%(37/107)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42.86%(6/14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.00%(1/2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60.00%(12/20)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePPOS protocol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e43.07%(59/137)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e15.79%(3/19)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48.21%(27/56)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.75%(7/16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.46%(25/65)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEndometrial preparation protocols\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003edown-regulation combined with hormone replacement cycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e47.65%(81/170)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e29.06%(34/117)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51.39%(37/72)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.00%(9/18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.75%(35/80)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ehormone replacement cycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e33.33%(2/6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0%(0/2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.00%(1/4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%(0/0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.00%(1/2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eovulation induction cycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e0%(0/3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e50.00%(2/4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0%(0/1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%(0/0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%(0/2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003enatural ovulation cycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e45.00%(18/40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e44.78%(30/67)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40.00%(4/10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.00%(1/4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.00%(13/26)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the patients of down-regulation combined with hormone replacement cycle, the live birth rate was significantly higher in the PGT group (47.65%) than in the IVF group (29.06%) (p\u0026thinsp;=\u0026thinsp;0.0016, OR 0.4501, 95% CI 0.2701\u0026ndash;0.7443); the PGT-A and PGT-SR subgroups (51.39% and 43.75%, respectively) also had significantly higher live birth rates than the IVF group (p\u0026thinsp;=\u0026thinsp;0.0021, OR 0.3875, 95% CI 0.2137\u0026ndash;0.7217 and p\u0026thinsp;=\u0026thinsp;0.0338, OR 0.5267, 95% CI 0.2863\u0026ndash;0.9575, respectively). In the patients undergoing conventional IVF, the live birth rate was significantly higher in the natural ovulation cycle (44.78%) than in the down-regulation combined with hormone replacement cycle (29.06%) (p\u0026thinsp;=\u0026thinsp;0.0313, OR 0.5052, and 95% CI 0.2726\u0026ndash;0.9318). The other significant results should be referred to with caution in our opinion because the sample size was too low.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUntil today, selecting the best embryos for transfer remains a major challenge for IVF, especially when clinicians choose the single embryo transfer (SET) protocol for a variety of different reasons (Greco et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). There have been randomized controlled trials and Meta-analyses confirming the poor clinical outcomes of SET (Kamath et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Gelbaya et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2010\u003c/span\u003e); whereas multiple embryo transfer is often used to increase embryo implantation rates in clinical practice, but this regimen increases the risk of multiple pregnancies (Fragouli et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2008\u003c/span\u003e, Alfarawati et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). It is still widely recognized that the morphology of the embryo is closely related to its ability to survive and develop during conventional IVF (Abeyta and Behr, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2014\u003c/span\u003e, Minasi et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Although culturing embryos to the blastocyst stage has been proven to improve clinical outcomes in SET (Papanikolaou et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2006\u003c/span\u003e), morphologically normal blastocysts are still at risk of abnormal genetic material (Minasi et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Forman et al., 2014, Fragouli et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Therefore, three PGT techniques have been introduced for assisted embryo selection with the expectation that they improve assisted reproductive outcomes (Mastenbroek et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn our single-center retrospective cohort study, a total of 409 couples were included in the statistics, all women underwent a single frozen embryo transfer, and we only counted the clinical outcomes of the first embryo transfer. The results showed that the live birth rate of PGT was higher than that of conventional IVF, in which the live birth rate of PGT- A was also higher than that of conventional IVF, although the live birth rates of PGT-M and PGT-SR did not differ from those of conventional IVF, but were numerically higher. In addition, PGT and PGT-A had lower miscarriage rates compared to conventional IVF. However, biochemical pregnancy rate, clinical pregnancy rate and multiple pregnancy rate did not differ between groups.