Evaluating the Efficacy of a Novel Endometrial Receptivity Analysis Test in Improving Pregnancy Outcomes for Chinese IVF Patients: A Single-Center Retrospective Study

Evaluating the Efficacy of a Novel Endometrial Receptivity Analysis Test in Improving Pregnancy Outcomes for Chinese IVF Patients: A Single-Center Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluating the Efficacy of a Novel Endometrial Receptivity Analysis Test in Improving Pregnancy Outcomes for Chinese IVF Patients: A Single-Center Retrospective Study Chunyan Ji, Xiaoyan Wang, Jinfang Yao, Xusheng Zhao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6963352/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background The current data about whether endometrial receptivity test could improve the pregnancy outcomes for Chinese IVF patients is conflicting and limited. This single-center retrospective study evaluated the efficacy of HerRecepta, a novel transcriptomic endometrial receptivity test in guiding personalized embryo transfer (pET) for Chinese IVF patients, with a focus on RIF and clinical factors influencing window of implantation (WOI). Methods This retrospective study included 220 IVF patients who underwent HerRecepta testing. Endometrial biopsies were analyzed via RNA sequencing to determine receptivity status (receptive/non-receptive), and pregnancy outcomes after frozen embryo transfer (FET) were compared between standard and personalized FET (pET) groups. Results Of 220 patients, 43.6% had non-receptive endometria (71.9% pre-receptive). Advanced age (> 35 years) and high AMH levels were risk factors for non-receptivity. Among 200 FET cases, overall pregnancy rate (PR), clinical pregnancy rate (CPR), and live birth rate (LBR) were 53.50%, 46.50%, and 32.11%, respectively. Non-receptive (pET) group showed comparable clinical outcomes to the receptive (standard ET) group in PR (51.82% vs. 55.56%, P = 0.49), CPR (46.36% vs. 46.67%, P = 0.96), and LBR (32.38% vs. 31.76%, P = 0.93. Similar results were observed in the RIF subgroup (124 patients). Conclusion Our findings suggest that HerRecepta test can be a valuable tool for personalized embryo transfer in IVF, particularly in specific subgroups with advanced age and with high AMH levels. Future studies to validate the optimal indication of endometrial receptivity test are needed. endometrial receptivity transfer failure window of implantation personalized embryo transfer advanced maternal age Figures Figure 1 Introduction Successful embryo implantation is a critical step in achieving pregnancy through assisted reproductive technologies (ART). Despite significant advancements in in vitro fertilization (IVF) techniques, including improved embryo culture conditions and genetic testing, implantation failure remains a major challenge for many couples undergoing fertility treatment [ 1 ]. Recurrent implantation failure (RIF), typically defined as the failure to achieve clinical pregnancy after multiple embryo transfers with good-quality embryos, is a particularly frustrating and complex issue that affects a significant proportion of IVF patients [ 2 ]. The success of embryo implantation depends on a delicate interplay between a receptive endometrium and a competent embryo. The window of implantation (WOI), a brief period during which the endometrium is optimally receptive to embryo implantation, is a crucial factor in this process. Traditionally, the timing of embryo transfer has been based on standard protocols that assume a uniform WOI across all patients. However, emerging evidence suggests that the WOI can vary significantly between individuals and may be displaced in some women [ 3 ], particularly those experiencing RIF [ 4 ]. This realization has led to the development of various diagnostic tools aimed at identifying the optimal timing for embryo transfer on an individual basis. One such tool that has gained considerable attention is the commercial Endometrial Receptivity Analysis (ERA) test [ 5 , 6 ]. Some investigations have reported significant improvements in implantation and live birth rates following ERA-guided personalized embryo transfer (pET) [ 7 – 9 ], while others have found no significant benefit compared to standard embryo transfer protocols [ 10 ]. The conflicting evidence highlights the need for further investigation into the optimal diagnostic methods and the applicable population. In addition, because of the high demand for ART services in China and the limited data in the Chinese population, understanding the applicability and efficacy of endometrial receptivity test in this population is crucial for optimizing treatment strategies. In this context, we adopted a novel receptivity test tool of HerRecepta which was constructed according to over one thousand Chinese IVF patients’ endometrial transcriptome data and outcome data. This study aimed to evaluate the clinical impact of HerRecepta assay on pregnancy outcome and to explore the clinical and biological factors leading to abnormal endometrial receptivity assessed by HerRecepta. Methods We performed a single-Centre retrospective review including the patients who agreed to undergo the HerRecepta testing between November 2019 and March 2024 at Tianjin Aiwei Hospital. This study was approved by the Institutional Review Borad of Tianjin Aiwei Hospital. Signed informed consent was obtained from all participants. Patient characteristics including age, body mass index (BMI), Anti-muller hormone (AMH) level, infertile causes, history of pregnancy and embryo transfer, HerRecepta results, and pregnancy outcomes of the first cycle after receptivity test were documented for research from the patients’ medical records system in an unidentifiable manner. Endometrial sampling and processing Patients underwent the HerRecepta test under either a hormonal replacement therapy (HRT) cycle or a natural cycle. In the HRT cycle, exogenous estradiol was administered, and once endometrial thickness reached 7 mm or greater with serum progesterone less than 1.0 ng/mL, participants initiated either 50 mg of intramuscular progesterone daily or 50 mg of intramuscular progesterone every third day plus 200 mg twice daily of Endometrin (micronized vaginal progesterone; Ferring Pharmaceuticals). Fifty to seventy mg of endometrial biopsy samples were collected from the uterine fundus using a sterile suction tube (Shanghai Jiabao) 120 ± 3 h after the start of progesterone administration. In the natural cycle, endometrial specimens were sampled 7 days after the luteinizing hormone surge (LH + 7) or 7 days after the administration of human chorionic gonadotropin (hCG + 7). Each endometrial sample was placed in a cryotube containing 1.5 mL of RNA later solution from Qiagen GmbH, which was then vigorously shaken to stabilize the genetic material within the tissue. Specimens were stored at 4°C for a minimum of 4 hours before being shipped at room temperature to Hangzhou Yizhen Medical Laboratory for receptivity test. Endometrial receptivity testing and WOI recommendation Total RNA was extracted from the endometrial specimen using a QIAsymphony RNA Kit (QIAGEN, 931636) according to the manufacture procedure. Spectrophotometry method was used for RNA concentration detection using MultiSkanGO (Thermo Fisher), and Agilent 4200 TapeStation (Agilent) for RIN. The library was constructed using VAHTS Universal V8 RNA-seq Library Prep Kit for Illumina (Vazyme, NR605), and sequenced on Novaseq 6000 platform (Illumina). Over 240 endometrial receptivity-related gene expression values were processed, and the endometrial receptivity status was assessed by the HerRecepta computational predictor based on inhouse predictor developed by Hangzhou HERANOVA Biotechnology Co., LTD using python sklearn model ( https://scikit-learn.org/stable/index.html ). The receptivity results were reported as receptive or non-receptive. Non-receptive results included pre-receptive, early receptive, post-receptive and late receptive. The optimal WOI was also recommended in the test reports. Receptivity test-guided embryo transfer and pregnancy outcome measures Frozen embryo transfer (FET) was performed typically in the cycle subsequent to endometrial biopsy. Patients with a receptive endometrium underwent standard transfer in the cycle identical to the receptivity test cycle. In patients with a displayed implantation window or a non-receptive status, individual embryo transfer was performed based on the receptivity results’ recommendations. Pregnancy outcome indictors including pregnancy rate (PR), clinical pregnancy rate (CPR) and live birth rate (LBR, when available) were calculated. The pregnancy rate was defined as the proportion of women who were positive for serum b-human chorionic gonadotropin (b-hCG) (> 25 mIU/mL), without confirmation by vaginal ultrasound; CPR was defined as the proportion of women who were positive for b-hCG, and a gestational sac was visualized by vaginal ultrasound at the fifth week of pregnancy; LBR was defined as the proportion of live births > 22 weeks’ gestation. Statistical analysis Statistical comparisons of pregnancy outcomes were performed using Chi-squared test. As for the patient characteristics, continuous data subject to a normal distribution are expressed as the mean ± SD and were compared using independent-samples t-tests; continuous data subject to a skewed distribution are expressed as the median and interquartile range (IQR) and were compared using the independent-samples Mann–Whitney U test; categorical data were expressed as counts and percentages and were determined to be statistically significant using