Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
권호 표지
DOI QR코드

DOI QR Code

Factors affecting the ongoing pregnancy rate in women with repeated implantation failure undergoing an endometrial receptivity array

  • Hyun Kyoung Lee (iORA Fertility Clinic) ;
  • Kyoung Yong Moon (iORA Fertility Clinic) ;
  • Haerin Paik (Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Byung Chul Jee (Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2023.05.24
  • Accepted : 2023.07.25
  • Published : 2023.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: In this retrospective study, we analyzed factors influencing the ongoing pregnancy rate (PR) in women with repeated implantation failure (RIF) undergoing embryo transfer with endometrial receptivity array (ERA). Methods: Eighty-three consecutive personalized embryo transfers (pETs) with ERA, from 54 women with RIF, were selected from June 2020 to April 2022. Vitrified blastocyst transfer was timed based on ERA results. Results: The ongoing PR per pET was 33.7%. Using ERA, the endometrium was identified as pre-receptive in 26 cycles, early receptive in 25 cycles, receptive in 31 cycles, and late receptive in one cycle. With cycles categorized into three receptivity phases (pre-receptive, early receptive, or receptive), no significant differences were found in the clinical PR (27.3%, 55.6%, and 40%, respectively) or ongoing PR (9.1%, 55.6%, and 40%, respectively) after a single blastocyst transfer. Similarly, no significant differences were observed in the clinical PR or ongoing PR after the transfer of two or more blastocysts. Among women with ongoing pregnancy relative to those without, age at first pET was significantly lower (35 years vs. 39 years, p=0.001), while blastocyst score (23 vs. 18, p=0.012) and the proportion of blastocyst scores >18 (71.4% vs. 38.9%, p=0.005) were significantly higher. In multiple logistic regression analysis, the woman's age (odds ratio [OR], 0.814; 95% confidence interval [CI], 0.706 to 0.940; p=0.005) and blastocyst score >18 (OR, 3.052; 95% CI, 1.075 to 8.665; p=0.036) were identified as significant factors influencing ongoing pregnancy. Conclusion: In pET with ERA, ongoing pregnancy was closely associated with woman's age and blastocyst quality.