\u003c/p\u003e\u003cp\u003eWhether PGT-A can improve the live birth rate of patients is still a controversial topic until now. At first, PGT-A was thought to increase the live birth rate of embryos in a single transfer (Scott et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), reduce the risk of multiple births (Practice Committee of the American Society for Reproductive and the Practice Committee for the Society for Assisted Reproductive Technologies. Electronic address, 2021), decrease the risk of early pregnancy and shorten the duration of pregnancy (Neal et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Early clinical trials and meta-analyses also support this view (Dahdouh et al., 2015, Natsuaki and Dimler, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). However, in recent years, more and more counter-arguments have begun to emerge. Early studies often analyzed live birth rates on the basis of a single embryo transfer when patients had high-quality blastocysts (Scott et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2013\u003c/span\u003e, Neal et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Sacchi et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), and these studies are considered to have subjectively excluded from the analysis cycles with fewer embryos, poorer embryo quality, no blastocysts, and no transferable embryos, invisibly overstating the effect of PGT-A on the live birth rate (Kemper et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). More and more studies have begun to report that the cumulative live birth rate is the reasonable metric to assess the utility of PGT-A (Kemper et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Doyle et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Yan et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), and that PGT-A did not improve the cumulative live birth rate in patients (Rubio et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Verpoest et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Munne et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, Ozgur et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In our study, both the PGT group and the conventional IVF group included only patients with excellent blastocyst quality in an attempt to reduce selection bias, but the results still favored PGT-A. There are two main possible reasons. First, because of the short period of time that PGT has been conducted in our center, it resulted in our inability to count the cumulative live birth rate, and we still used the live birth rate of a single transfer as the outcome indicator. Second, we did not transfer mosaic embryos, which may have had an impact on the final outcome. Some studies have shown that transferring mosaic embryos increases the rate of implantation failure and miscarriage despite the chance of a healthy delivery (Capalbo et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, Munne et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Lin et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Viotti et al., \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2021\u003c/span\u003ea). For safety reasons, no mosaic embryos were transferred in our study.\u003c/p\u003e\u003cp\u003eThere are very few studies on the effect of PGT-M and PGT-SR on live birth rates; after all, their own purpose is to avoid the transmission of abnormal genetic material, not to improve the live birth rates of patients. A few studies have shown that PGT-M and PGT-SR do not have a significant effect on the live birth rate; rather, the live birth rate of patients with PGT-M or PGT-SR is more closely related to the patient's own age, endocrine status, oocyte quality and embryo quality (Shetty et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Insogna et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, Ben-Nagi et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, Van Der Kelen et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In our study, due to the small number of patients in the PGT-M subgroup, the statistical results are not representative of the patient population and thus need to be considered with caution. However, it is reasonable that patients with PGT-SR did not have a significant profit in live birth rate.\u003c/p\u003e\u003cp\u003eIn our secondary outcomes, PGT-A significantly reduced the miscarriage rate in patients, which seems to be in line with the current aim of using PGT-A technique (Scott et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2013\u003c/span\u003e, Practice Committee of the American Society for Reproductive and the Practice Committee for the Society for Assisted Reproductive Technologies. Electronic address, 2021, Neal et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). However, biochemical pregnancy rates, clinical pregnancy rates, and multiple pregnancy rates did not differ between PGT and conventional IVF, and perhaps the effect of PGT on pregnancy is not limited to early pregnancies (Yan et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), but is also reflected in ongoing pregnancies.