the chi-square test. Multifactor logistic regression was performed to analyze the impact factors on clinical pregnancy and on endometrial receptivity. A two-sided P-value ≤ 0.05 was considered to be statistically significant. Statistical analysis was performed using R software (Version 4.4.0). Results Patient characteristics and clinical factors affecting the WOI Between November 2019 and March 2024, a total of 220 in vitro fertilization (IVF) patients, with an average age of 35.3 ± 4.3 years and an average of 3.4 ± 1.8 previous implantation failures, underwent the HerRecepta test. As detailed in Table 1 , 66 .36% (146/220) of patients had a history of multiple transfer failures (≥ 3), 30.91% (68/220) had one or two transfer failures, and 2.73% (6/220) had no prior failures. The 6 patients with no prior failures underwent the test mostly due to a scarcity of viable frozen embryos. As for the infertile causes, approximately half of the infertility cases were attributed to tubal factors. Table 1 Overview of patient characteristics. Characteristics Results Total patients 220 RIF (≥ 3 implantation failures) 146 (66.36) 1 or 2 prior implantation failures 68 (30.91) No implantation failures 6 (2.72) Prior implantation failures (mean) 3.40 ± 1.80 Age 35.30 ± 4.30 BMI 23.00 ± 3.30 AMH in the fresh cycle (ng/mL) 2.80 ± 2.70 Primary infertility 126 (57.27) Causes of infertility Tubal factor 108 (49.09) Ovulatory dysfunction 5 (2.27) Endometriosis 17 (7.72) Male factor 32 (14.55) Combined male and female factor 32 (14.55) Other female causes 18 (8.18) Unexplained 6 (2.72) test results after biopsy Receptive 124 (56.36) Nonreceptive 96 (43.64) Pre-receptive 69 (71.87) Early receptive 19 (19.79) Late receptive 7 (7.29) Post receptive 1 (1.04) Patients with reproductive outcomes post-test a 200 (90.90) Transferred embryo type D3/D4 32/200 (16.00) D5/D6 168/200 (84.00) Overall pregnancy rate 107/200 (53.50) Overall clinical pregnancy rate 93/200 (46.50) Overall live birth rate b 61/190 (32.11) *Values expressed as N (%) and mean ± SD a. Twenty patients were awaiting the embryo transfer cycle or awaiting the pregnancy results b. Ten patients were still ongoing pregnancy at the time of data collection. The HerRecepta test results revealed that 43.64% (96 out of 220) of patients exhibited a non-receptive endometrium, while 56.46% (124/220) had a receptive endometrium. Among those with non-receptive results, 71.88% (69/96) were classified as pre-receptive, with only one patient identified as post-receptive. To further investigate the clinical factors influencing endometrial receptivity, binary regression analysis was conducted. The findings, summarized in Table 2 , indicate that advanced age (> 35 years) and elevated AMH levels are independent risk factors for displacement of the implantation window. Although natural endometrial preparation cycles appeared to promote a receptive endometrium compared to hormone replacement therapy (HRT) cycles, this difference was not significant upon multivariate analysis. Figure 1 A illustrates a slight decline in the proportion of receptive statuses with increasing age. Patients over 35 years old showed a significantly lower receptivity rate than their younger counterparts aged ≤ 35 (48.5% vs. 62.6%, P = 0.036, Fig. 1 B). Regarding AMH levels, additional analyses demonstrated that among patients with AMH levels exceeding 5.00 ng/ml, the deviation of the endometrial implantation window was notably higher at 74.07% (20 out of 27), compared to 39.38% (76 out of 193) in patients with AMH levels ≤ 5.0 (P = 0.0007). Table 2 Regression analysis of factors affecting the displacement of implanting window. Variables Univariate Multivariate β S.E Z P OR (95%CI) β S.E Z P OR (95%CI) Age ≤35 1.00 (Reference) 1.00 (Reference) >35 0.58 0.28 2.09 0.04 1.78 (1.04 ~ 3.06) 0.70 0.32 2.21 0.03 2.01 (1.08 ~ 3.73) BMI 0.07 0.04 1.68 0.09 1.07 (0.99 ~ 1.16) 0.04 0.05 0.78 0.43 1.04 (0.95 ~ 1.14) AMH 0.13 0.06 2.34 0.02 1.14 (1.02 ~ 1.27) 0.17 0.07 2.56 0.01 1.19 (1.04 ~ 1.36) Primary yes 1.00 (Reference) 1.00 (Reference) no -0.00 0.27 -0.00 1.00 1.00 (0.58 ~ 1.71) -0.13 0.31 -0.42 0.68 0.88 (0.48 ~ 1.61) RPL yes 1.00 (Reference) 1.00 (Reference) no 15.86 727.70 0.02 0.98 7760530.38 (0.00 ~ Inf) 15.41 727.34 0.02 0.98 4926596.31 (0.00 ~ Inf) Endometrial cycle HRT 1.00 (Reference) 1.00 (Reference) natural -1.36 0.66 -2.07 0.04 0.26 (0.07 ~ 0.93) -1.21 0.67 -1.81 0.07 0.30 (0.08 ~ 1.11) OR, Odds Ratio; CI, Confidence Interval; Overall pregnancy outcomes Among the total 220 patients, 200 received a frozen embryo transfer after receptivity test and were documented at least one pregnancy outcome until the last follow-up time of August 2024. All of them received a single-embryo transfer and 84.0% implanted a Day 5/6 blastocyst embryo. The overall pregnancy rate was 53.50% and clinical pregnancy rate was 46.50%. of the 93 clinical pregnancies, 61 got a live birth while 22 miscarried and 10 were still ongoing pregnancy at the time of the data collection (Table 1 ). As shown in Table 3 , elder age is an independent risk factor of clinical pregnancy and implanting good-quality embryo as well as blastocyst embryo was more likely to get a pregnancy success though the two factors are not significant in multivariate analysis. Table 3 Results of the logistic regression analysis based on clinical pregnancy. Variables Univariate Multivariate β S.E Z P OR (95%CI) β S.E Z P OR (95%CI) Primary infertile yes 1.00 (Reference) 1.00 (Reference) no -0.36 0.28 -1.30 0.192 0.70 (0.40 ~ 1.20) -0.20 0.33 -0.61 0.543 0.82 (0.43 ~ 1.56) D5/D6 embryo no 1.00 (Reference) 1.00 (Reference) yes -1.13 0.36 -3.12 0.002 0.32 (0.16 ~ 0.66) -0.62 0.45 -1.37 0.170 0.54 (0.22 ~ 1.30) Good embryo yes 1.00 (Reference) 1.00 (Reference) no -0.81 0.28 -2.89 0.004 0.45 (0.26 ~ 0.77) -0.56 0.32 -1.75 0.080 0.57 (0.31 ~ 1.07) Age -0.14 0.04 -3.88 < .001 0.87 (0.81 ~ 0.93) -0.15 0.04 -3.50 < .001 0.86 (0.79 ~ 0.94) BMI 0.00 0.03 0.19 0.851 1.00 (0.96 ~ 1.06) 0.01 0.03 0.31 0.754 1.01 (0.95 ~ 1.07) AMH 0.06 0.05 1.22 0.221 1.06 (0.96 ~ 1.17) -0.02 0.06 -0.31 0.759 0.98 (0.87 ~ 1.11) Prior transfer failures -0.02 0.08 -0.30 0.766 0.98 (0.84 ~ 1.14) -0.01 0.09 -0.11 0.910 0.99 (0.83 ~ 1.18) Endometrial thickness 0.08 0.08 1.11 0.266 1.09 (0.94 ~ 1.26) 0.09 0.08 1.04 0.299 1.09 (0.92 ~ 1.29) OR: Odds Ratio, CI: Confidence Interval We compared the pregnancy outcomes between patients who had a receptive result receiving standard embryo transfer and patients who had a non-receptive result receiving pET by adjusting the progesterone administration time. According to Table 4 , patient profiles between the two groups were largely similar. There were no statistically significant differences in the pregnancy outcomes between the receptive (standard ET) and non-receptive (pET) groups (PR, 51.82% vs. 55.56%, respectively, P = 0.49; CPR, 46.36% vs. 46.67%, respectively, P = 0.96; LBR, 32.38% vs. 31.76%, respectively, P = 0.93). Table 4 Patient profiles and pregnancy outcomes of patients undergoing standard ET protocol after receptive endometrium vs. patients with pET protocol after nonreceptive endometrium Standard ET (receptive) pET (nonreceptive) P value Patients 124 96 0.12 ≥ 3 failures 89/124 (71.77) 57/96 (59.38) 1 or 2 prior failures 33/124 (26.61) 35/96 (36.45) No failures 2/124 (1.61) 4/96 (4.16) Age 35.1 ± 4.2 35.6 ± 4.4 0.41 BMI 22.6 ± 3.3 23.5 ± 3.4 0.08 AMH in the fresh cycle (ng/mL) 2.4 ± 2.1 3.3 ± 3.3 0.09 Primary infertility (%) 71/124 (57.25) 55/96 (57.29) 0.99 Patients with reproductive outcomes post-test a 110/124 (88.71) 90/96 (93.75) 0.19 Transferred good quality embryo 61/110 (55.45) 51/90 (56.67) 0.86 PR, n(%) 57/110 (51.82) 50/90 (55.56) 0.49 CPR, n(%) 51/110 (46.36) 42/90 (46.67) 0.96 LBR b , n(%) 34/105 (32.38) 27/85 (31.76) 0.93 *Values expressed as N (%) and mean ± SD a. Twenty patients were awaiting the embryo transfer cycle or awaiting the pregnancy results b. Ten patients were still ongoing pregnancy and the time of data collection. Pregnancy outcomes in the RIF subgroup To further explore the individual effectiveness of pET, we performed s subgroup analysis in RIF patients (defined as cases with a history of ≥ 3 transfer failures and age ≤ 40 year, without a history of recurrent abortion). A total of 124 RIF patients with a mean age of 33.98 were included in this analysis. Seventy-nine RIF patients with receptive endometrium underwent standard ET while forty-five RIF patients with non-receptive endometrium underwent pET. The baseline characteristics including age, BMI, AMH level, prior transfer failures and importation indicators such as endometrial thickness at the transfer day, embryo type, proportion of good-quality embryo were similar between the standard ET group and pET group. As for the pregnancy outcomes, the overall PR, CPR and LBR in this RIF group were 60.53%, 53.51%, and 37.38%, respectively (Table 5 ). The PR between the receptive (standard ET) and non-receptive (pET) groups was not statistically different (59.15% vs. 62.79%, P = 0.70). Similar trends were observed in CPR (53.52% vs. 53.49%, P = 1.00) and LBR (40.3% vs. 32.5%, P = 0.42) between the two groups. Table 5 Comparison of the RIF patients having receptive and non-receptive endometrium based on the endometrial receptivity analysis test regarding their demographic and clinical characteristics. Variables Total (n = 124) R (n = 79) NR (n = 45) Statistic P Age, Mean ± SD 33.98 ± 3.24 34.04 ± 3.07 33.89 ± 3.56 t = 0.25 0.806 BMI, M (Q₁, Q₃) 22.35 (20.38, 24.22) 22.20 (20.31, 24.00) 22.48 (20.80, 26.45) Z=-1.17 0.24 AMH, M (Q₁, Q₃) 2.25 (1.47, 3.81) 2.10 (1.38, 