Hunkler Kiley, Boedeker David, Flannagan Kerry, Yeshua Arielle, Gill Elizabeth, Devine Kate, Romanski Phillip, Spitzer Trimble
Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland.
Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland.
Fertil Steril. 2025 Aug;124(2):261-269. doi: 10.1016/j.fertnstert.2025.02.017. Epub 2025 Feb 15.
To determine if the use of preimplantation genetic testing for aneuploidy (PGT-A) increased after the Dobbs decision leak on May 2, 2022, and after the Dobbs final ruling on June 24, 2022, compared with before the Dobbs decision.
Retrospective cohort study.
Patients who underwent in vitro fertilization (IVF) within a large fertility network geographically distributed across six states from June 2021 through June 2023. Preimplantation genetic testing for aneuploidy cycles were defined as cycles with at least one embryo biopsied.
In vitro fertilization cycles were grouped by cycle start date. Cycles starting between May 3, 2022 and June 24, 2022 were considered post-Dobbs leak. These were compared with cycles starting within the year leading up to the leak and those starting within the year after the final ruling.
Percentage of cycles utilizing PGT-A, defined as the number of IVF cycles utilizing PGT-A divided by the total number of IVF cycles during the study period. We stratified by age, socioeconomic status, and state abortion access legislation.
We analyzed 9,371 IVF cycles before Dobbs, 1,581 IVF cycles after Dobbs leak, and 11,536 IVF cycles after Dobbs final ruling, totaling 22,488 IVF cycles. Age, body mass index, antimüllerian hormone, parity, and number of embryos obtained per cycle were similar across time periods, but differences existed among race and infertility diagnoses. There were no differences in the primary outcome of the percentage of cycles utilizing PGT-A between study time periods (57.2% pre-Dobbs, 56.8% post-Dobbs leak, 56.2% post-Dobbs final ruling); a finding which remained when adjusting for confounders. There was no association between the Dobbs decision and PGT-A use in subgroups stratified by age and socioeconomic status. A slight decrease in PGT-A use was noted in states with protective abortion legislation after the Dobbs final ruling (risk ratio, 0.96; 95% confidence interval, 0.93-0.99), with overall PGT-A use higher in states with restrictive policies (66.8%) than protective states (52.4%) across all time periods using Guttmacher's Institute's protective vs. restrictive classifications.
There is no association between Dobbs decision timing and patients' pursuit of PGT-A, but PGT-A use was more common in restrictive states across all included time periods.
确定与多布斯案判决之前相比，2022年5月2日多布斯案判决泄露后以及2022年6月24日多布斯案最终裁决后，非整倍体植入前基因检测（PGT-A）的使用是否增加。
回顾性队列研究。
2021年6月至2023年6月期间在一个分布于六个州的大型生育网络中接受体外受精（IVF）的患者。非整倍体植入前基因检测周期定义为至少有一个胚胎进行活检的周期。
体外受精周期按周期开始日期分组。2022年5月3日至2022年6月24日开始的周期被视为多布斯案判决泄露后周期。将这些周期与在判决泄露前一年开始的周期以及最终裁决后一年开始的周期进行比较。
使用PGT-A的周期百分比，定义为使用PGT-A的体外受精周期数除以研究期间体外受精周期总数。我们按年龄、社会经济地位和州堕胎准入立法进行分层。
我们分析了多布斯案判决前的9371个体外受精周期、多布斯案判决泄露后的1581个体外受精周期以及多布斯案最终裁决后的11536个体外受精周期，共计22488个体外受精周期。不同时间段的年龄、体重指数、抗苗勒管激素、产次和每个周期获得的胚胎数量相似，但种族和不孕诊断存在差异。研究时间段之间使用PGT-A的周期百分比这一主要结果没有差异（多布斯案判决前为57.2%，多布斯案判决泄露后为56.8%，多布斯案最终裁决后为56.2%）；调整混杂因素后这一结果仍然成立。在按年龄和社会经济地位分层的亚组中，多布斯案判决与PGT-A的使用之间没有关联。在多布斯案最终裁决后，有保护性堕胎立法的州PGT-A的使用略有下降（风险比，0.96；95%置信区间，0.93 - 0.99），在所有时间段，使用古特马赫研究所的保护性与限制性分类，实行限制性政策的州的总体PGT-A使用率（66.8%）高于实行保护性政策的州（52.4%）。
多布斯案判决时间与患者对PGT-A的追求之间没有关联，但在所有纳入的时间段内，PGT-A在实行限制性政策的州使用更为普遍。