\u003c/p\u003e\u003cp\u003eWe also subgrouped patients by different controlled ovarian hyperstimulation protocols and endometrial preparation protocols. Our results showed that when the PPOS protocol was used, the live birth rate in the PGT group and PGT-A subgroup would be higher than that in the conventional IVF group, and among patients undergoing conventional IVF, a higher live birth rate would be obtained with the agonist long protocol than with the PPOS protocol. Unfortunately, however, too few patients in the conventional IVF group used the PPOS protocol, resulting in these results having to be taken into account very carefully. It has been reported in the literature that in fresh transplantation cycles, the agonist long protocol can indeed be advantageous in terms of live birth rate (Li et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), and that a low GN dose is more favorable to improve the live birth rate of patients (Gerber et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), but in frozen transplantation cycles, the effect of different controlled ovarian hyperstimulation protocols do not seem to have as pronounced an effect on the live birth rate (Gerber et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The effect of the endometrial preparation protocol on the live birth rate of patients appears to be more pronounced for frozen transplantation cycles. Previous studies have shown that down-regulation combined with hormone replacement cycle and hormone replacement cycle are associated with significantly lower live birth rates and patients are at a higher risk of gestational hypertension, postpartum hemorrhage, and preterm labor; in contrast, the natural ovulation cycle resulted in optimal pregnancy outcomes (Wu et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This is also consistent with our results, but the number of patients who chose the ovulation induction cycle was too small for the current study to give constructive conclusions. However, it is interesting to note that in the group of patients who chose down-regulation combined with hormone replacement cycle, the live birth rate of PGT was significantly higher than that of the conventional IVF group, which has not been reported before. We believe that this is likely to be related to male factors.\u003c/p\u003e\u003cp\u003eThere are certain limitations to our study. The first and foremost is the insufficient sample size. The small sample size resulted in a restrictive interpretation of many of the results in the subgroup analyses. Similarly, because of the small sample size, this study did not further differentiate between age groups for subgroup analysis. Second, due to the relatively short period of time that PGT has been conducted in our center, the cumulative live birth rate was not adopted as the primary outcome in this study, which may have potentially inflated the contribution of PGT to the live birth rate. In addition, the baseline characteristics of the patients were not consistent, and it is good to note that we do not believe this had a significant impact on our results. These issues are expected to be improved in future large studies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003eART\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003eassisted reproductive technology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003econfidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003eGnRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003egonadotropin-releasing hormone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003ehCG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003ehuman chorionic gonadotropin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003eICSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003eintracytoplasmic sperm injection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003eIVF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cem\u003ein vitro\u003c/em\u003e fertilization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003eodds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003ePGT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003epreimplantation genetic testing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003ePGT-A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003epreimplantation genetic testing for aneuploidy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003ePGT-M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003epreimplantation genetic testing for monogenic disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003ePGT-SR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003epreimplantation genetic testing for structural rearrangements\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003ePPOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003eprogestin-primed ovarian stimulation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003eSET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003esingle embryo transfer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50%;\"\u003e\n \u003cp\u003estandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYicheng Wang and Xinting Yu contributed equally to this research. Yicheng Wang and Xinting Yu participated in\u0026nbsp;Data curation, Formal analysis, Funding acquisition, Roles/Writing - original draft, and Writing - review \u0026amp; editing. Yacong Wang, Wending Teng and Hong Xian participated in Investigation, Methodology, Resources, and Software. Fang Wang participated in\u0026nbsp;Conceptualization, Investigation, and Resources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge support from the National Natural Science Foundation of China (82401912) and Natural Science Foundation of Sichuan Province (2024NSFSC1677).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are openly available at https://pan.quark.cn/s/343d7cac932a.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eABEYTA, M. \u0026amp; BEHR, B. 2014. 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Blastocyst biopsy with comprehensive chromosome screening and fresh embryo transfer significantly increases in vitro fertilization implantation and delivery rates: a randomized controlled trial. \u003cem\u003eFertil Steril,\u003c/em\u003e 100\u003cstrong\u003e,\u003c/strong\u003e 697-703.