Image 1_Cumulative live birth following preimplantation genetic testing for aneuploidy versus conventional IVF/ICSI in unexplained recurrent pregnancy loss: a retrospective cohort study with intention-to-treat and per-protocol analyses.tif

The primary outcome was CLBR per oocyte retrieval.</p>Results<p>In the ITT population, unadjusted CLBR was comparable (48.5% vs 47.4%, P = 0.779) and remained non-significant after adjustment (aOR 0.862, 95% CI 0.591–1.255, P = 0.437). In the PP population, neither first-transfer live birth (63.8% vs 58.3%, P = 0.272; aOR 0.942, P = 0.814) nor CLBR (75.1% vs 69.6%, P = 0.230; aOR 0.858, P = 0.595) differed significantly.

Age and prior miscarriage number did not significantly modify the treatment–CLBR association (age: ITT P = 0.871, PP P = 0.071; miscarriage number: ITT P = 0.695, PP P = 0.289; both miscarriage-number tests were exploratory owing to limited propensity-score overlap in the >2-miscarriage stratum). Among women aged ≥35 years, ITT CLBR did not differ (33.6% vs 29.7%, P = 0.534; aOR 0.846, 95% CI 0.447–1.603, P = 0.608). Unadjusted PP outcomes favored PGT-A among women aged ≥35 years and those with exactly two prior miscarriages, but no adjusted differences remained significant after Bonferroni correction, except first-transfer clinical pregnancy in the ≥35-year stratum, which requires cautious interpretation.

Miscarriage rates did not differ significantly between groups; no statistically significant perinatal differences were observed in this sample (166 vs 117 deliveries).</p>Conclusions<p>PGT-A did not improve CLBR per oocyte retrieval in women with uRPL and should not be routinely recommended. Unadjusted PP subgroup advantages are more plausibly attributable to embryo attrition and residual confounding than true benefit and require prospective confirmation.</p>