Live Birth Outcomes in PGT-a Tested Cycles: Autologous Versus Donor Oocyte Ivf With Fresh and Frozen Oocytes

Background: Preimplantation genetic testing for aneuploidy (PGT-A) tested single frozen embryo transfer (eSET) optimizes IVF outcomes by decreasing age-related chromosomal risks. However, live birth rates (LBR) still vary based on oocyte origin (autologous vs. donor) and embryo state (fresh vs. frozen). Whether significant differences in pregnancy outcomes exist between autologous oocytes and fresh or frozen donor oocytes, when controlling for embryonic euploidy via PGT-A, remains unknown. Objective: To compare live birth rates (LBR), implantation failure, and pregnancy loss across autologous and donor oocyte IVF cycles by oocyte state PGT-A tested eSET cycles. Design: Retrospective cohort study. Materials and Methods: PGT-A tested eSET cycles (2023–2024) at a single private fertility center were stratified: autologous fresh (n=3,251), autologous frozen (n=78), donor fresh (n=58), donor frozen oocyte (n=48). Chi-square, Fisher’s exact, and logistic regression applied (p<0.05). Results LBR and pregnancy loss rates were not significant. Not-pregnant rate higher in donor frozen vs autologous fresh and autologous frozen. Using multivariate analysis, age (OR 0.92/SD, p=0.03) and BMI (OR 0.84/SD, p<0.001) were the independent predictors of LBR. Conclusions: Euploid FET results in the same LBR and miscarriage rate regardless of autologous vs donor and fresh vs frozen. The elevated not-pregnant rate in donor frozen oocyte recipients using PGT-A may reflect recipient uterine and endometrial factors from advanced age. Zero donor recipients used gestational carriers which may represent an underutilized strategy. Lower pregnancy rates with euploid embryos from frozen donor eggs may reflect the added stress of double vitrification at the oocyte and embryo stages. Once implantation occurs, miscarriage risk appears similar to fresh eggs. Euploid FET neutralizes the effect of age and egg source as pregnancy rates are similar regardless of egg source. Advantages of frozen oocytes such as speed to transfer are important considerations. Adding PGTA may be an additional stress resulting in potentially lower pregnancy rates.