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A clinical predictive model for live birth in women of advanced age undergoing PGT cycles

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The trend of delaying childbirth has resulted in a growing number of advanced-aged women who are opting for preimplantation genetic testing (PGT) to screen for monogenic diseases or structural chromosomal rearrangements (PGT-M and PGT-SR). This increase in demand necessitates the development of a clinical predictive model for live birth outcomes in these women. Therefore, the objective of this study is to construct a comprehensive predictive model that assesses the likelihood of achieving a successful live birth in advanced-aged women undergoing PGT-M and PGT-SR treatments.

Methods

A retrospective cohort study of 37–45-year-old women undergoing preimplantation genetic testing for monogenic disease or structural chromosomal rearrangement cycles from 2010 to 2021 was conducted at a university hospital reproductive centre. The purpose was to develop a clinical predictive model for live birth in these women. The main outcome studied was the cumulative live birth rate in the first or subsequent cycles. Developing a decision tree enabled a comprehensive study of clinical parameters and expected outcomes.

Results

The analysis included 158 women undergoing 753 preimplantation genetic testing cycles. The cumulative live birth rate was 37.342% (59/158). Decision tree analysis revealed that women aged ≤ 40.1 or women > 40.1 with one or more top-quality transferable embryos in their first cycle had the best chance for a live baby (56% and 41%, respectively). Those older than 40.1 without top-quality embryos and seven or fewer dominant follicles had no live births. A Kaplan–Meier curve showed that for autosomal dominant diseases, there was a negligible increase in live birth rate after three cycles, compared to six cycles in autosomal recessive inheritance.

Conclusion

In older women, the chance of delivering after repeated cycles is higher in those with at least one top-quality unaffected embryo in their first preimplantation genetic testing cycle. Additional preimplantation genetic testing cycles after three in carriers of an autosomal dominant disorder and six in those with an autosomal recessive disorder should be considered prudently.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

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Funding

The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.

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Authors and Affiliations

  1. Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel

    Or Bercovich

  2. Racine In Vitro Fertilization Unit, Lis Maternity Hospital, Soraski Medical Centre, Tel Aviv, Israel

    Or Bercovich, Galia Klar, Talya Shaulov, Benny Almog, Yael Kalma, Roni Rahav, Foad Azem, Mira Malcov & Yoni Cohen

  3. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Or Bercovich, Galia Klar, Talya Shaulov, Benny Almog, Yael Kalma, Roni Rahav, Foad Azem, Mira Malcov & Yoni Cohen

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  1. Or Bercovich
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  2. Galia Klar
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  3. Talya Shaulov
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  4. Benny Almog
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  7. Foad Azem
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  8. Mira Malcov
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  9. Yoni Cohen
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Contributions

OB: data collection, data analysis, data interpretation and writing of the manuscript. GK: data collection, data interpretation. TS: manuscript revision. BA: study design, manuscript revision and final approval. YK: data collection, manuscript revision and final approval. RR: manuscript revision. FA: manuscript revision and final approval. MM: data collection, study design and manuscript revision. YC: study design, writing of the manuscript, manuscript revision and final approval.

Corresponding author

Correspondence to Or Bercovich.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

The protocol of this retrospective study was approved by the institutional review board of the Tel Aviv Soraski Medical Centre’s ethics committee (0149-20-TLV).

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Bercovich, O., Klar, G., Shaulov, T. et al. A clinical predictive model for live birth in women of advanced age undergoing PGT cycles. Arch Gynecol Obstet 309, 1083–1090 (2024). https://doi.org/10.1007/s00404-023-07329-6

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  • DOI: https://doi.org/10.1007/s00404-023-07329-6

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