What Is the Clinical Impact of the Endometrial Receptivity Array in PGT-A and Oocyte Donation Cycles?

摘要

Endometrial receptivity is a critical factor to likelihood of implantation after embryonic transfer (ET), yet potential bio-markers for receptivity have thus far failed at reliably predicting clinical pregnancy. Recent evidence has suggested that the Endometrial Receptivity Analysis (ERA), a microarray-based test to evaluate endometrial gene expression, may be valuable in prediction of endometrial receptivity and recommendation of endometrial preparation before ET. This retrospective cohort study aimed to evaluate the influence of the ERA test on the reproductive outcomes in patients with previously documented implantation failure (IF) in IVF with preimplantation testing for embryonic aneuploidy (PGT-A) or oocyte donation cycles. Patients in the intervention group had previous IF and underwent an ERA test before March 2018 and a post-ERA ET between October 2012 and December 2018. The intervention group was stratified into the Euploid-ET group if the patient had >= 1 prior failed euploid embryo transfer and the Donor-ET group if the patient had >= 2 prior failed ET from reception cycles without PGT-A. The control cohort included patients with prior IF who underwent ET without a prior ERA test during the same study period. Only blastocyst stage transfers were included in this analysis. The ERA test was performed in a hormone replacement therapy mock cycle. ERA test results were divided to receptive, prereceptive, or postreceptive, and recommendations regarding endometrial preparation were established based on these classifications. A total of 333 patients were included in this study, and the proportion of ERA tests performed was equal in the Euploid-ET group (16.8%; 24/143) and in the Donor-ET group (16.8%; 32/190). The total pregnancy rate was 68.5%(98/143) and 60.0% (114/190) in the Euploid-ET group and Donor-ET group, respectively. A lower implantation rate (IR) (26.8% [12.3%-41.4%] vs 57.2% [50.1%-64.3%]) and clinical pregnancy rate (CPR) (34.4% vs 65.2%; P = 0.001) were found in the Donor-ET ERA group compared with the control. Similarly, a lower IR and CPR was found in the Euploid-ET ERA group compared with the control, although this difference was not statistically significant. Multivariate analysis revealed that transferring top quality embryos (adjusted odds ratio, 3.93; 95% confidence interval, 2.03-7.57) and not performing the ERA test (adjusted odds ratio, 3.60; 95% confidence interval, 1.46-8.86) were associated with increased CP. The results show that the ERA test did not significantly improve pregnancy outcomes in patients with at least 1 previously failed Euploid-ETor at least 2 previously failed Donor-ETs. The results showed a significant decrease in CPR associated with the Donor-ET ERA test. The small sample size of the ERA subgroups in this analysis could have influenced these results, and prospective studies with larger sample sizes are needed to elucidate the effects of personalized embryo transfer on reproductive outcomes.