Recommendations for müllerian anomalies classificationSi Su1,2, Lan Zhu1*1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, China2 Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China*Corresponding Author: Lan Zhu, MD, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China (zhu_julie@vip.sina.com)The word count for the main text: 506.In 2021, a new müllerian Anomalies Classification was proposed by American Society for Reproductive Medicine (ASRM 2021), 1 which was based on the American Fertility Society (AFS) 1988 2 and combined the benefits of existing classifications. However, mullerian anomalies is a group of complex diseases with various manifestations. And no consensus has been reached about the classification and diagnosis in clinical practice. The purpose of this study is to test the clinical application value of this new classification through the analysis of the cases from Peking Union Medical College Hospital in the past 20 years, and put forward valuable recommendations.A retrospective study was conducted using clinical data of hospitalized patients from January 2003 to December 2022 from Peking Union Medical College Hospital. Inclusion criteria included patients with 46, XX karyotype, diagnosed of müllerian anomalies, and clearly identified alterations of the uterus, cervix, and vagina. Clinical data of patients were collected through the hospital information system, and classification was performed based on the ASRM 2021. SPSS 25.0 version was used for data analysis.2671 patients were included, with an average visiting age of 28.9±10.0 years. The most common is septate uterus with 1144 cases (42.8%), followed by MRKH syndrome (20.4%), Herlyn-Werner-Wunderlich syndrome (HWWS) (10.4%), unicornuate uterus (7.4%), cervical agenesis (6.5%), uterus didelphys (5.6%), bicornuate uterus (2.9%), longitudinal vaginal septum (without uterine malformation) (2.0%), transverse vaginal septum (1.2%), complex anomalies (0.5%) and other anomalies (0.3%) (Table 1). It should be emphasized that HWWS was taken as an independent classification for statistical analysis, with reference to the clinical definition (uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis).3,4 13 cases of complex anomalies were identified and 8 cases that could not be classified were classified as other anomalies (Supplement table 1).ASRM 2021 was proposed based on the AFS 1988, which is the most widely used classification in the past 30 years. We found ASRM 2021could distinguish most clinical patients well, but there are still some shortcomings. First, the classification of patients with uterine malformations and longitudinal/transverse/oblique vaginal septum is not clear. We recommend that patients with longitudinal vaginal septum and uterine anomalies should be classified into the uterine anomalies respectively, while others without uterine anomalies should be included in longitudinal vaginal septum. All transverse vaginal septum should be included in transverse vaginal septum, because the symptoms of transverse septum are prominent. A new type of HWWS should be added. Because the obstructive symptom is prominent. Second, we found several cases of complex anomalies. For these patients, multidisciplinary and individualized treatment should be carried out. The anomalies we found that are not currently classified include T-shaped uterus, congenital vaginal stenosis, and accessory and cavitated uterine masses (ACUM). With the deeper insight into this field, there may be a better way to classify them. The limitation of this study is that as a single-center retrospective study, there could be statistical biases.In conclusion, we put forward following suggestions for ASRM 2021 classification: 1) Minimize overlaps of classification and add a type of HWWS; 2) Update complex anomalies timely; 3) Add other anomalies classification.

Cesarean Section Rates in India: A Retrospective Analysis of Districts and States from 2011 to 2019

Objective: Increased rates of pro-inflammatory and metabolic-related disorders, plus perinatal death and other pregnancy complications such as gestational diabetes (GDM), are consistently reported among women of Indian ethnicity. This study compares lipid profiles and early pregnancy biomarkers associated with metabolic dysfunction between healthy nulliparous pregnant women of Indian and European ethnicity. Design: a prospective cohort study. Setting: Australia, Ireland, New Zealand and the United Kingdom; 2004-2011. Population: 138 and 5,240 women of Indian and European ethnicity were included from the prospective Screening for Pregnancy Endpoints cohort study. Methods: Early pregnancy biomarkers were selected a priori on the basis of a potential association with the metabolic syndrome, diabetes/GDM or obesity, and compared between ethnic groups. Biomarkers that differed significantly between ethnic groups were adjusted for maternal age, body mass index, smoking, alcohol use and socioeconomic status. Main outcome measures: Mean values for 21 placental, metabolic, inflammatory and cardiovascular biomarkers, plus blood lipids, measured at 15±1 weeks gestation. Results: Ten biomarkers were significantly different by ethnicity, mostly consistent with a pro-inflammatory and less favourable metabolic profile in Indian women: PlGF (p=0.02), adiponectin (p<0.01), NGAL (p<0.01), TNFR1A (p<0.01), CXCL10 (p=0.01), ICAM-1 (p<0.01), ST2 (p<0.01), angiogenin (p<0.01), and proANP (p<0.01). We additionally found increased triglycerides (1.6±0.6 vs 1.5±0.6, p<0.01) and reduced HDL cholesterol (1.7±0.4 vs 1.9±04, p<0.01) in Indian mothers, compared with European. Conclusions: Low-risk mothers of Indian ethnicity have an overall less favourable metabolic health profile at early gestation compared with European women. Future research should investigate the association with pregnancy outcomes.