Keywords

References

  1. Forman EJ, Hong KH, Ferry KM, Tao X, Taylor D, Levy B, et al. In vitro fertilization with single euploid blastocyst transfer: a randomized controlled trial. Fertil Steril 2013;100:100-7. 
  2. Diaz-Gimeno P, Ruoiz-Alonso M, Blesa D, Simon C. Transcriptomics of the human endometrium. Int J Dev Biol 2014;58:127-37. 
  3. Horcajadas JA, Pellicer A, Simon C. Wide genomic analysis of human endometrial receptivity: new times, new opportunities. Hum Reprod Update 2007;13:77-86. 
  4. Simon C, Gomez C, Cabanillas S, Vladimirov I, Castillon G, Giles J, et al. A 5-year multicentre randomized controlled trial comparing personalized, frozen and fresh blastocyst transfer in IVF. Reprod Biomed Online 2020;41:402-15. 
  5. Riestenberg C, Kroener L, Quinn M, Ching K, Ambartsumyan G. Routine endometrial receptivity array in first embryo transfer cycles does not improve live birth rate. Fertil Steril 2021;115:1001-6. 
  6. Bergin K, Eliner Y, Duvall DW Jr, Roger S, Elguero S, Penzias AS, et al. The use of propensity score matching to assess the benefit of the endometrial receptivity analysis in frozen embryo transfers. Fertil Steril 2021;116:396-403. 
  7. Doyle N, Jahandideh S, Hill MJ, Widra EA, Levy M, Devine K. Effect of timing by endometrial receptivity testing vs standard timing of frozen embryo transfer on live birth in patients undergoing in vitro fertilization: a randomized clinical trial. JAMA 2022;328:2117-25. 
  8. Cozzolino M, Diaz-Gimeno P, Pellicer A, Garrido N. Evaluation of the endometrial receptivity assay and the preimplantation genetic test for aneuploidy in overcoming recurrent implantation failure. J Assist Reprod Genet 2020;37:2989-97. 
  9. Cozzolino M, Diaz-Gimeno P, Pellicer A, Garrido N. Use of the endometrial receptivity array to guide personalized embryo transfer after a failed transfer attempt was associated with a lower cumulative and per transfer live birth rate during donor and autologous cycles. Fertil Steril 2022;118:724-36. 
  10. Fodina V, Dudorova A, Erenpreiss J. Evaluation of embryo aneuploidy (PGT-A) and endometrial receptivity (ERA) testing in patients with recurrent implantation failure in ICSI cycles. Gynecol Endocrinol 2021;37(sup1):17-20. 
  11. Jia Y, Sha Y, Qiu Z, Guo Y, Tan A, Huang Y, et al. Comparison of the effectiveness of endometrial receptivity analysis (ERA) to guide personalized embryo transfer with conventional frozen embryo transfer in 281 chinese women with recurrent implantation failure. Med Sci Monit 2022;28:e935634. 
  12. Arian SE, Hessami K, Khatibi A, To AK, Shamshirsaz AA, Gibbons W. Endometrial receptivity array before frozen embryo transfer cycles: a systematic review and meta-analysis. Fertil Steril 2023;119:229-38. 
  13. Schoolcraft WB, Gardner DK, Lane M, Schlenker T, Hamilton F, Meldrum DR. Blastocyst culture and transfer: analysis of results and parameters affecting outcome in two in vitro fertilization programs. Fertil Steril 1999;72:604-9. 
  14. Ruiz-Alonso M, Blesa D, Diaz-Gimeno P, Gomez E, Fernandez-Sanchez M, Carranza F, et al. The endometrial receptivity array for diagnosis and personalized embryo transfer as a treatment for patients with repeated implantation failure. Fertil Steril 2013;100:818-24. 
  15. Mahajan N. Endometrial receptivity array: clinical application. J Hum Reprod Sci 2015;8:121-9. 
  16. Hashimoto T, Koizumi M, Doshida M, Toya M, Sagara E, Oka N, et al. Efficacy of the endometrial receptivity array for repeated implantation failure in Japan: a retrospective, two-centers study. Reprod Med Biol 2017;16:290-6. 
  17. Patel JA, Patel AJ, Banker JM, Shah SI, Banker MR. Personalized embryo transfer helps in improving in vitro fertilization/ICSI outcomes in patients with recurrent implantation failure. J Hum Reprod Sci 2019;12:59-66. 
  18. Neves AR, Devesa M, Martinez F, Garcia-Martinez S, Rodriguez I, Polyzos NP, et al. What is the clinical impact of the endometrial receptivity array in PGT-A and oocyte donation cycles? J Assist Reprod Genet 2019;36:1901-8. 
  19. Cohen AM, Ye XY, Colgan TJ, Greenblatt EM, Chan C. Comparing endometrial receptivity array to histologic dating of the endometrium in women with a history of implantation failure. Syst Biol Reprod Med 2020;66:347-54. 
  20. Bellver J, Marin C, Lathi RB, Murugappan G, Labarta E, Vidal C, et al. Obesity affects endometrial receptivity by displacing the window of implantation. Reprod Sci 2021;28:3171-80. 
  21. Ota K, Takahashi T, Mitsui J, Kuroda K, Hiraoka K, Kawai K. A case of discrepancy between three ERA tests in a woman with repeated implantation failure complicated by chronic endometritis. BMC Pregnancy Childbirth 2022;22:891. 
  22. Hong YH, Lee JM, Kim SK, Youm HW, Jee BC. Associations of post-warming embryo or blastocyst development with clinical pregnancy in vitrified embryo or blastocyst transfer cycles. Clin Exp Reprod Med 2020;47:140-6. 
  23. Raff M, Jacobs E, Voorhis BV. End of an endometrial receptivity array? Fertil Steril 2022;118:737. 
  24. Ben Rafael Z. Endometrial receptivity analysis (ERA) test: an unproven technology. Hum Reprod Open 2021;2021:hoab010. 
  25. Jia Y, Dong YJ, Sha YL, Cai SC, Diao LH, Qiu Z, et al. Effectiveness comparison between endometrial receptivity array, immune profiling and the combination in treating patients with multiple implantation failure. Am J Reprod Immunol 2022;87:e13513. 
  26. Ohara Y, Matsubayashi H, Suzuki Y, Takaya Y, Yamaguchi K, Doshida M, et al. Clinical relevance of a newly developed endometrial receptivity test for patients with recurrent implantation failure in Japan. Reprod Med Biol 2022;21:e12444. 
  27. He A, Zou Y, Wan C, Zhao J, Zhang Q, Yao Z, et al. The role of transcriptomic biomarkers of endometrial receptivity in personalized embryo transfer for patients with repeated implantation failure. J Transl Med 2021;19:176.