3.33) 2.81 (1.56, 5.78) Z=-1.80 0.07 Failures, Mean ± SD 4.26 ± 1.34 4.20 ± 1.35 4.36 ± 1.32 t=-0.61 0.542 Thickness, M (Q₁, Q₃) 9.30 (8.60, 10.47) 9.30 (8.55, 10.65) 9.28 (8.60, 10.15) Z=-0.28 0.78 Embryo type, n(%) χ²=2.12 0.15 D3/D4 21 (18.42) 16 (22.54) 5 (11.63) D5/D6 93 (81.58) 55 (77.46) 38 (88.37) Good quality embryo, n(%) 63 (55.26) 38 (53.52) 25 (58.14) χ²=0.23 0.63 PR, n(%) 69 (60.53) 42 (59.15) 27 (62.79) χ²=0.15 0.70 CPR, n(%) 61 (53.51) 38 (53.52) 23 (53.49) χ²=0.00 1.00 LBR, n(%) 40 (37.38) 27 (40.30) 13 (32.50) χ²=0.65 0.42 Z: Mann-Whitney test, χ²: Chi-square test M: Median, Q₁: 1st Quartile, Q₃: 3st Quartile Discussion The findings from our study provide valuable insights into the role of HerRecepta in assessing the optimal WOI and guiding personalized embryo transfer (pET) strategies for IVF patients, giving an overall pregnancy rate of 53.50%, clinical pregnancy rate of 46.50% and live birth rate of 32.11%. Our data also highlights the potential of HerRecepta test in optimizing pregnancy outcomes in the advanced-age patients—a subgroup that remains a critical challenge in ART. In this study, comparable outcomes were found between patients with receptive endometria undergoing standard embryo transfer and those with non-receptive endometria receiving pET. It highlights that HerRecepta-guided pET can bring the outcomes of patients with displaced WOI in line with those of patients with a naturally receptive endometrium. This finding agreed with the previous studies about the transcriptomic tool of ERA [ 11 , 12 ], suggesting HerRecepta -guided pET is helpful in improving IVF outcomes. A notable finding was the association between advanced maternal age (> 35 years) and reduced endometrial receptivity. Older women in our cohort exhibited a significantly lower receptive rate (48.5% vs. 62.6% in younger patients, P = 0.036), corroborating studies linking reproductive aging to impaired uterine function [ 13 , 14 ]. However, when HerRecepta test identified a displaced window of implantation (WOI) in older patients, adjusting transfer timing via pET seemly did not translate to improved pregnancy outcomes. Advanced age introduces multifactorial barriers—such as diminished ovarian reserve, embryonic aneuploidy, or cumulative endometrial damage—that receptivity test cannot fully address. Endometrial receptivity shift could serve as one of the factors that contribute to transfer failures in advanced-age patients. In addition, elevated AMH levels (> 5.0 ng/mL) were strongly associated with WOI displacement (74.1% vs. 39.4%, P = 0.0007), likely reflecting the endocrine profile of polycystic ovary syndrome (PCOS) patients. While PCOS is linked to hyperandrogenism and ovulatory dysfunction, and androgen excess may also disrupt endometrial gene expression, reducing receptivity [ 15 , 16 ]. A previous study showed also high incidence of non-receptivity in PCOS patients (10/11,90%) [ 17 ], while larger studies are needed in this group of patient to validate the utility of endometrial receptivity test. Besides, our data showed that different endometrial preparation protocols (HRT or natural cycle) were one of the potential factors affecting WOI. As the previous study reported, artificial cycles seemed to have a stronger negative effect on endometrial receptivity [ 18 ].Various modes of HRT cycles may also influence the receptive status, which should be taken into account in clinical practice and future researches. In this study, young age and blastocyst with good quality were found to be significantly associated with successful clinical pregnancy. For IVF patients undergoing receptivity test, high-quality blastocyst transfer could enhance the likelihood of clinical pregnancy. In addition to WOI adjustment, recent advancements in the field have also introduced new considerations in the management of RIF. The role of the endometrial microbiome in implantation success has gained attention, with studies [ 19 , 20 ] suggesting that the presence of certain bacterial species may influence ART outcomes. Though our study has its limitations, including its retrospective design and lacking control group, it further suggested the effectiveness of receptivity test in the general IVF patients and contributed to the ongoing debate about the indications of receptivity test as well as the selection from the various test tools. Though the present data suggested WOI shift assessed by HerRecepta is one of the factors of implantation failures in advanced-age IVF patients, future parallel controlled study with large cohorts and comprehensive data collection are needed to validate its performance in the advanced-age groups. Conclusions In conclusion, the findings suggest that the novel HerRecepta test could be a valuable tool in guiding pET and improving IVF outcomes in patients. Abbreviations ART Assisted Reproductive Technology BMI Body Mass Index CPR Clinical Pregnancy Rate ERA Endometrial Receptivity Analysis ET Embryo Transfer FET Frozen Embryo Transfer hCG Human Chorionic Gonadotropin HRT Hormonal Replacement Therapy IVF In Vitro Fertilization LBR Live Birth Rate LH Luteinizing Hormone PCOS polycystic ovary syndrome PR Pregnancy Rate pET Personalized Embryo Transfer RIF Recurrent Implantation Failure WOI Window of Implantation Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Borad of Tianjin Aiwei Hospital (Approval no.: 2025-ER-01). Signed informed consent was obtained from all participants. The research was carried out in accordance with the ethical guidelines set forth by both institutional and national human experimentation committees, and followed the principles of the 1964 Helsinki Declaration and its later revisions. Consent for publication Not applicable. Data Availability Statement The data used and/or analyzed during the current study is available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding No Grant support on this study. Author Contributions CYJ designed the study and was a major contributor in writing the manuscript. XYW performed the data processing and analysis and was responsible for the revision of the manuscript. JFY and XSZ were responsible for clinical data collection, and manuscript editing. Acknowledgments Not applicable. References Cimadomo D, et al. Leave the past behind: women's reproductive history shows no association with blastocysts' euploidy and limited association with live birth rates after euploid embryo transfers. Hum Reprod. 2021;36(4):929–40. Cimadomo D, et al. ESHRE good practice recommendations on recurrent implantation failure. Hum Reprod Open. 2023;2023(3):hoad023. Haouzi D, et al. 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Age- and endometrial microbiota-related delay in development of endometrial receptivity. Reprod Med Biol. 2023;22(1):e12523. Barbakadze T, et al. Assessment of the Role of Endometrial Receptivity Analysis in Enhancing Assisted Reproductive Technology Outcomes for Advanced-Age Patients. Cureus. 2024;16(6):e62949. Palomba S, Piltonen TT, Giudice LC. Endometrial function in women with polycystic ovary syndrome: a comprehensive review. Hum Reprod Update. 2021;27(3):584–618. Guo F, et al. Altered Molecular Pathways and Biomarkers of Endometrial Receptivity in Infertile Women with Polycystic Ovary Syndrome. Reprod Sci. 2022;29(12):3335–45. Ahmed Bahgat N, Syed WJJoG, Obstetrics. Displacement of Window of Implantation in Cases of Unexplained Recurrent Implantation Failure as Detected by Endometrial Receptivity Array Testing. 2022. Altmäe S, et al. Endometrial transcriptome analysis indicates superiority of natural over artificial cycles in recurrent implantation failure patients undergoing frozen embryo transfer. Reprod Biomed Online. 2016;32(6):597–613. Iwami N, et al. Therapeutic intervention based on gene sequencing analysis of microbial 16S ribosomal RNA of the intrauterine microbiome improves pregnancy outcomes in IVF patients: a prospective cohort study. J Assist Reprod Genet. 2023;40(1):125–35. Moreno I, et al. Endometrial microbiota composition is associated with reproductive outcome in infertile patients. Microbiome. 2022;10(1):1. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 11 Dec, 2025 Reviews received at journal 30 Nov, 2025 Reviewers agreed at journal 24 Nov, 2025 Reviews received at journal 09 Aug, 2025 Reviewers agreed at journal 04 Aug, 2025 Reviewers invited by journal 31 Jul, 2025 Editor assigned by journal 23 Jul, 2025 Editor invited by journal 30 Jun, 2025 Submission checks completed at journal 27 Jun, 2025 First submitted to journal 27 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6963352","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495236806,"identity":"0ddf5baa-a728-46fc-b43d-2a6cd9e34184","order_by":0,"name":"Chunyan Ji","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsklEQVRIiWNgGAWjYBACxgYg8cGgRo6Nvf0A8VoYZxQcM+bjOZNAvE3MPB+YE+dJOBgQqbz9jAHjDAO29DYJhgSGHxXbiHBYT44B0C8yuW3SjQcYe87cJkLLDB6wLbltMgcSmBnbiNTCDETpbBIJBqRpSSBBS09aAdBhxwzbgIF8kCi/GLYf3sDw4U+NvHx7+8EHPyqI0dLAYf4DxjlAWD0QyDOwPyBK4SgYBaNgFIxgAADtQjhLxdH2JAAAAABJRU5ErkJggg==","orcid":"","institution":"Tianjin Aiwei Hospital","correspondingAuthor":true,"prefix":"","firstName":"Chunyan","middleName":"","lastName":"Ji","suffix":""},{"id":495236807,"identity":"4befaa48-fb4c-4a5f-a093-3912d060e2d1","order_by":1,"name":"Xiaoyan Wang","email":"","orcid":"","institution":"Tanggu Maternity Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaoyan","middleName":"","lastName":"Wang","suffix":""},{"id":495236809,"identity":"fd249f63-2f71-4b7f-87c0-2bc951cc71cc","order_by":2,"name":"Jinfang Yao","email":"","orcid":"","institution":"Tianjin Aiwei Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jinfang","middleName":"","lastName":"Yao","suffix":""},{"id":495236810,"identity":"375c29b2-14ba-44cf-9cba-c4a965c5b627","order_by":3,"name":"Xusheng Zhao","email":"","orcid":"","institution":"Tianjin Aiwei Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xusheng","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2025-06-24 08:23:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6963352/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6963352/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88408355,"identity":"88b9ce11-0eab-4386-a94d-241c87e8b407","added_by":"auto","created_at":"2025-08-06 08:12:02","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":297423,"visible":true,"origin":"","legend":"\u003cp\u003eThe correlation between age and endometrial receptivity evaluated by HerRecepta test. A. the receptivity result proportions of different age groups, R, receptive. B. The proportion of receptive result comparison between the young group (≤35 years) and advanced-age group (\u0026gt; 35 years).