Objectives: To evaluate whether preimplantation genetic testing for aneuploidy (PGT-A) can improve pregnancy and neonatal outcomes for patients with limited good-quality embryos. Design: Retrospective cohort study. Setting: University hospital. Population: A total of 1,553 patients who intended to pursue PGT-A for the first time but obtained only two or less good-quality embryos on day 3 after oocyte retrieval were divided into two groups: 997 in the PGT-A group and 556 in the drop-out group of withdrawing PGT-A due to poor embryological outcome. Results: After adjusting for potential confounding factors, PGT-A group exhibited significantly lower cumulative rates of biochemical pregnancy (19.96% vs. 30.22%, P-adj < 0.001), clinical pregnancy (17.55% vs. 23.38%, P-adj < 0.001) and live birth (14.14% vs. 16.19%, P-adj = 0.005) per oocyte retrieval and longer median time to pregnancy and live birth compared with drop-out group. However, significant increases in rates of biochemical pregnancy (72.16% vs. 35.50%, P-adj < 0.001), clinical pregnancy (61.86% vs. 26.98%, P-adj < 0.001), and live birth (48.45 vs. 18.26%, P-adj < 0.001) per transfer were found in the PGT-A group. No significant differences were observed in cumulative miscarriage and ectopic pregnancy rates, number of ETs needed per live birth and neonatal outcomes. Conclusion: PGT-A failed to improve cumulative live birth rate or shorten time to pregnancy, but optimized pregnancy outcomes per transfer for patients with limited good-quality embryos. Keywords: preimplantation genetic testing for aneuploidy, cumulative live birth rate, live birth rate per transfer, neonatal outcomes