Background <p>Recurrent pregnancy loss (RPL) affects 1–2% of women worldwide and poses diagnostic and therapeutic challenges due to its multifactorial causes. Preimplantation genetic testing for aneuploidy (PGT-A) aims to improve outcomes by selecting euploid embryos, but its benefits in RPL patients remain uncertain. This study compared the effectiveness of PGT-A versus conventional in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) in improving cumulative live birth rates (CLBRs) and explored the effects of maternal age and miscarriage frequency on treatment efficacy.</p> Methods <p>This study included RPL patients who underwent their first oocyte retrieval and at least one single-blastocyst transfer between June 2016 and June 2022. Patients were divided into an IVF/ICSI group (<i>n</i> = 156) and a PGT-A group (<i>n</i> = 198). Primary outcomes included the CLBR, live birth rate, miscarriage rate, time to live birth, and perinatal outcomes.</p> Results <p>After three single-blastocyst transfer cycles, no significant difference was observed in the conservative CLBR between the PGT-A and IVF/ICSI groups (Cycle 1: adjusted odds ratio [aOR] = 0.78, 95% confidence interval [CI]: 0.49–1.23; Cycle 2: aOR = 0.81, 95% CI: 0.51–1.29; Cycle 3: aOR = 0.96, 95% CI: 0.60–1.53; all <i>P</i> &gt; 0.05). Similarly, the optimal CLBR after three transfer cycles showed no significant difference between the two groups (<i>P</i> &gt; 0.05). However, the time to live birth was significantly longer in the PGT-A group than in the IVF/ICSI group (adjusted hazard ratio = 0.56, 95% CI: 0.42–0.75, <i>P</i> &lt; 0.05). Other outcomes were comparable between the two groups.</p> Conclusion <p>PGT-A did not significantly improve the CLBR or shorten the time to live birth in RPL patients. Further research is needed to elucidate its role and identify potential subgroups within the RPL population that may benefit from PGT-A.</p>