Objective: Few studies have examined whether number of births is associated with women’s aging. This study aims to evaluate the association of number of births with women’s biological aging, premature mortality and life expectancy. Methods: A total of 272,494 participants from UK biobank who completed the questionnaire on number of live births were enrolled at baseline. The number of births was categorized into 6 groups, and participants with one live birth was the reference group. General linear regression model and cox proportional hazards model were performed to evaluate the association of number of births with women’s biological aging and premature mortality. Restricted cubic spline (RCS) was used to visualize dose-response relationship. Moreover, the latest Office for National Statistics life tables rom was used to calculate the life expectancy. Results: During a median follow-up of 11.9 years, a total of 10,992 cases of all-cause premature death were documented. After adjustment for potential confounders, compared to women had one birth, childless women had greater premature death (hazard ratio, HR=1.17, 95%CI: 1.09-1.25), whereas women with two or three children had lower risk of premature death (HR=0.87, 95%CI:0.82-0.93, HR=0.90, 95%CI: 0.82-0.99), which showed a U-shaped relationship visualized by RCS (P<0.05 for non-linearity). Further, at age 40, childless women had 1.41 years lower life expectancy, and women with two children was related to 1.10 years higher life expectancy. Moreover, compared to women had one birth, the women with two or three children had lower corrected estimated values of FI, ΔKDM-biological age and HD, and the women with five or more children had higher corrected estimated values of FI, ΔKDM-biological age, and HD (all the P<0.05). Conclusions: The association of number of live births with women’s biological aging, premature mortality and life expectancy had a U-shape relation. The childless or five more child women were more likely to be aging with increased risk of premature death and decreased life expectancy years. The double-child women decreased aging process with lower risk of premature death and high life expectancy.

Objective: To explore the potential factors that contribute to the occurrence of medical abortion(MA) through a Mendelian randomization(MR) study. Design: Univariate MR(UVMR) and multivariate MR(MVMR) analyses. Setting: Genetic variants from European populations. Population or Sample: Instrumental variants for MA were obtained from FinnGen with 36,232 cases and 149,622 controls. Methods: The inverse variance weighting method was adopted as the primary analysis. Main outcome measures: The associations of MA with household income(HI), education attainment(EA), cognitive performance(CP), risky behaviors: smoking behavior(SB), alcohol consumption(AC), and reproductive traits: age at first sexual intercourse(AFS), lifetime number of sexual partners(LNSP), age at first birth(AFB), age at last birth(ALB). Results: In the UVMR, increasing HI, EA, AFS and AFB appeared to reduce MA risk(HI, OR=0.569, P = 7.93E-08; EA, OR=0.875, P = 6.02E-21; AFS, OR=0.439, P = 5.17E-25; AFB, OR=0.815, P = 5.46E-12), whereas SB and LNSP appeared to add to MA risk((SB, OR=1.424, P =8.32E-11; LNSP, OR=2.777, P =2.14E-11). In the MVMR, EA, SB, LNSP and AFS seems to be the predominant risk factor for MA risk with the independent effect, while HI had no effect after controlling EA(HI in model 1, OR=0.890, P = 5.78E-01). AFB functioned as mediators in the causal chain of MA risk reduction by EA, with the mediated proportion of AFS and AFB being 57.8%. Conclusions: Our MR study demonstrated the causal potential of the associations of HI, EA, SB, LNSP, AFS and AFB with medical abortion.

A document by Hiba J. Mustafa. Click on the document to view its contents.

