OBJECTIVE: 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. DESIGN: Retrospective cohort study. SUBJECTS: 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. EXPOSURE: 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. MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSION: 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.