Department of Obstetrics and Gynecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC, Canada.
Olive Fertility Centre, 555 West 12th Avenue #300, Vancouver, BC, V5Z 3X7, Canada.
J Assist Reprod Genet. 2018 Apr;35(4):683-692. doi: 10.1007/s10815-017-1112-2. Epub 2018 Jan 11.
Endometrial receptivity issues represent a potential source of implantation failure. The aim of this study was to document our experience with the endometrial receptivity array (ERA) among patients with a history of euploid blastocyst implantation failure. We investigated whether the contribution of the endometrial factor could be identified with the ERA test and if actionable results can lead to improved outcomes.
A retrospective review was performed for 88 patients who underwent ERA testing between 2014 and 2017. Reproductive outcomes were compared for patients undergoing frozen embryo transfer (FET) using a standard progesterone protocol versus those with non-receptive results by ERA and subsequent FET according to a personalized embryo transfer (pET) protocol.
Of patients with at least one previously failed euploid FET, 22.5% had a displaced WOI diagnosed by ERA and qualified for pET. After pET, we found that implantation and ongoing pregnancy rates were higher (73.7 vs. 54.2% and 63.2 vs. 41.7%, respectively) compared to patients without pET, although differences were not statistically significant.
Our experience demonstrates that a significant proportion of patients with a history of implantation failure of a euploid embryo have a displaced WOI as detected by the ERA. For these patients, pET using a modified progesterone protocol may improve the outcomes of subsequent euploid FET. Larger randomized studies are required to validate these results.
子宫内膜容受性问题是胚胎着床失败的一个潜在原因。本研究旨在记录我们在既往整倍体胚胎着床失败患者中应用子宫内膜容受性分析（ERA）的经验。我们研究了 ERA 检测是否能识别子宫内膜因素的作用，以及是否能得到有意义的结果以改善结局。
对 2014 年至 2017 年间进行 ERA 检测的 88 例患者进行了回顾性分析。比较了采用标准孕激素方案行冻融胚胎移植（FET）的患者与因 ERA 检测结果为非容受性而采用个体化胚胎移植（pET）方案行 FET 的患者的生殖结局。
既往至少有一次整倍体 FET 失败的患者中，22.5%经 ERA 诊断为 WOI 移位，符合 pET 标准。pET 后，我们发现着床率和持续妊娠率更高（分别为 73.7%比 54.2%和 63.2%比 41.7%），尽管差异无统计学意义。
我们的经验表明，既往整倍体胚胎着床失败的患者中有相当一部分存在 ERA 检测到的 WOI 移位。对于这些患者，采用改良孕激素方案的 pET 可能会改善后续整倍体 FET 的结局。需要更大规模的随机研究来验证这些结果。
