目的 分析≥38岁首次行助孕且取卵后第3天有可利用胚胎的女性患者不同助孕方案的累积助孕结局及其影响因素。 方法 本研究为回顾性队列研究，纳入2019年1月至2023年6月在郑州大学第三附属医院生殖健康医院首次行胚胎植入前非整倍体检测（preimplantation genetic testing for aneuploidy， PGT-A）或体外受精-胚胎移植（in vitro fertilization and embryo transfer， IVF-ET）/卵胞浆内单精子注射（intracytoplasmic sperm injection， ICSI）助孕，且取卵后第3天有可利用胚胎的高龄女性（年龄≥ 38岁），根据方案选择的不同分为PGT-A组和IVF/ICSI组，采用1∶1倾向性评分匹配（propensity score matching，PSM），主要观察指标为每取卵周期的累积活产率，通过Cox回归探究累积活产率的影响因素。 结果 经PSM后，PGT-A组和IVF/ICSI组各有192例，PGT-A组的流产次数更多（2次vs.1次，P < 0.001），无可移植周期占比较高（24.48%）。PGT-A组每移植周期的临床妊娠率、活产率更高（59.42% vs. 32.96%，P < 0.001；44.93% vs. 19.63%，P < 0.001）；与PGT-A组相比，IVF/ICSI组每取卵周期的乐观估计累积妊娠率更高（65.62% vs. 51.56%，P = 0.005）。根据Cox回归结果进一步对年龄（38 ≤ 年龄 < 41岁组、41 ≤ 年龄 < 43岁组和≥ 43岁组）、AMH（AMH < 1.2 ng/mL组和AMH ≥ 1.2 ng/mL组）和流产次数（流产次数< 2次组和流产次数≥ 2次组）进行亚组分析。在这3个亚组中，除年龄≥ 43岁组，其他各亚组里PGT-A组的临床妊娠率、活产率高于IVF/ICSI组，差异有统计学意义（P < 0.05）。年龄≥ 43岁亚组，IVF/ICSI组的早期流产率更高（77.78% vs. 18.18%，P = 0.012）；同时，该亚组PGT-A组的无可移植周期占比高达56.76%。对于AMH < 1.2 ng/mL或流产次数 ≥ 2的患者，IVF/ICSI组每取卵周期的乐观估计累积妊娠率高于PGT-A组（47.22% vs. 30.56%，P = 0.040；65.17% vs. 51.54%，P = 0.045）。而在41 ≤ 年龄 < 43岁的女性中，PGT-A组每取卵周期的乐观估计累积活产率高于IVF/ICSI组（47.50% vs. 23.40%，P = 0.018）。 结论 对于41 ≤ 年龄 < 43岁的不孕女性，行PGT-A助孕每取卵周期的累积活产率高于行IVF/ICSI，更推荐该类人群行PGT-A助孕。

Objective To analyze the cumulative assisted reproductive outcomes and influencing factors of different assisted reproductive protocols in female patients aged 38 years or older who are undergoing their first fertility treatment with available embryos on day 3 after oocyte retrieval. Methods This study was a retrospective cohort study. It included elderly women （aged ≥ 38 years） who underwent their first cycle of either preimplantation genetic testing for aneuploidy （PGT-A） or in vitro fertilization/intracytoplasmic sperm injection （IVF/ICSI） for assisted reproduction at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University between January 2019 and June 2023， and had usable embryos available on the third day after oocyte retrieval. The participants were divided into two groups according to the protocol they selected： the PGT-A group and the IVF/ICSI group. A 1∶1 propensity score matching was performed to match the two groups （PGT-A group vs. IVF/ICSI group）. The primary observation indicator was the cumulative live-birth rate per oocyte retrieval cycle， and the influencing factors of cumulative live birth were further investigated through Cox regression. Results After PSM， there were 192 cases in both the PGT-A group and the IVF/ICSI group. The PGT-A group experienced a greater number of miscarriages （2 vs. 1， P < 0.001）， and the proportion of non-transplantable cycles was relatively high （24.48%）. The PGT-A group also showed higher clinical pregnancy rates and live birth rates per embryo transfer cycle （59.42% vs. 32.96%， P < 0.001； 44.93% vs. 19.63%， P < 0.001）. In comparison with the PGT-A group， the optimistically-estimated cumulative pregnancy rate for each oocyte retrieval cycle in the IVF/ICSI group was higher （65.62% vs. 51.56%， P = 0.005）. Subsequently， subgroup analyses were carried out according to age （categorized as 38 - 40， 41 - 42， and ≥ 43 years）， AMH level （< 1.2 ng/mL vs. ≥ 1.2 ng/mL）， and number of prior miscarriages （< 2 vs. ≥ 2）， as indicated by the Cox regression findings. Among these three subgroups， the PGT-A group presented significantly higher clinical pregnancy and live birth rates compared to the IVF/ICSI group in all subgroups （P < 0.05）， except for patients aged ≥ 43 years. In the subgroup of women aged ≥ 43 years， the IVF/ICSI group had a significantly higher early miscarriage rate （77.78% vs. 18.18%， P = 0.012）. Additionally， in this subgroup， the proportion of cycles with no transplantable embryos in the PGT-A group reached as high as 56.76%. Among patients with AMH < 1.2 ng/mL or ≥ 2 prior miscarriages， the optimistically estimated cumulative pregnancy rate per oocyte retrieval cycle was significantly higher in the IVF/ICSI group compared to the PGT-A group （47.22% vs. 30.56%， P = 0.040； 65.17% vs. 51.54%， P = 0.045， respectively）. Among women aged 41 to 42 years， the optimistically estimated cumulative live birth rate per oocyte retrieval cycle was significantly higher in the PGT-A group （47.50% vs. 23.40%， P = 0.018）. Conclusions For infertile women aged 41 - 42 years， the cumulative live birth rate per oocyte retrieval cycle is significantly higher with PGT-A-assisted reproduction compared to IVF/ICSI. Consequently， PGT-A is more strongly recommended for this population.