The effect of preimplantation genetic testing for aneuploidy (PGT-A) on obstetric and neonatal outcomes: a systematic review and meta-analysis

Are pregnancies after preimplantation genetic testing for aneuploidy (PGT-A) with trophectoderm (TE) biopsy and preferable elective freeze-all procedure associated with an increased risk of adverse obstetric and neonatal outcomes compared to pregnancies after IVF/ICSI without PGT-A?

In this systematic review and meta-analysis specifically focusing on comparing a homogenous infertile population treated with IVF/ICSI, PGT-A was not associated with any adverse obstetric or neonatal outcomes.

An increased risk of hypertensive disorders of pregnancy (HDP) following IVF/ICSI with PGT in general as compared to IVF/ICSI without PGT has been reported. However, people undergoing PGT for monogenic diseases or structural rearrangements are often fertile in contrast to infertile people undergoing general IVF/ICSI treatment.

A systematic literature search was performed in PubMed, Embase, and Cochrane Library on 15 November 2024 and the search was updated on 11 June 2025. Inclusion criteria were: (i) randomized clinical trials or cohort studies comparing IVF/ICSI with or without PGT-A, (ii) embryo cultivation until the blastocyst stage, (iii) TE biopsy, and (iv) vitrification as cryopreservation method. Exclusion criteria were: (i) case series and case reports, (ii) polar body- or cleavage-stage biopsy, (iii) slow freeze, (iv) use of donor oocytes, or (v) natural conception controls. The main outcomes were HDP, preterm delivery, abnormal placentation, low birth weight, very low birth weight, and small for gestational age.

Meta-analyses were performed for outcomes reported in ≥3 of the included studies. Frozen embryo transfer (FET)-cycles only subgroup-analyses were performed if the data were available in ≥3 of the included studies. Newcastle-Ottawa quality assessment score and Risk-of-Bias 2 were used to assess potential bias in the individual studies, and the GRADE approach was used to assess the certainty of evidence.

A total of 2260 records were screened, and 12 studies comprising 56 113 live births were included, of which 17 254 resulted from PGT-A and 38 859 resulted from IVF/ICSI without PGT-A. No outcomes differed significantly between the PGT-A and non-PGT-A group in the main analyses or the subgroup-analyses on FET-cycles.

The included studies were mainly retrospective, and the number of cases was low for some outcomes.

Current evidence does not suggest adverse obstetric or neonatal effects of PGT-A, though further research is needed, particularly for rare outcomes.

STUDY FUNDING/COMPETING INTERTEST(S): This study was not funded. A.P. has received independent research grants and lecture fees from Abbott, IBSA, Gedeon Richter, Ferring, and Merck A/S. A.P. is part of research advisory boards for Gedeon Richter and Ferring Pharmaceuticals A/S. K.L. has received an independent research grant from Gedeon Richter and lecture fees from Ferring Pharmaceuticals. K.L. participated in a research advisory board for Ferring Pharmaceuticals A/S. N.F.W. has received a speaker's fee from Ferring Pharmaceuticals and travel support paid to institution from Gedeon Richter. The other authors had no conflict of interest to declare in relation to this work.

PROSPERO No: CRD42024599519.