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6963352/v1/c14821fe5efa77aac6ce89f5.jpeg"},{"id":88411843,"identity":"24a934ed-bb92-40ba-9dda-6bfd665f4059","added_by":"auto","created_at":"2025-08-06 08:28:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1345793,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6963352/v1/fddc63a0-56af-464b-9057-98139b860f9f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating the Efficacy of a Novel Endometrial Receptivity Analysis Test in Improving Pregnancy Outcomes for Chinese IVF Patients: A Single-Center Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSuccessful embryo implantation is a critical step in achieving pregnancy through assisted reproductive technologies (ART). Despite significant advancements in in vitro fertilization (IVF) techniques, including improved embryo culture conditions and genetic testing, implantation failure remains a major challenge for many couples undergoing fertility treatment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Recurrent implantation failure (RIF), typically defined as the failure to achieve clinical pregnancy after multiple embryo transfers with good-quality embryos, is a particularly frustrating and complex issue that affects a significant proportion of IVF patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe success of embryo implantation depends on a delicate interplay between a receptive endometrium and a competent embryo. The window of implantation (WOI), a brief period during which the endometrium is optimally receptive to embryo implantation, is a crucial factor in this process. Traditionally, the timing of embryo transfer has been based on standard protocols that assume a uniform WOI across all patients. However, emerging evidence suggests that the WOI can vary significantly between individuals and may be displaced in some women [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], particularly those experiencing RIF [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This realization has led to the development of various diagnostic tools aimed at identifying the optimal timing for embryo transfer on an individual basis.\u003c/p\u003e\u003cp\u003eOne such tool that has gained considerable attention is the commercial Endometrial Receptivity Analysis (ERA) test [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Some investigations have reported significant improvements in implantation and live birth rates following ERA-guided personalized embryo transfer (pET) [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], while others have found no significant benefit compared to standard embryo transfer protocols [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The conflicting evidence highlights the need for further investigation into the optimal diagnostic methods and the applicable population. In addition, because of the high demand for ART services in China and the limited data in the Chinese population, understanding the applicability and efficacy of endometrial receptivity test in this population is crucial for optimizing treatment strategies.\u003c/p\u003e\u003cp\u003eIn this context, we adopted a novel receptivity test tool of HerRecepta which was constructed according to over one thousand Chinese IVF patients\u0026rsquo; endometrial transcriptome data and outcome data. This study aimed to evaluate the clinical impact of HerRecepta assay on pregnancy outcome and to explore the clinical and biological factors leading to abnormal endometrial receptivity assessed by HerRecepta.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e We performed a single-Centre retrospective review including the patients who agreed to undergo the HerRecepta testing between November 2019 and March 2024 at Tianjin Aiwei Hospital. This study was approved by the Institutional Review Borad of Tianjin Aiwei Hospital. Signed informed consent was obtained from all participants. Patient characteristics including age, body mass index (BMI), Anti-muller hormone (AMH) level, infertile causes, history of pregnancy and embryo transfer, HerRecepta results, and pregnancy outcomes of the first cycle after receptivity test were documented for research from the patients\u0026rsquo; medical records system in an unidentifiable manner.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eEndometrial sampling and processing\u003c/h2\u003e\u003cp\u003ePatients underwent the HerRecepta test under either a hormonal replacement therapy (HRT) cycle or a natural cycle. In the HRT cycle, exogenous estradiol was administered, and once endometrial thickness reached 7 mm or greater with serum progesterone less than 1.0 ng/mL, participants initiated either 50 mg of intramuscular progesterone daily or 50 mg of intramuscular progesterone every third day plus 200 mg twice daily of Endometrin (micronized vaginal progesterone; Ferring Pharmaceuticals). Fifty to seventy mg of endometrial biopsy samples were collected from the uterine fundus using a sterile suction tube (Shanghai Jiabao) 120\u0026thinsp;\u0026plusmn;\u0026thinsp;3 h after the start of progesterone administration. In the natural cycle, endometrial specimens were sampled 7 days after the luteinizing hormone surge (LH\u0026thinsp;+\u0026thinsp;7) or 7 days after the administration of human chorionic gonadotropin (hCG\u0026thinsp;+\u0026thinsp;7). Each endometrial sample was placed in a cryotube containing 1.5 mL of RNA later solution from Qiagen GmbH, which was then vigorously shaken to stabilize the genetic material within the tissue. Specimens were stored at 4\u0026deg;C for a minimum of 4 hours before being shipped at room temperature to Hangzhou Yizhen Medical Laboratory for receptivity test.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEndometrial receptivity testing and WOI recommendation\u003c/h3\u003e\n\u003cp\u003eTotal RNA was extracted from the endometrial specimen using a QIAsymphony RNA Kit (QIAGEN, 931636) according to the manufacture procedure. Spectrophotometry method was used for RNA concentration detection using MultiSkanGO (Thermo Fisher), and Agilent 4200 TapeStation (Agilent) for RIN. The library was constructed using VAHTS Universal V8 RNA-seq Library Prep Kit for Illumina (Vazyme, NR605), and sequenced on Novaseq 6000 platform (Illumina).\u003c/p\u003e\u003cp\u003eOver 240 endometrial receptivity-related gene expression values were processed, and the endometrial receptivity status was assessed by the HerRecepta computational predictor based on inhouse predictor developed by Hangzhou HERANOVA Biotechnology Co., LTD using python sklearn model (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://scikit-learn.org/stable/index.html\u003c/span\u003e\u003cspan address=\"https://scikit-learn.org/stable/index.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The receptivity results were reported as receptive or non-receptive. Non-receptive results included pre-receptive, early receptive, post-receptive and late receptive. The optimal WOI was also recommended in the test reports.\u003c/p\u003e\n\u003ch3\u003eReceptivity test-guided embryo transfer and pregnancy outcome measures\u003c/h3\u003e\n\u003cp\u003eFrozen embryo transfer (FET) was performed typically in the cycle subsequent to endometrial biopsy. Patients with a receptive endometrium underwent standard transfer in the cycle identical to the receptivity test cycle. In patients with a displayed implantation window or a non-receptive status, individual embryo transfer was performed based on the receptivity results\u0026rsquo; recommendations.\u003c/p\u003e\u003cp\u003ePregnancy outcome indictors including pregnancy rate (PR), clinical pregnancy rate (CPR) and live birth rate (LBR, when available) were calculated. The pregnancy rate was defined as the proportion of women who were positive for serum b-human chorionic gonadotropin (b-hCG) (\u0026gt;\u0026thinsp;25 mIU/mL), without confirmation by vaginal ultrasound; CPR was defined as the proportion of women who were positive for b-hCG, and a gestational sac was visualized by vaginal ultrasound at the fifth week of pregnancy; LBR was defined as the proportion of live births\u0026thinsp;\u0026gt;\u0026thinsp;22 weeks\u0026rsquo; gestation.