P-471 Impact of endometrial receptivity analysis on pregnancy outcomes In patients undergoing embryo transfer: A systematic review and meta-analysis
Authors: Irene Z , Monzó Miralles A M , Hidalgo Mora J J , Marcos Puig B , Rubio Rubio J M 
Published: June 2023

Abstract

Study question
To analyze the influence of endometrial receptivity analysis (ERA) on embryo transfer (ET) results in patients undergoing in vitro fertilization (IVF) treatment.

Summary answer
We identified thirteen studies, including 14396 patients. No differences were observed between patients undergoing ERA test and those not undergoing ERA test prior to ET.

What is known already
Previous studies studying ERA’s efficacy and safety have provided conflicting results. Therefore there is an urgent need to provide a quantitative and comprehensive pool data.

Study design, size, duration
A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines. The primary endpoint was live birth. Secondary endpoints included positive pregnancy test, biochemical pregnancy, implantation rate, clinical pregnancy and miscarriage. A total of 13 studies including 14396 patients were selected and included in this systematic review and meta-analysis.Electronic search was performed on MEDLINE and Embase databases (from inception to December 2022).

Participants/materials, setting, methods
Eligible studies were: (1) studies including patients for IVF treatment; (2) investigations comparing the use of ERA test vs non-test; (3) availability of pregnancy outcome data. For dichotomous outcomes, the odds ratios (ORs) with 95% confidence intervals (CIs) were calculated from the available data and trial-specific ORs were combined with the DerSimonian and Laird random effects model with the estimate of heterogeneity being taken from the Mantel-Haenszel model.

Main results and the role of chance
Of the 1492 citations screened, 7 were excluded as they were considered non-relevant, 1240 were excluded because of a preclinical design (no ERA test was used to assess endometrial receptivity), 3 because of different clinical outcomes. 14 studies were notachieved on humans, 19 included other diseases and 122 for others reasons. Therefore, a total of 13 studies including 14396 patients were selected and included in this systematic review and meta-analysis.
No differences were observed between patients undergoing ERA test and those not undergoing ERA testprior to ET in terms of live birth (OR 1.00, 95% CI 0.63-1.58, I2=92.7%), clinical pregnancy (OR 1.23, 95% CI 0.93-1.63, I2=85.4%), biochemical pregnancy (OR 0.83, 95% CI 0.46-1.49, I2=87%), positive pregnancy test (OR 0.99, 95% CI 0.80-1.22, I2=0%), miscarriage (OR 0.91, 95% CI 0.62-1.34, I2=67.1%) and implantation rate (OR 1.27, 95% CI 0.57-2.88, I2=89.9%).
Two studies had a randomized design, three had a prospective cohort design and eight studies had a retrospective cohort design. All studies included patients undergoing ET in blastocysts stage with a Gardner grade BB or higher except one that took in consideration also cleavage stage. In two studies fresh and frozen ET was performed, in the remaining studies only frozen embryos were transferred.

Limitations, reasons for caution
Our study should be interpreted in light of some limitations. This is a study-level meta-analysis providing average treatment effects. The lack of patient-level-data prevents us from assessing the impact of baseline clinical characteristics and other changes in therapeutic strategies on treatment effects. However, all-stratified analyses are combined with meta-regression analyses.

Wider implications of the findings
In our investigation, after pooling data from 13 studies and 14386 patients; the risk of live birth, positive pregnancy test, biochemical pregnancy, miscarriage, clinical pregnancy and implantation rate did not differ between patients undergoing ERA test and those not undergoing ERA. Therefore, the utility of ERA should be revisited.

Trial registration number
CRD42022332891