\u003c/li\u003e\n\u003cli\u003eSHI, Y., SUN, Y., HAO, C., ZHANG, H., WEI, D., ZHANG, Y., ZHU, Y., DENG, X., QI, X., LI, H., MA, X., REN, H., WANG, Y., ZHANG, D., WANG, B., LIU, F., WU, Q., WANG, Z., BAI, H., LI, Y., ZHOU, Y., SUN, M., LIU, H., LI, J., ZHANG, L., CHEN, X., ZHANG, S., SUN, X., LEGRO, R. S. \u0026amp; CHEN, Z. J. 2018. Transfer of Fresh versus Frozen Embryos in Ovulatory Women. \u003cem\u003eN Engl J Med,\u003c/em\u003e 378\u003cstrong\u003e,\u003c/strong\u003e 126-136.\u003c/li\u003e\n\u003cli\u003eVANNESTE, E., MELOTTE, C., VOET, T., ROBBERECHT, C., DEBROCK, S., PEXSTERS, A., STAESSEN, C., TOMASSETTI, C., LEGIUS, E., D\u0026apos;HOOGHE, T. \u0026amp; VERMEESCH, J. R. 2011. PGD for a complex chromosomal rearrangement by array comparative genomic hybridization. \u003cem\u003eHum Reprod,\u003c/em\u003e 26\u003cstrong\u003e,\u003c/strong\u003e 941-9.\u003c/li\u003e\n\u003cli\u003eVIOTTI, M., VICTOR, A. R., BARNES, F. L., ZOUVES, C. G., BESSER, A. G., GRIFO, J. A., CHENG, E. H., LEE, M. S., HORCAJADAS, J. A., CORTI, L., FIORENTINO, F., SPINELLA, F., MINASI, M. G., GRECO, E. \u0026amp; MUNNE, S. 2021. Using outcome data from one thousand mosaic embryo transfers to formulate an embryo ranking system for clinical use. \u003cem\u003eFertil Steril,\u003c/em\u003e 115\u003cstrong\u003e,\u003c/strong\u003e 1212-1224.\u003c/li\u003e\n\u003cli\u003eYAN, J., QIN, Y., ZHAO, H., SUN, Y., GONG, F., LI, R., SUN, X., LING, X., LI, H., HAO, C., TAN, J., YANG, J., ZHU, Y., LIU, F., CHEN, D., WEI, D., LU, J., NI, T., ZHOU, W., WU, K., GAO, Y., SHI, Y., LU, Y., ZHANG, T., WU, W., MA, X., MA, H., FU, J., ZHANG, J., MENG, Q., ZHANG, H., LEGRO, R. S. \u0026amp; CHEN, Z. J. 2021. Live Birth with or without Preimplantation Genetic Testing for Aneuploidy. \u003cem\u003eN Engl J Med,\u003c/em\u003e 385\u003cstrong\u003e,\u003c/strong\u003e 2047-2058.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Preimplantation genetic testing, Live birth rate, In vitro fertilization","lastPublishedDoi":"10.21203/rs.3.rs-7203090/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7203090/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEmbryo selection and preimplantation genetic testing (PGT) are used in clinical practice with the aim of improving pregnancy outcomes in patients. However, it remains uncertain whether different PGT techniques improve the live birth rate in patients compared to conventional \u003cem\u003ein vitro\u003c/em\u003e fertilization (IVF).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eIn this single-center retrospective cohort study, we included couples undergoing their first IVF-assisted conception cycle with only their first single frozen embryo transfer. All couples were fertilized by intracytoplasmic sperm injection (ICSI) and had three or more high-quality blastocysts on the fifth day of embryo culture. The PGT group screened the optimal blastocysts for transfer by their counterpart technique, while the conventional IVF group selected blastocysts based on morphological criteria. The primary outcome was to observe the live birth rate in each group.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 409 couples were enrolled in the study, of which 219 were in the PGT group, 87 were PGT-A, 22 were PGT-M, 110 were PGT-SR, and 190 were in the IVF group. The live birth rate was higher in the PGT group (46.12%) compared to that of the conventional IVF group (34.74%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0195, OR 0.6218, 95% CI 0.4161\u0026ndash;0.9189). The live birth rate in the PGT-A subgroup (48.28%) was also higher than that in the IVF group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032, OR 0.5703, 95% CI 0.3380\u0026ndash;0.9610). Different controlled ovarian hyperstimulation protocols and endometrial preparation protocols had no effect on the live birth rate of PGT.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eCompared to conventional IVF, PGT, especially PGT-A, has the ability to increase the live birth rate in patients. Different controlled ovarian hyperstimulation protocols and endometrial preparation protocols had no effect on the live birth rate of PGT.\u003c/p\u003e","manuscriptTitle":"Live birth rates with and without preimplantation genetic testing: a single-center retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-11 07:13:13","doi":"10.21203/rs.3.rs-7203090/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-15T15:50:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-14T15:51:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-13T10:15:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300613974590425061442600518562936898717","date":"2025-08-11T13:17:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232261659245175157442134892398800248734","date":"2025-08-03T08:05:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-03T06:29:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-28T21:35:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-24T16:38:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Gynecology and Obstetrics","date":"2025-07-24T08:04:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a08bcc72-6d79-4240-8a1a-8176d1a8f8ad","owner":[],"postedDate":"August 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T16:26:53+00:00","versionOfRecord":{"articleIdentity":"rs-7203090","link":"https://doi.org/10.1007/s00404-025-08225-x","journal":{"identity":"archives-of-gynecology-and-obstetrics","isVorOnly":false,"title":"Archives of Gynecology and Obstetrics"},"publishedOn":"2025-10-22 16:17:00","publishedOnDateReadable":"October 22nd, 2025"},"versionCreatedAt":"2025-08-11 07:13:13","video":"","vorDoi":"10.1007/s00404-025-08225-x","vorDoiUrl":"https://doi.org/10.1007/s00404-025-08225-x","workflowStages":[]},"version":"v1","identity":"rs-7203090","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7203090","identity":"rs-7203090","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}