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical comparisons of pregnancy outcomes were performed using Chi-squared test. As for the patient characteristics, continuous data subject to a normal distribution are expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD and were compared using independent-samples t-tests; continuous data subject to a skewed distribution are expressed as the median and interquartile range (IQR) and were compared using the independent-samples Mann\u0026ndash;Whitney U test; categorical data were expressed as counts and percentages and were determined to be statistically significant using the chi-square test. Multifactor logistic regression was performed to analyze the impact factors on clinical pregnancy and on endometrial receptivity. A two-sided P-value\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered to be statistically significant. Statistical analysis was performed using R software (Version 4.4.0).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePatient characteristics and clinical factors affecting the WOI\u003c/h2\u003e\u003cp\u003eBetween November 2019 and March 2024, a total of 220 in vitro fertilization (IVF) patients, with an average age of 35.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 years and an average of 3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 previous implantation failures, underwent the HerRecepta test. As detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cb\u003e66\u003c/b\u003e.36% (146/220) of patients had a history of multiple transfer failures (\u0026ge;\u0026thinsp;3), 30.91% (68/220) had one or two transfer failures, and 2.73% (6/220) had no prior failures. The 6 patients with no prior failures underwent the test mostly due to a scarcity of viable frozen embryos. As for the infertile causes, approximately half of the infertility cases were attributed to tubal factors.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOverview of patient characteristics.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResults\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRIF (\u0026ge;\u0026thinsp;3 implantation failures)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e146 (66.36)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 or 2 prior implantation failures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68 (30.91)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo implantation failures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (2.72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior implantation failures (mean)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAMH in the fresh cycle (ng/mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary infertility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e126 (57.27)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCauses of infertility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTubal factor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e108 (49.09)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOvulatory dysfunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (2.27)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndometriosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (7.72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale factor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (14.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCombined male and female factor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (14.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther female causes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (8.18)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnexplained\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (2.72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003etest results after biopsy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReceptive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124 (56.36)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNonreceptive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e96 (43.64)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-receptive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69 (71.87)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly receptive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (19.79)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLate receptive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (7.29)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePost receptive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1.04)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatients with reproductive outcomes post-test\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e200 (90.90)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransferred embryo type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD3/D4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32/200 (16.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD5/D6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e168/200 (84.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall pregnancy rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e107/200 (53.50)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall clinical pregnancy rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93/200 (46.50)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall live birth rate\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61/190 (32.11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e*Values expressed as N (%) and mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003ea. Twenty patients were awaiting the embryo transfer cycle or awaiting the pregnancy results\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eb. Ten patients were still ongoing pregnancy at the time of data collection.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe HerRecepta test results revealed that 43.64% (96 out of 220) of patients exhibited a non-receptive endometrium, while 56.46% (124/220) had a receptive endometrium. Among those with non-receptive results, 71.88% (69/96) were classified as pre-receptive, with only one patient identified as post-receptive.\u003c/p\u003e\u003cp\u003eTo further investigate the clinical factors influencing endometrial receptivity, binary regression analysis was conducted. The findings, summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, indicate that advanced age (\u0026gt;\u0026thinsp;35 years) and elevated AMH levels are independent risk factors for displacement of the implantation window. Although natural endometrial preparation cycles appeared to promote a receptive endometrium compared to hormone replacement therapy (HRT) cycles, this difference was not significant upon multivariate analysis. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA illustrates a slight decline in the proportion of receptive statuses with increasing age. Patients over 35 years old showed a significantly lower receptivity rate than their younger counterparts aged\u0026thinsp;\u0026le;\u0026thinsp;35 (48.5% vs. 62.6%, P\u0026thinsp;=\u0026thinsp;0.036, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). Regarding AMH levels, additional analyses demonstrated that among patients with AMH levels exceeding 5.00 ng/ml, the deviation of the endometrial implantation window was notably higher at 74.07% (20 out of 27), compared to 39.38% (76 out of 193) in patients with AMH levels\u0026thinsp;\u0026le;\u0026thinsp;5.0 (P\u0026thinsp;=\u0026thinsp;0.0007).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRegression analysis of factors affecting the displacement of implanting window.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u003cp\u003eUnivariate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c12\" namest=\"c8\"\u003e\u003cp\u003eMultivariate\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eS.E\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eZ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eS.E\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eZ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.78 (1.04\u0026thinsp;~\u0026thinsp;3.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2.01 (1.08\u0026thinsp;~\u0026thinsp;3.73)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.07 (0.99\u0026thinsp;~\u0026thinsp;1.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.04 (0.95\u0026thinsp;~\u0026thinsp;1.14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAMH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.14 (1.02\u0026thinsp;~\u0026thinsp;1.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.19 (1.04\u0026thinsp;~\u0026thinsp;1.36)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eyes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eno\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (0.58\u0026thinsp;~\u0026thinsp;1.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.88 (0.48\u0026thinsp;~\u0026thinsp;1.61)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRPL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eyes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eno\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e727.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7760530.38 (0.00\u0026thinsp;~\u0026thinsp;Inf)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e727.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e4926596.31 (0.00\u0026thinsp;~\u0026thinsp;Inf)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndometrial cycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHRT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003enatural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.26 (0.07\u0026thinsp;~\u0026thinsp;0.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-1.