LAUSR

What other factors, besides female age, significantly influence the likelihood of having ≥3 euploid embryos in an IVF/ICSI cycle with preimplantation-genetic-testing for aneuploidies (PGT-A)? Ovarian reserve parameters, basal follicle stimulating hormone (FSH), and sperm source influence the likelihood of having ≥3 euploid embryos, besides female age. Predicting the number of euploid embryos that can be obtained from the mature oocyte (MII) cohort is crucial for ensuring a successful outcome and remains a fundamental question in in vitro fertilization (IVF). Existing studies often focus on specific patient characteristics, influenced by varying PGT-A indications. Typically, studies target patients above a certain age or those with severe male factors, repeated implantation failure, or miscarriage. Additionally, other crucial patient-specific factors, such as ovarian reserve, hormonal profiles, and male characteristics are often overlooked, despite their potential significant influence on predicting the likelihood of achieving euploid embryos. Retrospective cohort study of 7,590 cycles from 4,251 women undergoing autologous ovarian stimulation (OS) for IVF/ICSI with PGT-A between 2018 and 2024. Luteal phase and long agonist OS protocols were excluded. Patient and partner demographic characteristics, ovarian reserve markers, hormonal profiles, and sperm sources were recorded. Outcome measures included euploid number per MII, and factors associated with obtaining ≥1 euploid and ≥3 euploid embryos were analyzed. Women were stimulated using standard OS protocols, tailored according to women’s characteristics (age, ovarian reserve). Embryos that reached the blastocyst stage underwent trophectoderm biopsy on days 5–7, followed by next-generation sequencing. Multivariable logistic regression models assessed the odds of obtaining euploid embryos per MII, ≥1 euploid, or ≥ 3 euploid embryos, incorporating random effects for patient-specific variability. Models were validated using 10-fold cross-validation, with probability density plots visualizing results. All analyses were conducted in R. Female age exhibited a quadratic relationship with euploidy rate per MII. The rate gradually increased from approximately 22% in patients close to 20 years of age, reaching a peak of around 26-27% at ages 27–29. Following this peak, the euploidy rate declined gradually until about age 35, after which the decline became steep, falling below 10% by the early 40s. By age 44, the euploidy rate dropped to ≤ 1%. Besides female age (OR: 0.05, p < 0.001), testicular sperm (OR: 0.64, p < 0.001) had an independent strong association with euploidy rate per MII. Male age also presented a slight association (OR: 0.95, p = 0.019). The probability of retrieving ≥1 euploid embryo was, as expected, significantly influenced by female age (OR: 0.01, p < 0.001). However, other variables like anti-müllerian hormone (AMH; OR: 1.89, p < 0.001), testicular sperm (OR = 0.35, p < 0.001), basal antral follicle count (AFC; OR: 1.57, p < 0.001), and basal FSH (OR: 0.82, p < 0.001) were also independently associated. When focusing on retrieving ≥3 euploid embryos—ensuring a high probability of cumulative live birth—female age (OR: 0.00, p < 0.001), AMH (OR: 2.05, p < 0.001), basal AFC (OR: 1.64,p<0.001) and basal FSH (OR: 0.76,p<0.001) maintained robust and reliable associations, while testicular sperm (OR: 0.60,p=0.046) presented a weaker statistical significance. Patient-specific variability (genetic and clinical factors), the predominantly Middle Eastern population studied, the absence of stimulation characteristics, and the retrospective nature of the study may limit the generalizability of the findings. Age remains the dominant factor in determining euploid outcomes, emphasizing the need to create awareness about its impact on fertility, but other patient characteristics should not be overlooked. Predictive models integrating these factors, and density plots visualizing the probability of obtaining euploid embryos can enhance patient guidance and treatment optimization. No