P-533 Comparison of Endometrial Receptivity Array (ERA) with Preimplantation genetic testing (PGT) versus ERA alone in improving outcomes in Recurrent implantation failure.
Authors: Kaur S , Gedela D R , Mantravadi K C , Yakasiri V S 
Published: June 2023

Abstract

Study question
Whether addition of Preimplantation Genetic Testing for aneuploidy (PGT-A) to Endometrial Receptivity Array (ERA) helps in improving success rates in Recurrent Implantation Failure (RIF) patients.

Summary answer
Addition of PGT-A intervention to ERA in RIF patients did not improve outcomes.

What is known already
RIF causes great emotional stress and financial burden for the infertile couple. Successful implantation requires a synchronous interaction between a competent blastocyst and a receptive endometrium. Though ERA, as a measure to assess window of implantation (WOI), is around a decade old, its role in improving success rates in patients with RIF is still controversial. PGT-A, as a tool for selecting euploid embryos, though has shown to be beneficial in women with advanced maternal age, its role in improving success rates in RIF needs further evaluation.

Study design, size, duration
This is a multicenter retrospective cohort study carried out from September 2015 till September 2022. 285 patients with RIF with previous failed transfers with ≥ 3 good quality embryos were included.

Participants/materials, setting, methods
285 patients with RIF were divided into 2 groups. Group 1 underwent PGT-A and Personalised Embryo Transfer (pET) guided by ERA and Group 2 underwent only ERA followed by pET. In Group 1 patients, embryo biopsy was done on day 5 and day 6 blastocyst before cryopreservation and NGS platform was used to detect euploid embryos. Both groups then underwent ERA followed by pET in the next cycle.

Main results and the role of chance
In total of 285 RIF patients studied, 59.2% patients showed displaced WOI. 91.7% ERA reports were pre-receptive. Group 1 included 137 patients and Group 2 had 148 patients & baseline characteristics were similar in both the groups. Group 1 had more self transfer cycles, i.e. 76.7% self and 17.2% donor oocytes, as compared to Group 2 with 40.2% self and 30.7% donor oocyte cycles. The implantation rate (IR), live birth rate (LBR), miscarriage rate and cumulative LBR were similar in both the groups. Higher Pregnancy rate (PR) in Group 2 (70.9% vs 57.83%) could be attributed to higher donor cycles in this group. Multiple gestation rate was also higher in Group 2 (31.49% vs 11.21%) as 2 blastocysts were transferred in most cycles in group 2 compared to Single embryo transfer(SET) in most cycles in Group 1. As PR was higher in ERA group, subgroup analysis of self gamete transfers and donor oocyte transfers was also done, which showed similar PR, IR and LBR in both the groups. Hence, PGT failed to show any value in improving pregnancy outcomes in RIF.

Limitations, reasons for caution
Retrospective study design.

Wider implications of the findings
The role of PGT in improving clinical outcomes in RIF patients needs to be studied in larger prospective studies. In our study, ERA as an intervention improved outcomes in RIF.

Trial registration number
not applicable