Impact of personalized embryo transfer based on endometrial receptivity assay on pregnancy outcomes in women with recurrent implantation failure: a retrospective study

Padmalatha Yarasi, Rekha Rajesh, Radhakrishnan Rajesh, Meenakshi Jain, Sahithya Desireddy, Indhumathi Pattubala, Preetam R. Yemme, Varnikha Rajesh, Varshikha Rajesh
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2025 · vol. 14(3) , pp. 852–855 · doi:10.18203/2320-1770.ijrcog20250517 · W4407958252
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This study found that personalized embryo transfer guided by endometrial receptivity assay significantly increased pregnancy and live birth rates in women with recurrent implantation failure.

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This retrospective study evaluated whether personalized embryo transfer (PET) guided by an endometrial receptivity assay (ERA) improves pregnancy outcomes in couples with recurrent implantation failure who had undergone two or more failed ICSI cycles with grade A blastocyst transfer. During standard hormone replacement therapy cycles, endometrial biopsies were analyzed using the ERA to classify patients into receptive, pre-receptive, or post-receptive phases, and subsequent PET cycles were adjusted based on those results. After ERA-guided PET, 93.94% of patients achieved pregnancy with an 80.65% live birth rate, and 69.81% were categorized as receptive at the ERA biopsy. A key limitation is that, as a retrospective design, it provides limited causal inference about effectiveness and is based on inclusion criteria limited to women with grade A blastocyst transfers. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Background: Recurrent implantation failure (RIF) poses a persistent challenge in assisted reproductive technology (ART), characterized by the repeated inability to achieve pregnancy following multiple embryo transfers. This retrospective study aimed to assess the impact of personalized embryo transfer (PET) guided by the endometrial receptivity assay (ERA) on pregnancy outcomes in couples experiencing RIF. Methods: The study included couples who had undergone two or more failed ICSI cycles despite transferring grade A blastocyst. Endometrial biopsies were obtained during standard HRT cycles and analyzed using the ERA, a genomic diagnostic tool that evaluates the transcriptomic signature of the endometrium to pinpoint the window of implantation (WOI). Subsequent PET cycles were tailored based on ERA results, categorizing patients into receptive, pre-receptive, or post-receptive phases. Results: Our findings revealed that 69.81% of patients were receptive, while 22.64% were pre-receptive and 7.55% were post-receptive. Following ERA-guided PET, 93.94% of patients achieved pregnancy, with a live birth rate of 80.65%. These results underscore the potential of this personalized approach to enhance ART success in challenging cases of RIF. Conclusions: These results contribute to advancing personalized medicine in reproductive health, emphasizing the importance of individualized treatment strategies based on the precise assessment of endometrial receptivity.
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Background

Recurrent implantation failure (RIF) poses a persistent challenge in assisted reproductive technology (ART), characterized by the repeated inability to achieve pregnancy following multiple embryo transfers. This retrospective study aimed to assess the impact of personalized embryo transfer (PET) guided by the endometrial receptivity assay (ERA) on pregnancy outcomes in couples experiencing RIF.

Methods

The study included couples who had undergone two or more failed ICSI cycles despite transferring grade A blastocyst. Endometrial biopsies were obtained during standard HRT cycles and analyzed using the ERA, a genomic diagnostic tool that evaluates the transcriptomic signature of the endometrium to pinpoint the window of implantation (WOI). Subsequent PET cycles were tailored based on ERA results, categorizing patients into receptive, pre-receptive, or post-receptive phases.

Results

Our findings revealed that 69.81% of patients were receptive, while 22.64% were pre-receptive and 7.55% were post-receptive. Following ERA-guided PET, 93.94% of patients achieved pregnancy, with a live birth rate of 80.65%. These results underscore the potential of this personalized approach to enhance ART success in challenging cases of RIF.

Conclusions

These results contribute to advancing personalized medicine in reproductive health, emphasizing the importance of individualized treatment strategies based on the precise assessment of endometrial receptivity. Metrics

References

Check JH, Check ML. Recurrent implantation failure: evaluation and treatment. Clin Exp Obstet Gynecol. 2015;42(4):405-13. DOI: https://doi.org/10.12891/ceog1690.2015 Haahr T, Erb K, Kolte AM, Laursen RJ. Endometrial Receptivity Assay in recurrent implantation failure: a systematic review and meta-analysis. BJOG Int J Obstet Gynaecol. 2021;128(2):216-25. Díaz-Gimeno P, Ruiz-Alonso M, Blesa D, Bosch N, Martínez-Conejero JA, Alamá P, et al. The accuracy and reproducibility of the endometrial receptivity array is superior to histology as a diagnostic method for endometrial receptivity. Fertil Steril. 2013;99(2):508-17. Ruiz-Alonso M, Blesa D, Díaz-Gimeno P, Gómez E, Fernández-Sánchez M, Carranza F, et al. The endometrial receptivity array for diagnosis and personalized embryo transfer as a treatment for patients with repeated implantation failure. Fertil Steril. 2013;100(3):818-24. Tan J, Kan A, Hitkari J, Taylor B, Tallon N, Warraich G, et al. The role of the endometrial receptivity array (ERA) in patients who have failed euploid embryo transfers. J Assist Reprod Genet. 2018;35(4):683-92. DOI: https://doi.org/10.1007/s10815-017-1112-2 Díaz-Gimeno P, Ruiz-Alonso M, Blesa D, Bosch N, Martínez-Conejero JA, Alamá P, et al. The accuracy and reproducibility of the endometrial receptivity array is superior to histology as a diagnostic method for endometrial receptivity. Fertil Steril. 2013;99(2):508-17. DOI: https://doi.org/10.1016/j.fertnstert.2012.09.046 Ruiz-Alonso M, Blesa D, Díaz-Gimeno P, Gómez E, Fernández-Sánchez M, Carranza F, et al. The endometrial receptivity array for diagnosis and personalized embryo transfer as a treatment for patients with repeated implantation failure. Fertil Steril. 2013;100(3):818-24. DOI: https://doi.org/10.1016/j.fertnstert.2013.05.004 Garcia M, Rodríguez A, Sánchez R. Endometrial gene expression in endometriosis patients: implications for endometrial receptivity. Hum Reprod. 2019;34(7):1304-13. Wong AW, Li M, Cheung WC, Yeung WS. Use of the endometrial receptivity array in women with adenomyosis undergoing IVF treatment. Reprod BioMed Online. 2020;40(1):94-101. Barnhart K, Dunsmoor-Su R, Coutifaris C. Effect of endometriosis on in vitro fertilization. Fertil Steril. 2002;77(6):1148-55. DOI: https://doi.org/10.1016/S0015-0282(02)03112-6 Bulun SE. Endometriosis. N Engl J Med. 2009;360(3):268-79. DOI: https://doi.org/10.1056/NEJMra0804690 Vercellini P, Consonni D, Dridi D, Bracco B, Frattaruolo MP, Somigliana E. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod. 2014;29(5):964-77. DOI: https://doi.org/10.1093/humrep/deu041 Nelson LM. Primary ovarian insufficiency. N Engl J Med. 2009;360(6):606-14. DOI: https://doi.org/10.1056/NEJMcp0808697

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