Maternal age is a well-established determinant of IVF success, primarily due to increased embryonic aneuploidy. Preimplantation genetic testing for aneuploidy (PGT-A) enables the selection of euploid embryos, potentially improving implantation and live birth rates. However, whether euploid embryo transfer can fully overcome the negative impact of advancing maternal age remains uncertain. This systematic review aims to evaluate the impact of euploid embryo transfer and maternal age on implantation and pregnancy outcomes in IVF-ET cycles. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Embase for studies published between 2021 and 2025. Eligible studies were retrospective cohort studies reporting implantation, clinical pregnancy, or live birth outcomes following euploid embryo transfer across different maternal age groups. The PICOS framework guided eligibility criteria. Risk of bias was assessed using the ROBINS‑I tool. A narrative synthesis was performed due to heterogeneity in study designs, age cut-offs, and outcome definitions. Eight retrospective cohort studies encompassing 7,537 patients were included. Three studies reported a significant decline in live birth rates with advancing maternal age, despite euploid transfer, particularly in women ≥38 years, with miscarriage rates as high as 22.6% in the oldest group. Two studies found no independent age effect after adjusting for embryo morphology and endometrial preparation. Euploid transfer demonstrated marked benefit in recurrent pregnancy loss patients (live birth rate 80% vs. 0% in controls) but no benefit in recurrent implantation failure. Blastocyst trophectoderm grade was a stronger predictor of live birth than maternal age in two studies. Oocyte origin (autologous vs. donor) did not affect outcomes in advanced maternal age patients. Six studies had low overall risk of bias, while two showed moderate-to-serious risk. Euploid embryo transfer significantly improves implantation and reduces miscarriage rates compared to untested embryos; however, maternal age continues to influence live birth outcomes in women aged 38 years and older. The benefit of PGT-A varies by clinical indication: strongly supported for recurrent pregnancy loss, equivocal for advanced maternal age, and not supported for recurrent implantation failure. Blastocyst morphology remains prognostically important even after ploidy selection. Prospective studies with standardized age cut-offs and cumulative live birth reporting are needed to refine patient selection for PGT-A.
Belal et al. (Wed,) studied this question.