U.S. Racial and Ethnic Disparities in Outcomes Using Preimplantation Genetic Testing for Aneuploidies

OBJECTIVE: To determine live birth, intrauterine pregnancy, and miscarriage rates in cycles using preimplantation genetic testing for aneuploidy (PGT-A) as a function of race and ethnicity. METHODS: This retrospective cohort analysis used data collected from the Society of Assisted Reproductive Technology Clinical Outcomes Reporting System (SART CORS). Women who underwent their first autologous cycle that resulted in a primary transfer from 2014 to 2020 with the intent of assisted reproductive technology (ART) with and without PGT-A were included in this study. We compared live birth, intrauterine pregnancy, and miscarriage rates by race and ethnicity (American Indian/Alaska Native, Asian, Black, Hispanic, Native Hawaiian/Other Pacific Islander, and White). Statistical analyses of live birth, intrauterine pregnancy, and miscarriage rates with t tests and multiple logistic regression were used to determine adjusted odds ratios (aORs). RESULTS: A total of 438,583 ART cycles were included with 150,604 PGT-A and 287,979 non–PGT-A primary autologous cycles with a single blastocyst transfer. There was a decrease in live-birth rate in White women using PGT-A (37.4% vs 39.7%, P <.001, P adjusted>.05). Live-birth rates were similar in PGT-A cycles of Black and Hispanic women compared with non–PGT-A cycles. Asian women who used PGT-A had higher intrauterine pregnancy rate (34.7% vs 30.4%, P <.001) and live-birth rate (31.4% vs 27.3%, P <.001) compared with Asian women who did not. The intrauterine pregnancy rate for White women regardless of PGT-A use was the same (40.8% vs 40.8%, P >.05), whereas Black and Hispanic women had a slightly increased rate of intrauterine pregnancy rate with PGT-A. For all races and ethnicities, PGT-A use was associated with a lower miscarriage rate. In Black and Hispanic women using PGT-A, there were higher rates of miscarriage and lower rates of intrauterine pregnancy and live-birth rates compared with White women using PGT-A. After adjustment for demographic and clinical confounders, race and ethnicity remained independent predictors for live birth, intrauterine pregnancy, and miscarriage in women using PGT-A. Race and ethnicity, PGT-A use, age 35 years or older, high body mass index (BMI), and low anti-müllerian hormone levels were independent predictors of miscarriage. Despite PGT-A use, Black women were 13% (aOR 0.87, 95% CI, 0.86-0.91, P <.001) and 17% (aOR 0.83, 95% CI, 0.81–0.85, P <.001) less likely to have an intrauterine pregnancy and live birth, respectively, compared with White women who used PGT-A. Of note, the miscarriage rate in Black women using PGT-A was similar to that in White women not using PGT-A (16.7% and 16.5%). CONCLUSION: Despite PGT-A use, Black and Hispanic women continue to have higher miscarriage rates and lower intrauterine pregnancy and live-birth rates compared with White women using PGT-A. However, the use of PGT-A is associated with lower miscarriage rate for women of each race and ethnic group compared with nonusers of PGT-A.