Objectives:  Pre-eclampsia is a hypertensive disorder of pregnancy which, left untreated, can cause significant foeto-maternal morbidity. Accordingly, the National Institution for Health and Care Excellence (NICE) recommends that high-risk women be prescribed daily prophylaxis with 75-150mg aspirin from twelve weeks’ gestation until delivery. NICE stratifies risk using eleven maternal risk factors; however, no secondary research has been published evaluating the diagnostic accuracy of this algorithm. This systematic review and meta-analysis evaluates the sensitivity and specificity of the NICE risk‑stratification algorithm in predicting pre‑eclampsia in pregnant women ≥16 years. Methods: Systematic searches were conducted using PubMed, Cochrane Library and SCOPUS to identify relevant papers with a CBEM Level of Evidence ≤4. A total of twenty eligible studies and 892,061 pregnancies were included in our analyses. The logit-transformed sensitivities and specificities from each study were modelled as a bivariate distribution with random effects in order to generate maximum-likelihood estimates (MLEs) for the overall sensitivity and specificity of the algorithm in predicting pre-eclampsia. Results: MLEs for the NICE algorithm’s sensitivity and specificity were 44.4% (95% CI 33.7-55.5) and 88.3% (95% CI 83.9-91.6), respectively. Significant heterogeneity was exhibited between the sensitivities  (I2=99.8%, 95% CI = 99.54-99.65) and specificities (I2=99.88%, 95% CI = 99.87-99.89) calculated by each of the included studies. Consequently, there is a low degree of certainty in these estimates. Conclusions: The NICE risk‑stratification algorithm performs remarkably poorly when used to predict pre‑eclampsia in any of three gestational categories. Clinicians should advise women that around 1 in 5 high-risk patients and 1 in 25 low-risk patients go on to develop pre‑eclampsia. However, future studies will likely alter the values of these statistics and the confidence therein. Key Words: Pre-eclampsia, High-risk Pregnancy, Sensitivity and Specificity, Predictive Value of Tests, Clinical Decision Rules.

Background: The prevalence of infertility has rarely been synthesized at the global level. Objective: To conduct a systematic review and meta-analysis to assess the community-based global prevalence of infertility. Search Strategy: PubMed, MEDLINE, Web of Science, and Science Direct were searched from inception until October 2022. Selection Criteria: Studies were included if they were published in English, had quantitative data, and reported the community-based prevalence of infertility. Data Collection and Analysis: Two authors independently extracted data. Random-effects meta-analysis was used to derive the pooled prevalence of infertility. Variations in the prevalence estimates in different subgroups. Univariate meta-regression was used to explore possible sources of heterogeneity. Main Results: The findings indicated the pooled prevalence of infertility was 12.87% (95% CI,12.41%-13.33%). The prevalences of primary infertility and secondary infertility were 7.34% and 6.01%, respectively. The overall prevalence of infertility among people was the highest in Africa (16.73%) and lowest in the North America (8.84%). Lower prevalence in cohort or prospective follow-up studies (9.75%) than in cross-sectional studies (12.93%). Women aged 35 and above had a higher prevalence of infertility (11.68%) compared to women below 35 years old (5.92%). The prevalence of infertility increased with the number of years, and increased with the degree of literature bias from low to high. Conclusions: This community-based study estimated the global prevalence of infertility to be 12.87% and suggested that an upward trend of the prevalence of infertility may persist in the future.

Objective: Evaluate NHS-funded fertility treatment policies across England, Scotland, and Wales, assessing their alignment with the needs of those trying to conceive and comparing eligibility against NICE guidance. Design: Review of current NHS-funded fertility treatment policies and retrospective analysis of participant data. Setting: Not applicable. Population: Reproductive-age UK-based women using Hertility Health services from 2021-2023, focusing on those actively trying to conceive (TTC) or planning future pregnancies. Methods: Policy evaluation and data review without interventions. Main Outcome Measures: Eligibility for NHS-funded fertility treatment under UK regional policies versus NICE guidance. Results: In total, out of 2980 individuals actively trying to conceive and 6282 individuals planning for future pregnancies, 1700 (57.0%) and 2750 (43.8%) respectively would be ineligible for state-funded treatment under current regional policies: 1551 (57.7%) in England, 123 (53.2%) in Scotland, and 26 (41.9%) in Wales for those actively trying to conceive, and 2558 (43.9%), 146 (41.7%), and 46 (44.2%) for those planning future pregnancies respectively. In contrast, only 248 (8.3%) of those actively trying to conceive and 149 (2.4%) of those planning for future pregnancies would be ineligible if the NICE guidance were universally applied. Conclusions: By imposing outdated clinical and non-clinical qualifying criteria, the current NHS-funded fertility treatment policies exclude a substantial number of individuals requiring treatment. This necessitates a swift policy overhaul, as promised in the 2022 UK Women’s Health Strategy, to avoid further age-related fertility loss in women who require treatment imminently.