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.30 (0.08\u0026thinsp;~\u0026thinsp;1.11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e\u003cp\u003eOR, Odds Ratio; CI, Confidence Interval;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eOverall pregnancy outcomes\u003c/h3\u003e\n\u003cp\u003eAmong the total 220 patients, 200 received a frozen embryo transfer after receptivity test and were documented at least one pregnancy outcome until the last follow-up time of August 2024. All of them received a single-embryo transfer and 84.0% implanted a Day 5/6 blastocyst embryo. The overall pregnancy rate was 53.50% and clinical pregnancy rate was 46.50%. of the 93 clinical pregnancies, 61 got a live birth while 22 miscarried and 10 were still ongoing pregnancy at the time of the data collection (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, elder age is an independent risk factor of clinical pregnancy and implanting good-quality embryo as well as blastocyst embryo was more likely to get a pregnancy success though the two factors are not significant in multivariate analysis.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults of the logistic regression analysis based on clinical pregnancy.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u003cp\u003eUnivariate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c12\" namest=\"c8\"\u003e\u003cp\u003eMultivariate\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eS.E\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eZ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eS.E\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eZ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary infertile\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eyes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eno\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.70 (0.40\u0026thinsp;~\u0026thinsp;1.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.543\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.82 (0.43\u0026thinsp;~\u0026thinsp;1.56)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD5/D6 embryo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eno\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eyes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-3.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.32 (0.16\u0026thinsp;~\u0026thinsp;0.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-1.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.54 (0.22\u0026thinsp;~\u0026thinsp;1.30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood embryo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eyes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eno\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.45 (0.26\u0026thinsp;~\u0026thinsp;0.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-1.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.080\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.57 (0.31\u0026thinsp;~\u0026thinsp;1.07)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-3.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.87 (0.81\u0026thinsp;~\u0026thinsp;0.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-3.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.86 (0.79\u0026thinsp;~\u0026thinsp;0.94)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.851\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (0.96\u0026thinsp;~\u0026thinsp;1.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.754\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.01 (0.95\u0026thinsp;~\u0026thinsp;1.07)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAMH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.06 (0.96\u0026thinsp;~\u0026thinsp;1.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.759\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.98 (0.87\u0026thinsp;~\u0026thinsp;1.11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior transfer failures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.766\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.98 (0.84\u0026thinsp;~\u0026thinsp;1.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.910\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.99 (0.83\u0026thinsp;~\u0026thinsp;1.18)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndometrial thickness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.266\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.09 (0.94\u0026thinsp;~\u0026thinsp;1.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.299\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.09 (0.92\u0026thinsp;~\u0026thinsp;1.29)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e\u003cp\u003eOR: Odds Ratio, CI: Confidence Interval\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWe compared the pregnancy outcomes between patients who had a receptive result receiving standard embryo transfer and patients who had a non-receptive result receiving pET by adjusting the progesterone administration time. According to Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, patient profiles between the two groups were largely similar. There were no statistically significant differences in the pregnancy outcomes between the receptive (standard ET) and non-receptive (pET) groups (PR, 51.82% vs. 55.56%, respectively, P\u0026thinsp;=\u0026thinsp;0.49; CPR, 46.36% vs. 46.67%, respectively, P\u0026thinsp;=\u0026thinsp;0.96; LBR, 32.38% vs. 31.76%, respectively, P\u0026thinsp;=\u0026thinsp;0.93).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatient profiles and pregnancy outcomes of patients undergoing standard ET protocol after receptive endometrium vs. patients with pET protocol after nonreceptive endometrium\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStandard ET (receptive)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003epET (nonreceptive)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;3 failures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89/124 (71.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57/96 (59.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 or 2 prior failures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33/124 (26.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35/96 (36.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo failures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2/124 (1.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4/96 (4.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAMH in the fresh cycle (ng/mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary infertility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71/124 (57.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55/96 (57.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatients with reproductive outcomes post-test \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e110/124 (88.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90/96 (93.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransferred good quality embryo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61/110 (55.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51/90 (56.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePR, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57/110 (51.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50/90 (55.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCPR, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51/110 (46.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42/90 (46.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLBR\u003csup\u003eb\u003c/sup\u003e, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34/105 (32.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27/85 (31.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Values expressed as N (%) and mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ea. Twenty patients were awaiting the embryo transfer cycle or awaiting the pregnancy results\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eb. Ten patients were still ongoing pregnancy and the time of data collection.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003ePregnancy outcomes in the RIF subgroup\u003c/h3\u003e\n\u003cp\u003eTo further explore the individual effectiveness of pET, we performed s subgroup analysis in RIF patients (defined as cases with a history of \u0026ge;\u0026thinsp;3 transfer failures and age\u0026thinsp;\u0026le;\u0026thinsp;40 year, without a history of recurrent abortion). A total of 124 RIF patients with a mean age of 33.98 were included in this analysis. Seventy-nine RIF patients with receptive endometrium underwent standard ET while forty-five RIF patients with non-receptive endometrium underwent pET. The baseline characteristics including age, BMI, AMH level, prior transfer failures and importation indicators such as endometrial thickness at the transfer day, embryo type, proportion of good-quality embryo were similar between the standard ET group and pET group. As for the pregnancy outcomes, the overall PR, CPR and LBR in this RIF group were 60.53%, 53.51%, and 37.38%, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The PR between the receptive (standard ET) and non-receptive (pET) groups was not statistically different (59.15% vs. 62.79%, P\u0026thinsp;=\u0026thinsp;0.70). Similar trends were observed in CPR (53.52% vs. 53.49%, P\u0026thinsp;=\u0026thinsp;1.00) and LBR (40.3% vs. 32.5%, P\u0026thinsp;=\u0026thinsp;0.42) between the two groups.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of the RIF patients having receptive and non-receptive endometrium based on the endometrial receptivity analysis test regarding their demographic and clinical characteristics.