Single best euploid versus single best unknown-ploidy blastocyst frozen embryo transfers: a randomized controlled trial

PurposeThis paper aims to investigate the efficacy of IVF with preimplantation genetic testing for aneuploidy (PGT-A), using only best-scoring blastocysts from young (35years) infertile patients undergoing single blastocyst frozen embryo transfers (FET).MethodIn this randomized controlled trial (RCT) registered 29 March 2017, 302 infertile patient-couples eligible to participate underwent autologous ICSI blastocyst freeze-all cycles. Two-hundred and twenty patient-couples satisfied the inclusion criteria (i.e., female age35years, two-day 52BB blastocysts) and were randomized to either the PGT-A (PGT-A group, n=109) selection arm or morphology score (morphology group, n=111) selection arm. In both arms, the highest ranking (by morphological score) blastocysts were selected for FET.ResultsOf the 109 best-scoring blastocysts that underwent PGT-A, 80 were predicted to be euploid (73.4%) and were transferred in FET (euploid subgroup). There was no statistical difference in LB rate between the euploid subgroup and morphology group (56.3% vs 58.6%, odds ratio 0.91 (95% CI 0.51-1.63), p=0.750). In a multiple logistic regression, the transfer of euploid blastocysts was not found to be a significant predictor of LB when adjusting for female age, infertility duration, antral follicle count, and blastocyst quality, with the independent odds expressed as 0.91 (95% CI 0.50-1.66, p=0.760).ConclusionIn young (35years) infertile patients with at least two 2BB blastocysts, PGT-A blastocyst selection does not result in an enhanced LB rate, with the evidence suggesting that the effectivity of PGT-A may be limited by the effectivity of TE biopsy.Trial registration: ClinicalTrials.gov ID: NCT03095053.