Background Abdominal wall endometriosis (AWE) is the most common type of extrapelvic endometriosis in women of reproductive age, and several studies have compared high-intensity focused ultrasound (HIFU) ablation with surgical resection in the management of AWE; however, the results are controversial. Objective To compare the efficiency and safety of HIFU ablation with surgery in the treatment of AWE. Search strategy Literature on surgery versus HIFU ablation for treating AWE was identified using the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, WANFANG Database and the Cochrane Library databases. Selection Criteria Full-text manuscripts comparing HIFU ablation and surgery for treating AWE were included. Data collection and analysis Two independent reviewers reviewed and extracted data from the articles, and the risk of bias was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Data analysis was performed using RevMan 5.4. Main results We included 7 studies involving 405 patients. Compared with the surgery group, the immediate posttreatment visual analogue scale (VAS) score was lower in the HIFU group (mean difference [MD] -1.58, 95% CI -2.56 to -0.59), the length of hospitalization was shorter in the HIFU group (MD -1.95 days, 95% CI −2.43 to −1.48), and the incidence of adverse events was lower in the HIFU group (relative risk 0.32, 95% CI 0.15 to 0.65). There was no significant difference in the symptom recurrence rate, VAS score at the 3-, 6- and 12-month follow-ups, or treatment time between the two groups. Conclusions Compared with surgery, immediate postoperative VAS scores were lower, hospitalization times were shorter, and the risk of adverse events were lower in patients receiving HIFU ablation treatment for AWE.

ABSTRACT Objective To evaluate the impact of screening and treating asymptomatic pregnant women for C. trachomatis and N. gonorrhoeae infections on the frequency of preterm birth or low birth weight infants in Botswana. Design Non-randomized, cluster-controlled trial. Setting Four antenatal care clinics in Gaborone, Botswana. Population Pregnant women aged ≥15 years, attending a first antenatal care visit, ≤27 weeks gestation, and without urogenital symptoms were eligible. Methods Participants in the intervention clinics received screening (GeneXpert®, Cepheid) during pregnancy and at the post-natal visit. Participants in the standard-of-care clinics received screening at the postnatal visit only. We used multivariable logistic regression and post-estimation predictive margins analysis. Post-hoc analysis was conducted among sub-samples stratified by parity. Main outcome measures Preterm birth (<37 weeks gestation) and low birth weight (<2500g). Results After controlling for parity, hypertension, antenatal care visits, and clinic site, the predicted prevalence of preterm or low birth weight was lower in the intervention arm (11%) compared to the standard-of-care (16%) (AOR: 0.59; 95% CI: 0.28 to 1.24), but confidence intervals were wide. In post-hoc analysis, the intervention was more effective than the standard-of-care (AOR: 0.20; 95% CI: 0.07-0.64) among nulliparous participants. Conclusion A C. trachomatis and N. gonorrhoeae infection screening and treatment intervention among asymptomatic pregnant women did not significantly reduce preterm or low birth weight outcomes. Post hoc analysis found the intervention reduced adverse outcomes among nulliparous participants.

Objective: To compare the carbon footprint of caesarean and vaginal birth. Design: Life cycle assessment. Setting: Tertiary maternity units and home births in the UK and the Netherlands Methods: A life cycle assessment, including: equipment use, energy, analgesia, hospital stay, waste, sterilisation and laundry, was conducted using primary data combined with data from published sources. Main Outcome Measures: ‘Carbon footprint’ (in kgCO 2e) Results: Excluding analgesia, the carbon footprint of a caesarean birth in the UK was 31.21 kgCO 2e, compared with 12.47 kgCO 2e for vaginal birth in hospital and 7.63 kgCO 2e at home. In the Netherlands the carbon footprint of a caesarean was higher (32.96 kgCO 2e), but lower for vaginal birth in hospital and home (10.74 and 6.27 kgCO 2e respectively). Emissions associated with analgesia for vaginal birth were: 0.08 kgCO 2e (opioid analgesia), 0.75 kgCO 2e (remifentanil), 1.2 kgCO 2e (epidural) and 237.33 kgCO 2e (nitrous oxide with oxygen). Differences in analgesia use resulted in a lower average carbon footprint for vaginal birth in the Netherlands than the UK (11.64 vs. 193.26 kgCO 2e). Conclusion: The carbon footprint of a caesarean is higher than for vaginal birth if analgesia is excluded, but this is very sensitive to the analgesia used; use of nitrous oxide with oxygen multiplies the carbon footprint of vaginal birth 25-fold. Alternative methods of pain relief or nitrous oxide destruction systems would lead to a substantial improvement in carbon footprint. Although clinical need and maternal choice are paramount, protocols should consider the environmental impact of different choices.

