The study compared preimplantation genetic testing for aneuploidy (PGT-A) with intracytoplasmic sperm injection (ICSI) alone in 450 couples with severe male infertility at four Chinese reproductive medicine centers. Couples were randomized 1:1 into PGT-A (225 couples) and non-PGT-A (225 couples) groups, with testing performed on blastocysts before transfer. The live birth rate after the first embryo transfer was 48.4% (109/225) in the PGT-A group and 46.2% (104/225) in the non-PGT-A group (odds ratio 1.09, 95% CI 0.76-1.58, P=0.64). The cumulative rate of live births within three transfer cycles was 60.4% (136/225) in the PGT-A group and 60.9% (137/225) without PGT-A (odds ratio 0.98, 95% CI 0.67-1.43, P=0.92). However, PGT-A significantly reduced pregnancy loss after the first transfer to 5.8% (13/225) versus 19.1% (43/225) without PGT-A (odds ratio 0.26, 95% CI 0.14-0.50, P<0.001) and cumulative loss to 11.1% (25/225) versus 22.7% (51/225) (odds ratio 0.43, 95% CI 0.25-0.72, P=0.001). The study concluded that PGT-A did not improve live birth rates but reduced pregnancy loss.