Impact of Anti-Endometrial Antibodies on IVF Implantation and Pregnancy Outcomes: A Retrospective Study

Xiaoxuan Yang, Yan Su, Yaping Guo, Mianqiu Zhang, Juan Zhang, Xiaojing Hou, Shuangshuang Zhao, Huiqing An, Xiufeng Ling, Rong Shen
American journal of reproductive immunology (New York, N.Y. : 1989) · 2026 · vol. 95(1) , pp. e70202 · doi:10.1111/aji.70202 · PMID:41508781
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⚙ AI-generated summary by claude@2026-06, 2026-06-11 ⓘ

This retrospective study found that anti-endometrial antibodies were associated with significantly lower implantation rates in IVF patients, though clinical pregnancy, ongoing pregnancy, and miscarriage rates were not significantly different.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-11 · read from full text ⓘ

This retrospective study investigated whether anti-endometrial antibodies (EMAb) affect IVF implantation and pregnancy outcomes, comparing 47 EMAb-positive versus 166 EMAb-negative oocyte retrieval cycles matched using propensity score matching to balance key clinical factors. Across infertility-related, oocyte/embryo-related indicators, and reported endometriosis incidence, groups were broadly similar; however, EMAb-positive cycles had a significantly lower implantation rate (10.3 percentage points lower, p = 0.047) and a non-significant reduction in clinical pregnancy rate (8.2 points lower, p = 0.234). Ongoing pregnancy and miscarriage rates did not differ significantly, suggesting that miscarriage risk was not increased once implantation occurred. The study’s main limitation is its retrospective design and the relatively limited sample size, and it does not provide mechanistic data on how EMAb may influence IVF outcomes. This paper is centrally about endometriosis through its focus on anti-endometrial antibodies in IVF patients and its explicit reporting of endometriosis incidence as part of the comparative analysis of pregnancy outcomes.

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Abstract

PROBLEMS: To investigate the impact of anti-endometrial antibodies (EMAb) on pregnancy outcomes in infertile patients undergoing in vitro fertilization (IVF) and to assess the potential value of personalized treatment strategies. METHOD OF STUDY: A total of 47 EMAb-positive and 166 EMAb-negative oocyte retrieval cycles were retrospectively included following propensity score matching (PSM) to control for basic clinical characteristics influencing pregnancy outcomes. The two groups were compared in terms of various aspects closely associated with IVF outcomes. Pregnancy outcomes were assessed based on implantation, clinical pregnancy, miscarriage, and ongoing pregnancy rates. RESULTS: No significant differences were found between the two groups regarding infertility-related clinical characteristics, oocyte- and embryo-related indicators, endometriosis incidence, and so forth. Compared with the EMAb-negative group, the implantation rate in the EMAb-positive group was lower by 10.3 percentage points (p = 0.047), whereas the 8.2-point lower clinical pregnancy rate did not reach statistical significance (p = 0.234). There were no significant differences in ongoing pregnancy and miscarriage rates between the two groups. CONCLUSIONS: Our study observed that the presence of EMAb was associated with less favorable IVF outcomes, primarily reflected in lower implantation and clinical pregnancy rates. However, once the implantation was successful, the risk of miscarriage did not increase. These findings suggest a potential role for EMAb screening in guiding personalized treatment strategies, such as increasing the number of embryos transferred or using immunosuppressive agents, to improve IVF outcomes. Future research should involve more extensive and diverse populations to explore the mechanisms of action of EMAb and their impact on IVF treatment outcomes.
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Abstract

Problems To investigate the impact of anti-endometrial antibodies (EMAb) on pregnancy outcomes in infertile patients undergoing in vitro fertilization (IVF) and to assess the potential value of personalized treatment strategies.

Method

of Study A total of 47 EMAb-positive and 166 EMAb-negative oocyte retrieval cycles were retrospectively included following propensity score matching (PSM) to control for basic clinical characteristics influencing pregnancy outcomes. The two groups were compared in terms of various aspects closely associated with IVF outcomes. Pregnancy outcomes were assessed based on implantation, clinical pregnancy, miscarriage, and ongoing pregnancy rates.

Results

No significant differences were found between the two groups regarding infertility-related clinical characteristics, oocyte- and embryo-related indicators, endometriosis incidence, and so forth. Compared with the EMAb-negative group, the implantation rate in the EMAb-positive group was lower by 10.3 percentage points (p = 0.047), whereas the 8.2-point lower clinical pregnancy rate did not reach statistical significance (p = 0.234). There were no significant differences in ongoing pregnancy and miscarriage rates between the two groups.

Conclusions

Our study observed that the presence of EMAb was associated with less favorable IVF outcomes, primarily reflected in lower implantation and clinical pregnancy rates. However, once the implantation was successful, the risk of miscarriage did not increase. These findings suggest a potential role for EMAb screening in guiding personalized treatment strategies, such as increasing the number of embryos transferred or using immunosuppressive agents, to improve IVF outcomes. Future research should involve more extensive and diverse populations to explore the mechanisms of action of EMAb and their impact on IVF treatment outcomes. Conflicts of Interest The authors declare no conflicts of interest. Data Availability Statement The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Condition tags

endometriosisinfertility

MeSH descriptors

Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies Autoantibodies

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