Objectives To investigate the risk of stillbirth in relation to; 1) a previous CD compared to those following a vaginal birth (VB); and 2) vaginal birth after caesarean (VBAC) compared to a repeat CD. Design Population-based cohort study. Setting The Swedish Medical Birth registry Population Women with their first and second singletons between 1982 and 2012. Methods Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association between CD in the first pregnancy and stillbirth in the second pregnancy and the association between VBAC and stillbirth. Sub-group analyses were performed by types of CD and timing of stillbirth (antepartum and intrapartum). Main outcome measures Stillbirth (antepartum and intrapartum fetal death). Results Of the 1,771,700 singleton births from 885,850 women,117,114 (13.2%) women had a CD in the first pregnancy, and 51,755 had VBAC in the second pregnancy. We found a 37% increased odds of stillbirth (aOR:1.37 [95% CI, 1.23–1.52]) in women with a previous CD compared to VB. The odds of intrapartum stillbirth was higher in previous pre-labour CD group (aOR:2.72 [95% CI, 1.51–4.91]) than the previous in-labour CD group (aOR:1.35 [95% CI, 0.76–2.40,]), although not statistically significant in the latter case. No increased odds was found for intrapartum stillbirth in women who had VBAC (aOR:0.99 [95% CI, 0.48–2.06]) compared to women who had a repeat CD, whereas women with antepartum stillbirth were more likely to have a VBAC (aOR:4.49 [95% CI, 3.55–5.67]). Conclusions This study confirms that a CD is associated with an increased risk of subsequent stillbirth, with a greater risk among pre-labour CD. This association is not solely mediated by increases in intrapartum asphyxia, uterine rupture or attempted VBAC. Further research is needed to understand this association, but these findings might help health care providers to reach optimal decisions regarding mode of birth, particularly when CD is unnecessary.

This review article considers the physiology, differential diagnosis and immediate management of vasovagal response, vascular injury and carbon dioxide embolism caused during creation of the laparoscopic pneumoperitonium. These pathologies account for over half of all laparoscopic complications and therefore, by taking a systematic approach to these possibly life-threatening events, laparoscopy can become even safer.

Objectives To study effects of physiotherapist-guided pelvic floor muscle training on pelvic organ prolapse (POP) early postpartum period. Design Assessor-blinded, randomized controlled trial. Setting Physiotherapy Clinic, Reykjavik. Sample Eighty-four primiparous women with a singleton delivery. Methods Participants were screened for eligibility 6-13 weeks postpartum. Women randomized to the training group conducted 12 weekly individual sessions with a physiotherapist, starting on average 9 weeks after childbirth. Outcomes were assessed after the last session (short-term) and at 12 months postpartum (long-term). The control group received no instructions after the initial assessment. Main outcome measures Self-evaluated POP symptoms by the Australian Pelvic Floor Questionnaire. Results Forty-one and 43 women were randomized to the training and control groups, respectively. At recruitment, 17 (42.5%) of the training and 15 (37%) of the control group reported prolapse symptoms (p=0.6). Five (13%) from the training and 9 (21%) controls were bothered by the symptoms (p=0.3). There was a gradual decrease in the number of women with symptoms and no significant short-term (p=0.08 at 6 months) or long-term (p=0.6 at 12 months) differences between the groups regarding rates of women with POP sympoms. No difference was between groups regarding bother in the short (p=0.3) or longer term (p=0.4). Repeated measure analyses using Proc Genmod in SAS did not indicate a significant effect of the intervention over time, p>0.05. Conclusions There was an overall decrease in postpartum symptoms of POP and bother during the first year. Physiotherapist-lead pelvic floor muscle training did not change the outcomes.

