Bulletti Francesco M, Sciorio Romualdo, Conforti Alessandro, De Luca Roberto, Bulletti Carlo, Palagiano Antonio, Berrettini Marco, Scaravelli Giulia, Pierson Roger A
Fertility Medicine and Gynecological Endocrinology Unit, Department Woman Mother Child, Lausanne University Hospital, Lausanne, Switzerland.
Department Neuroscience, Reproductive Science and Odontostomatology University of Naples Federico II, Naples, Italy.
Front Endocrinol (Lausanne). 2025 Feb 14;15:1429193. doi: 10.3389/fendo.2024.1429193. eCollection 2024.
Infertility is characterized by the failure to conceive after 12 months of unprotected sexual intercourse. In assisted reproduction technologies (ARTs), fertilization and embryo transfer (IVF-ET) are pivotal, with the quality of embryo quality essential for successful implantation.
This systematic review with meta-analysis aimed to explore the prevalence of embryonic factors involved in the implantation process, concentrating on the following research inquiries: 1) the implantation rates of euploid versus untested embryo transfers; 2) the efficiency of transferring good embryos in different age groups; 3) the impact of age on good embryo transfers to gestational carriers; and 4) the transfer of donated gametes/embryos. The goal is to identify critical points in implantation to improve therapies.
A comprehensive literature search identified 1474 relevant papers, 11 of which met the inclusion criteria. The information was gathered using a standardized form, and the risk of bias was evaluated. A meta-analysis of subgroups to determine euploid embryo transfer efficiency was conducted to synthesize and explore the results. Furthermore, data extracted from registries document the persistent secondary role of extraembryonic determinants in successful implantation.
The meta-analysis demonstrated that preimplantation genetic testing for aneuploidy (PGT-A) significantly increased the odds of implantation. Age was found to influence extraembryonic factors, with older women experiencing reduced embryo implantation as gestational carriers. However, the overall incidence of extraembryonic factors was low. This review highlights the need to focus on PGT-A, diagnostic hysteroscopy, and endometrial receptivity for improving implantation rates.
Implantation success in ARTs largely depends on embryo euploidy. While achieving three euploid embryos greatly increases success rates, it is challenging in older women. Extraembryonic factors, although present, have a marginal impact. Subsequent studies ought to concentrate on modulating endometrial responses immunologically and developing algorithms to improve the precision of predicting implantation success; as well as the timing of endometrial receptivity and the occurrence of dormant embryo phenomena also warrants further investigation.
不孕症的特征是在无保护性交12个月后仍无法受孕。在辅助生殖技术（ART）中，受精和胚胎移植（IVF-ET）至关重要，胚胎质量对于成功着床至关重要。
本系统评价及荟萃分析旨在探讨着床过程中涉及的胚胎因素的发生率，重点关注以下研究问题：1）整倍体胚胎移植与未检测胚胎移植的着床率；2）不同年龄组移植优质胚胎的效率；3）年龄对向妊娠载体移植优质胚胎的影响；4）捐赠配子/胚胎的移植。目标是确定着床的关键点以改善治疗方法。
全面的文献检索共识别出1474篇相关论文，其中11篇符合纳入标准。使用标准化表格收集信息，并评估偏倚风险。进行亚组荟萃分析以确定整倍体胚胎移植效率，以综合和探索结果。此外，从登记处提取的数据记录了胚胎外决定因素在成功着床中的持续次要作用。
荟萃分析表明，非整倍体植入前基因检测（PGT-A）显著增加了着床几率。发现年龄会影响胚胎外因素，年龄较大的女性作为妊娠载体时胚胎着床率降低。然而，胚胎外因素的总体发生率较低。本综述强调需要关注PGT-A、诊断性宫腔镜检查和子宫内膜容受性以提高着床率。
ART中的着床成功很大程度上取决于胚胎整倍体。虽然获得三个整倍体胚胎可大大提高成功率，但对年龄较大的女性来说具有挑战性。胚胎外因素虽然存在，但影响较小。后续研究应集中在免疫调节子宫内膜反应和开发算法以提高预测着床成功的准确性；以及子宫内膜容受性的时机和休眠胚胎现象的发生也值得进一步研究。
