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.

中文翻译：

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评估子宫内膜容受性测定和非整倍体的植入前基因检测以克服复发性植入失败。

目的

评估子宫内膜容受性阵列 (ERA) 和非整倍体植入前基因检测 (PGT-A) 在重度和中度复发性植入失败 (RIF) 患者中的临床实用性。

设计

在至少 3 次单胚胎移植中移植 3 个或更多或 5 个或更多胚胎后未能实现着床的患者进行了一项回顾性多中心队列研究；患者分别被分类为中度或重度 RIF。之前 RIF 的患者根据他们接受的测试进行比较：PGT-A、ERA 或 PGT-A+ERA 与没有测试的对照组。每次胚胎移植的平均植入率和持续妊娠率被认为是主要结果。进行多元逻辑回归分析并计算调整后的 OR 以控制可能的偏倚。

结果

在属于中等RIF组的2110例患者中，PGT-A后接受整倍体胚胎移植的患者着床率高于未接受整倍体胚胎移植的患者。此外，PGT-A 组的持续妊娠率显着更高。对重度 RIF 组的 488 名患者测量的相同结果没有显示任何统计学上的显着改善。ERA 测试的使用似乎没有显着改善两组的结果。

结论

PGT-A 可能对中度复发性植入失败患者有益，但对严重病例无效。在目前的发展水平上，ERA 似乎对 RIF 患者没有临床意义。