Objective: Evaluation of the implementation of a new guideline for diagnosis and treatment of women with pregnancy of unknown location (PUL) or ectopic pregnancy (EP). Design: Multicenter retrospective cohort study Setting: Six hospitals in the Northern part of the Netherlands Population and methods: Women above 18-years old with a final diagnosis of PUL or EP between January 2012 to April 2020. Main outcome measures: Diagnostic findings, type of treatment and outcomes, before and after implementation of the guideline. User interpretation of the guidelines. Results: 1306 women with PUL or EP were included. The amount of women diagnosed with PUL has significantly increased between the guideline cohorts (28.4%;174/693 versus 16.6%;115/613 P<0.001). A significantly lower percentage of women using the new guideline underwent surgical management versus treatment with MTX (odds ratio [OR] =0.516, 95% confidence interval [CI] 0.399 – 0.668 P<0.001). Among women treated with MTX, the overall success rate was significantly lower compared to surgery (80.5%;103/128 versus 95.2%; 943/991 P=0.007). There was no observed difference in adverse events or guideline adherence between the guidelines. Conclusion: The implementation of the new guideline contributes to an increase in women diagnosed with PUL and treated with MTX. Treatment with MTX caused more complications and a lower treatment success compared to women undergoing surgery. This did not lead to an increase in adverse events between the guidelines. The overall adherence to the guidelines was equal.

Objective: Lifestyle factors including education, coffee intake, tea consumption, dietary fat intake, obesity, physical activities, smoking and alcohol drinking, sleep duration, and insomnia, have been linked to Ovarian Cancer (OC) in observational studies. We assessed whether the concerning factors are causally associated with the risk of OC by histological subtypes. Design: Mendelian Randomization (MR) study. Setting: Independent genetic instruments associated with thirteen lifestyle behaviors were selected from ten genome-wide association studies. Summary-level data for OC subtypes were obtained from the Ovarian Cancer Association Consortium. Population: Exposures population were including 375,833 to 1,232,091 European individuals, outcomes population were including up to 25,509 cases and 40,941 controls. Methods: Two-sample and multivariable MR study, and multiple complementary sensitivity analyses were conducted. Main Outcome Measures: Histological subtypes of OC. Results: We provided unconfounded genetic evidence of inverse associations of genetically predicted years of education and fat intake with specific OC subtypes, which are independent of BMI. Whereas consumption of coffee or tea was positively associated with endometroid OC, which may be partly mediated by BMI. Although physical activity and sleep characteristics have been reported to be the risk factors for OC, no causal associations were observed in our study. Conclusions: Our study clarified the protective and independent role of high level education and relative fat intake in particularly OC subtypes. We also showed detrimental effects of higher coffee or tea consumption on OC histotypes. Our results may provide insight into the corresponding interventions as lifestyle factors can easily be modified.

Objectives: To investigate the cost-effectiveness of preimplantation genetic testing for aneuploidy (PGT-A) versus conventional technology in in vitro fertilization (IVF) from the perspective of the healthcare system in China. Design: Economic evaluation based on a large multi-center randomized trial (CESE-PGS study). Population: Infertile women with a good prognosis for a live birth in China Methods: Following the exact steps in the IVF protocol, a decision tree model was developed, based on the data from the CESE-PGS trial and using cost scenarios for IVF in China. The scenarios were compared for costs per patient and cost-effectiveness. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to confirm the robustness of the findings. Main Outcome Measures: Costs per live birth, Costs per patient, Incremental cost-effectiveness for miscarriage prevention Results: The average costs per live birth of PGT-A were estimated as ¥39230.71, which is about 16.8% higher than that of the conventional group. Threshold analysis revealed that PGT-A would need to increase the pregnancy rate of 26.24% to 98.24% or a cost reduction of ¥4649.29 to ¥1350.71 to achieve the same cost-effectiveness. The incremental costs per prevented miscarriage was approximately ¥45600.23. Probabilistic sensitivity analysis indicated a probability of 97.50% that PGT-A is cost-effective when the willingness to pay was ¥ 21,7113.00 per prevented miscarriage. Conclusions: The present cost-effectiveness analysis demonstrates that embryo selection with PGT‑A is not suitable for routine applications from the perspective of healthcare providers in China, given the cumulative live birth rate (CLBR) and the high costs of PGT‑A.