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;124)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eR (n\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNR (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.04\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.806\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI, M (Q₁, Q₃)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.35 (20.38, 24.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.20 (20.31, 24.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.48 (20.80, 26.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZ=-1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAMH, M (Q₁, Q₃)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.25 (1.47, 3.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.10 (1.38, 3.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.81 (1.56, 5.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZ=-1.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFailures, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003et=-0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.542\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThickness, M (Q₁, Q₃)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.30 (8.60, 10.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.30 (8.55, 10.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.28 (8.60, 10.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZ=-0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmbryo type, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;=2.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD3/D4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (18.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (22.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (11.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD5/D6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93 (81.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (77.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38 (88.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood quality embryo, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63 (55.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (53.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (58.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;=0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePR, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69 (60.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 (59.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (62.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;=0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCPR, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (53.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (53.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (53.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;=0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLBR, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (37.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (40.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (32.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;=0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eZ: Mann-Whitney test, χ\u0026sup2;: Chi-square test\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eM: Median, Q₁: 1st Quartile, Q₃: 3st Quartile\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings from our study provide valuable insights into the role of HerRecepta in assessing the optimal WOI and guiding personalized embryo transfer (pET) strategies for IVF patients, giving an overall pregnancy rate of 53.50%, clinical pregnancy rate of 46.50% and live birth rate of 32.11%. Our data also highlights the potential of HerRecepta test in optimizing pregnancy outcomes in the advanced-age patients\u0026mdash;a subgroup that remains a critical challenge in ART.\u003c/p\u003e\u003cp\u003eIn this study, comparable outcomes were found between patients with receptive endometria undergoing standard embryo transfer and those with non-receptive endometria receiving pET. It highlights that HerRecepta-guided pET can bring the outcomes of patients with displaced WOI in line with those of patients with a naturally receptive endometrium. This finding agreed with the previous studies about the transcriptomic tool of ERA [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], suggesting HerRecepta -guided pET is helpful in improving IVF outcomes.\u003c/p\u003e\u003cp\u003eA notable finding was the association between advanced maternal age (\u0026gt;\u0026thinsp;35 years) and reduced endometrial receptivity. Older women in our cohort exhibited a significantly lower receptive rate (48.5% vs. 62.6% in younger patients, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036), corroborating studies linking reproductive aging to impaired uterine function [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, when HerRecepta test identified a displaced window of implantation (WOI) in older patients, adjusting transfer timing via pET seemly did not translate to improved pregnancy outcomes. Advanced age introduces multifactorial barriers\u0026mdash;such as diminished ovarian reserve, embryonic aneuploidy, or cumulative endometrial damage\u0026mdash;that receptivity test cannot fully address. Endometrial receptivity shift could serve as one of the factors that contribute to transfer failures in advanced-age patients. In addition, elevated AMH levels (\u0026gt;\u0026thinsp;5.0 ng/mL) were strongly associated with WOI displacement (74.1% vs. 39.4%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0007), likely reflecting the endocrine profile of polycystic ovary syndrome (PCOS) patients. While PCOS is linked to hyperandrogenism and ovulatory dysfunction, and androgen excess may also disrupt endometrial gene expression, reducing receptivity [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A previous study showed also high incidence of non-receptivity in PCOS patients (10/11,90%) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], while larger studies are needed in this group of patient to validate the utility of endometrial receptivity test. Besides, our data showed that different endometrial preparation protocols (HRT or natural cycle) were one of the potential factors affecting WOI. As the previous study reported, artificial cycles seemed to have a stronger negative effect on endometrial receptivity [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].Various modes of HRT cycles may also influence the receptive status, which should be taken into account in clinical practice and future researches.\u003c/p\u003e\u003cp\u003eIn this study, young age and blastocyst with good quality were found to be significantly associated with successful clinical pregnancy. For IVF patients undergoing receptivity test, high-quality blastocyst transfer could enhance the likelihood of clinical pregnancy. In addition to WOI adjustment, recent advancements in the field have also introduced new considerations in the management of RIF. The role of the endometrial microbiome in implantation success has gained attention, with studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] suggesting that the presence of certain bacterial species may influence ART outcomes.\u003c/p\u003e\u003cp\u003eThough our study has its limitations, including its retrospective design and lacking control group, it further suggested the effectiveness of receptivity test in the general IVF patients and contributed to the ongoing debate about the indications of receptivity test as well as the selection from the various test tools. Though the present data suggested WOI shift assessed by HerRecepta is one of the factors of implantation failures in advanced-age IVF patients, future parallel controlled study with large cohorts and comprehensive data collection are needed to validate its performance in the advanced-age groups.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, the findings suggest that the novel HerRecepta test could be a valuable tool in guiding pET and improving IVF outcomes in patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eART\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAssisted Reproductive Technology\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody Mass Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCPR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eClinical Pregnancy Rate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eERA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEndometrial Receptivity Analysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eET\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmbryo Transfer\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFET\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFrozen Embryo Transfer\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ehCG\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHuman Chorionic Gonadotropin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHRT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHormonal Replacement Therapy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIVF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIn Vitro Fertilization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLBR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLive Birth Rate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLuteinizing Hormone\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePCOS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epolycystic ovary syndrome\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePregnancy Rate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003epET\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePersonalized Embryo Transfer\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRIF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRecurrent Implantation Failure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWOI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWindow of Implantation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Borad of Tianjin Aiwei Hospital (Approval no.: 2025-ER-01). Signed informed consent was obtained from all participants.