Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
Kameda IVF Clinic Makuhari, Makuhari, 261-8501, Japan.
BMC Pregnancy Childbirth. 2022 Dec 1;22(1):891. doi: 10.1186/s12884-022-05241-6.
Endometrial receptivity array (ERA) is used to determine the timing of embryo transfer (ET) synchronized with the window of implantation (WOI). The effectiveness and evaluation of ERAs in women with recurrent implantation failure remain controversial. We report the case of a patient with recurrent implantation failure that raises the issue of reproducibility of ERA tests.
A 36-year-old Japanese woman with secondary infertility who had previously given birth failed to conceive after three frozen-thawed embryo transfer (FET) cycles. An ERA test was conducted to confirm the WOI. The first ERA test was performed 125 h after progesterone exposure. The laboratory reported that the endometrium was in a non-receptive (post-receptive) phase, and recommended retesting 101 h after progesterone exposure. A simultaneous chronic endometritis (CE) test showed a score of 3. After the antibiotics administration to treat CE, the second ERA test was performed after 101 h of progesterone exposure. The laboratory reported that the endometrium had not reached the WOI and estimated the WOI to be 113 ± 3 h after progesterone exposure. The third ERA test was performed 113 h after progesterone exposure. The laboratory reported that the endometrium was in a non-receptive (pre-receptive) phase and estimated the WOI to be 137 ± 3 h after progesterone exposure. A CE test performed at the same time as the second and third ERA tests showed a score of 1 for the collected endometrium. According to the third ERA test results, the vitrified-warmed blastocyst was transferred at 137 h of progesterone exposure. Pregnancy was achieved and the patient had an uncomplicated vaginal delivery at 39 weeks. One year later, another pregnancy was achieved after FET at 137 h of progesterone exposure, and the patient delivered at 33 weeks due to an unexpected membrane rupture.
Because the results of the ERA test may vary in the presence of CE, CE should be diagnosed simultaneously with or before conducting ERA tests. If CE is diagnosed, ERA testing should be performed after treatment with antimicrobials or other drugs.
子宫内膜容受性阵列（ERA）用于确定胚胎移植（ET）与着床窗口期（WOI）同步的时间。ERA 在复发性着床失败女性中的有效性和评估仍存在争议。我们报告了一例复发性着床失败患者的病例，该病例提出了 ERA 测试可重复性的问题。
一名 36 岁的日本继发不孕女性，此前曾进行过三次冻融胚胎移植（FET）周期，但均未受孕。进行 ERA 测试以确认 WOI。第一次 ERA 测试在孕酮暴露后 125 小时进行。实验室报告称子宫内膜处于非接受（后接受）期，并建议在孕酮暴露后 101 小时重新测试。同时进行的慢性子宫内膜炎（CE）测试显示评分为 3 分。在使用抗生素治疗 CE 后，在孕酮暴露后 101 小时进行第二次 ERA 测试。实验室报告称子宫内膜尚未达到 WOI，并估计 WOI 在孕酮暴露后 113±3 小时。孕酮暴露后 113 小时进行第三次 ERA 测试。实验室报告称子宫内膜处于非接受（前接受）期，并估计 WOI 在孕酮暴露后 137±3 小时。同时进行的 CE 测试显示收集的子宫内膜评分为 1 分。根据第三次 ERA 测试结果，在孕酮暴露后 137 小时转移了冷冻-解冻的囊胚。妊娠成功，患者在 39 周时经阴道分娩。一年后，在孕酮暴露后 137 小时进行 FET 后再次妊娠，并因意外胎膜早破于 33 周分娩。
由于存在 CE 时 ERA 测试的结果可能会有所不同，因此应在进行 ERA 测试之前或同时诊断 CE。如果诊断出 CE，应在用抗生素或其他药物治疗后进行 ERA 测试。
