Diminished Ovarian Reserve as an Aging Marker in PGT-a Tested Eset Cycles: Implications Beyond Oocyte Quality

Objective: To determine whether diminished ovarian reserve (DOR) independently predicts live birth rates (LBR) or implantation failure following confirmed euploid single frozen embryo transfer (eSET) in preimplantation genetic testing for aneuploidy (PGT-A) tested cycles, to contrast to prior literature demonstrating DOR as a determinant of IVF outcomes in non-PGT-A populations. Design: Retrospective cohort study. Materials and Methods: A total of 3,435 PGT-A tested eSET cycles (2023–2024) were analyzed. Cycles were stratified by DOR diagnosis and age group. Primary outcome: LBR per transfer. Chi-square, Fisher’s exact, logistic regression, and Spearman correlation applied (p<0.05). Results: DOR increases with age (Spearman r=0.31, p<0.001) and was associated with 13x higher donor oocyte use (12.9% vs 1.0%) and within the age groups, LBR was equal between DOR and non-DOR patients (all p>0.05). DOR with euploid transfer was not an independent predictor of LBR (OR 0.94, p=0.54) or not-pregnant rate (OR 0.99, p=0.91) on multivariate analysis. The recipient’s age was the significant predictor (p<0.001). Conclusions: Prior literature focuses on non-PGT-A DOR transfers and in this set, DOR did not independently predict LBR or implantation failure once euploidy was confirmed. DOR mainly works as a clinical marker influencing the decision to utilize donor oocytes which may be more beneficial than as a transfer success marker. This may point to PGT-A being able to effectively neutralize DOR’s impact on transfer outcomes.