\u0026nbsp;The research was carried out in accordance with the ethical guidelines set forth by both institutional and national human experimentation committees, and followed the principles of the 1964 Helsinki Declaration and its later revisions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used and/or analyzed during the current study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo Grant support on this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCYJ designed the study and was a major contributor in writing the manuscript. XYW performed the data processing and analysis and was responsible for the revision of the manuscript. JFY and XSZ were responsible for clinical data collection, and manuscript editing. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCimadomo D, et al. Leave the past behind: women's reproductive history shows no association with blastocysts' euploidy and limited association with live birth rates after euploid embryo transfers. Hum Reprod. 2021;36(4):929\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCimadomo D, et al. ESHRE good practice recommendations on recurrent implantation failure. Hum Reprod Open. 2023;2023(3):hoad023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaouzi D, et al. Customized Frozen Embryo Transfer after Identification of the Receptivity Window with a Transcriptomic Approach Improves the Implantation and Live Birth Rates in Patients with Repeated Implantation Failure. Reprod Sci. 2021;28(1):69\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRuiz-Alonso M, 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\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eD\u0026iacute;az-Gimeno P, et al. A genomic diagnostic tool for human endometrial receptivity based on the transcriptomic signature. Fertil Steril. 2011;95(1):50\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eD\u0026iacute;az-Gimeno 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\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu Z, et al. The Clinical Efficacy of Personalized Embryo Transfer Guided by the Endometrial Receptivity Array/Analysis on IVF/ICSI Outcomes: A Systematic Review and Meta-Analysis. Front Physiol. 2022;13:841437.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRuiz-Alonso M et al. P-368\u0026emsp;Clinical impact of personalized embryo transfer (pET) guided by endometrial receptivity analysis (ERA) in patients with \u0026ge;\u0026thinsp;1 failed transfers. 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSim\u0026oacute;n C, et al. A 5-year multicentre randomized controlled trial comparing personalized, frozen and fresh blastocyst transfer in IVF. Reprod Biomed Online. 2020;41(3):402\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRichter KS, Richter ML. Personalized embryo transfer reduces success rates because endometrial receptivity analysis fails to accurately identify the window of implantation. Hum Reprod. 2023;38(7):1239\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatel JA, et al. Personalized Embryo Transfer Helps in Improving In vitro Fertilization/ICSI Outcomes in Patients with Recurrent Implantation Failure. J Hum Reprod Sci. 2019;12(1):59\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHashimoto T, et al. Efficacy of the endometrial receptivity array for repeated implantation failure in Japan: A retrospective, two-centers study. Reprod Med Biol. 2017;16(3):290\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFujii S, Oguchi T. Age- and endometrial microbiota-related delay in development of endometrial receptivity. Reprod Med Biol. 2023;22(1):e12523.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarbakadze T, et al. Assessment of the Role of Endometrial Receptivity Analysis in Enhancing Assisted Reproductive Technology Outcomes for Advanced-Age Patients. Cureus. 2024;16(6):e62949.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePalomba S, Piltonen TT, Giudice LC. Endometrial function in women with polycystic ovary syndrome: a comprehensive review. Hum Reprod Update. 2021;27(3):584\u0026ndash;618.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuo F, et al. Altered Molecular Pathways and Biomarkers of Endometrial Receptivity in Infertile Women with Polycystic Ovary Syndrome. Reprod Sci. 2022;29(12):3335\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmed Bahgat N, Syed WJJoG, Obstetrics. Displacement of Window of Implantation in Cases of Unexplained Recurrent Implantation Failure as Detected by Endometrial Receptivity Array Testing. 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAltm\u0026auml;e S, et al. Endometrial transcriptome analysis indicates superiority of natural over artificial cycles in recurrent implantation failure patients undergoing frozen embryo transfer. Reprod Biomed Online. 2016;32(6):597\u0026ndash;613.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIwami N, et al. Therapeutic intervention based on gene sequencing analysis of microbial 16S ribosomal RNA of the intrauterine microbiome improves pregnancy outcomes in IVF patients: a prospective cohort study. J Assist Reprod Genet. 2023;40(1):125\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoreno I, et al. Endometrial microbiota composition is associated with reproductive outcome in infertile patients. Microbiome. 2022;10(1):1.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"endometrial receptivity, transfer failure, window of implantation, personalized embryo transfer, advanced maternal age","lastPublishedDoi":"10.21203/rs.3.rs-6963352/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6963352/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe current data about whether endometrial receptivity test could improve the pregnancy outcomes for Chinese IVF patients is conflicting and limited. This single-center retrospective study evaluated the efficacy of HerRecepta, a novel transcriptomic endometrial receptivity test in guiding personalized embryo transfer (pET) for Chinese IVF patients, with a focus on RIF and clinical factors influencing window of implantation (WOI).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective study included 220 IVF patients who underwent HerRecepta testing. Endometrial biopsies were analyzed via RNA sequencing to determine receptivity status (receptive/non-receptive), and pregnancy outcomes after frozen embryo transfer (FET) were compared between standard and personalized FET (pET) groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf 220 patients, 43.6% had non-receptive endometria (71.9% pre-receptive). Advanced age (\u0026gt;\u0026thinsp;35 years) and high AMH levels were risk factors for non-receptivity. Among 200 FET cases, overall pregnancy rate (PR), clinical pregnancy rate (CPR), and live birth rate (LBR) were 53.50%, 46.50%, and 32.11%, respectively. Non-receptive (pET) group showed comparable clinical outcomes to the receptive (standard ET) group in PR (51.82% vs. 55.56%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.49), CPR (46.36% vs. 46.67%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.96), and LBR (32.38% vs. 31.76%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.93. Similar results were observed in the RIF subgroup (124 patients).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eOur findings suggest that HerRecepta test can be a valuable tool for personalized embryo transfer in IVF, particularly in specific subgroups with advanced age and with high AMH levels. Future studies to validate the optimal indication of endometrial receptivity test are needed.\u003c/p\u003e","manuscriptTitle":"Evaluating the Efficacy of a Novel Endometrial Receptivity Analysis Test in Improving Pregnancy Outcomes for Chinese IVF Patients: A Single-Center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 08:11:57","doi":"10.21203/rs.3.rs-6963352/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-12T03:33:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-30T08:33:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"10740003937267791652386822834449344184","date":"2025-11-25T04:39:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-09T12:55:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"268942255058408501539227829040060759810","date":"2025-08-04T08:36:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-31T05:27:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-23T17:14:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-30T04:53:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-27T04:44:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-06-27T04:41:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"43983f0e-5ca4-4f11-adc6-59c3bdb92306","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-25T07:08:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-06 08:11:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6963352","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6963352","identity":"rs-6963352","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}