Evaluation of the endometrial receptivity assay and the preimplantation genetic test for aneuploidy in overcoming recurrent implantation failure

Abstract

Purpose: To evaluate the clinical usefulness of the endometrial receptivity array (ERA) and the preimplantation genetic test for aneuploidy (PGT-A) in patients with severe and moderate recurrent implantation failure (RIF).

Design: A retrospective multicenter cohort study was conducted in patients who failed to achieve implantation following transfer of 3 or more or 5 or more embryos in at least three single embryo transfers; patients were classified as moderate or severe RIF, respectively. Patients with previous RIF were compared based on the testing they received: PGT-A, ERA, or PGT-A+ERA versus a control group with no testing. Mean implantation rate and ongoing pregnancy rates per embryo transfer were considered primary outcomes. Multiple logistic regression analysis was performed and adjusted ORs were calculated to control possible bias.

Results: Of the 2110 patients belonging to the moderate RIF group, those who underwent transfer of euploid embryos after PGT-A had a higher implantation rate than those who did not. Additionally, the PGT-A group had a significantly higher rate of ongoing pregnancy. The same outcomes measured for the 488 patients in the severe RIF group did not reveal any statistically significant improvements. The use of the ERA test did not appear to significantly improve outcomes in either group.

Conclusions: PGT-A may be beneficial for patients with moderate recurrent implantation failure but not for severe cases. At its current level of development, ERA does not appear to be clinically useful for patients with RIF.

Keywords: ERA test; Embryo transfer; Endometrial receptivity; IVF cycles; Implantation rate; Infertility; Ongoing pregnancy rate; PGT-A; Pregnancy; Recurrent implantation failure; Window of implantation.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1

Patient selection flowchart. IVF in vitro fertilization, M-RIF moderate recurrent implantation failure, S-RIF severe recurrent implantation failure, pET personalized embryo transfer, ERA endometrial receptivity assay, PGT-A preimplantation genetic testing for aneuploidy