Abstract
This study aims to assess whether increased utilization for preimplantation genetic testing for aneuploidy (PGT-A) relates to improved live birth rates in IVF and whether IVF clinic ownership relates to PGT-A utilization. In a retrospective cohort study involving > 90% of US IVF clinics reporting to the Center for Disease Control and Prevention (CDC), stratified for ages (< 35, 35-37, 38-40, 41-42, and ≥ 43 years), and with reference point cycle start, we investigated whether PGT-A utilization related to live birth rates and ownership format as either physician-, academic/hospital/military, or equity/venture capital (VC) owned clinics. The lowest PGT-A-utilizing clinics reported significantly better live birth rates than the highest-utilizing clinics. Youngest patients (under age 35) were most adversely affected by high PGT-A utilization. Clinic ownership, moreover, is significantly related to the utilization of PGT-A, with equity and/or venture capital (VC)-owned clinics being significantly overrepresented among high-utilizing clinics in comparison to clinics owned by private physicians or by academia, hospitals, and the military. PGT-A, overall, reduces live birth chances in IVF, with the risks of adverse outcome effects increasing with growing PGT-A utilization in primarily younger women under age 35. Equity/VC ownership favors increasing PGT-A utilization in comparison to private physician and academic/hospital/military clinic ownership. These findings suggest intervention strategies to reverse excessive PGT-A utilization.