The Study on the Clinical Efficacy of Endometrial Receptivity Analysis and Influence Factors of Displaced Window of Implantation

Overview

Journal Sci Rep

Specialty Science

Date 2025 Mar 2

PMID 40025209

Authors

Shaoyuan Xu

Honglu Diao

Yao Xiong

Changjun Zhang

Ying Zhang

Yuanzhen Zhang

Affiliations

Soon will be listed here.

Abstract

The endometrial receptive status is critical for a successful embryo implantation, but it only last for a short period of time, and the window of implantation (WOI) of each woman changes individually, which will lead to poor outcomes of assisted reproduction. This so-called WOI can be detected by molecular diagnostic method, endometrial receptivity analysis (ERA), which was gradually applied to clinical practice. This study aimed to evaluate the clinical efficacy of personalized embryo transfer (pET) guided by ERA in patients with and without RIF. A total of 3605 patients with previous failed embryo transfer (ET) cycle in the reproductive medicine center of Renmin Hospital Hubei University of Medicine from January 2016 to October 2022 were retrospectively analyzed. The 3605 patients were divided into non-RIF group and RIF group, among which 782 patients who received ERA test underwent personalized embryo transfer (pET). The decision whether to accept ERA test or not was based on the patient's voluntary choice. We divided the 782 patients into normal WOI group and displaced WOI group according to the result of ERA test. The pregnancy outcomes were compared between the different groups. The age, number of previous ET cycle and serum E2/P ratio were mainly analyzed to investigate its relationship with displaced WOI. The clinical pregnancy rate and live birth rate in non-RIF with pET group were higher than that of non-RIF with non-personalized embryo transfer (npET) group (64.5% vs 58.3%, P = 0.025; 57.1% vs 48.3%, P = 0.003). The clinical pregnancy rate and the live birth rate in RIF with pET group were significantly higher than that of RIF with npET group (62.7% vs 49.3%, P < 0.001; 52.5% vs 40.4%, P < 0.001) after propensity score matching (PSM). The early abortion rate in the non-RIF with pET group was lower than that in the non-RIF with npET group (8.2% vs 13.0%, P = 0.038). There was a significant difference in age and the number of previous failed ET cycle between the normal WOI group and displaced WOI group (age: 32.26 vs 33.53 years, P < 0.001; the number of previous failed ET cycle: 1.68 vs 2.04, P < 0.001). Logistic regression analysis also showed that the age and number of previous failed ET cycles were positively correlated with displaced WOI. The displaced WOI rate increased gradually with the increase of age and number of previous failed ET cycle; the displaced WOI rate in the median group (4.46 < E2/P ≤ 10.39 pg/ng) was significantly lower than that in the other two groups (54.8% vs 40.6% vs 58.5%, P < 0.001). The clinical pregnancy rate and live birth rate of patients with previous failed ET cycle was improved after pET guided by ERA, especially in RIF patients; the early abortion rate of the non-RIF patient was reduced after pET guided by ERA. An appropriate E2/P ratio was beneficial for maintaining endometrial receptivity state, and the age and number of previous failed ET cycle was correlated with increased displaced WOI.

References

Shekhar B, Mittal S, Majumdar G, Tiwari N, Majumdar A . Low serum progesterone on day of transfer adversely impacts ongoing pregnancy rates in hormonally prepared single blastocyst frozen embryo transfer cycles. Eur J Obstet Gynecol Reprod Biol. 2023; 289:55-59. DOI: 10.1016/j.ejogrb.2023.08.016. View

Ma J, Gao W, Li D . Recurrent implantation failure: A comprehensive summary from etiology to treatment. Front Endocrinol (Lausanne). 2023; 13:1061766. PMC: 9849692. DOI: 10.3389/fendo.2022.1061766. View

Urban A, Warzecha D, Laudanski P, Pietrzak B, Wielgos M . Personalized embryo transfer (pET) guided by endometrial receptivity (ER) assessment - a possibility to increase effectiveness of IVF procedures. Review of available methods. Ginekol Pol. 2023; 94(12):1004-1010. DOI: 10.5603/GP.a2023.0041. View

Chen J, He A, Zhang Q, Zhao J, Fu J, Li H . The RNA-seq based endometrial receptivity test (rsERT) compared to pinopode: A better diagnostic tool for endometrial receptivity for patients with recurrent implantation failure in Chinese population. Front Endocrinol (Lausanne). 2022; 13:1009161. PMC: 9634259. DOI: 10.3389/fendo.2022.1009161. View

Mukherjee N, Sharma R, Modi D . Immune alterations in recurrent implantation failure. Am J Reprod Immunol. 2022; 89(2):e13563. DOI: 10.1111/aji.13563. View

Awonuga A, Camp O, Abu-Soud H, Rappolee D, E Puscheck E, Diamond M . Determinants of Embryo Implantation: Roles of the Endometrium and Embryo in Implantation Success. Reprod Sci. 2023; 30(8):2339-2348. DOI: 10.1007/s43032-023-01224-w. View

. [Expert consensus on diagnosis and treatment of recurrent implantation failure]. Zhonghua Yi Xue Za Zhi. 2023; 103(2):89-100. DOI: 10.3760/cma.j.cn112137-20221105-02317. View

Stevens Brentjens L, Obukhova D, den Hartog J, Delvoux B, Koskivuori J, Auriola S . An integrative analysis of endometrial steroid metabolism and transcriptome in relation to endometrial receptivity in in vitro fertilization patients. F S Sci. 2023; 4(3):219-228. DOI: 10.1016/j.xfss.2023.04.003. View

Perry G, Ketchum J, Quail L . Importance of preovulatory estradiol on uterine receptivity and luteal function. Anim Reprod. 2023; 20(2):e20230061. PMC: 10503890. DOI: 10.1590/1984-3143-AR2023-0061. View

10.

Simon C, Gomez C, Cabanillas S, Vladimirov I, Castillon G, Giles J . A 5-year multicentre randomized controlled trial comparing personalized, frozen and fresh blastocyst transfer in IVF. Reprod Biomed Online. 2020; 41(3):402-415. DOI: 10.1016/j.rbmo.2020.06.002. View

11.

Yaron Y, Botchan A, Amit A, Kogosowski A, Yovel I, Lessing J . Endometrial receptivity: the age-related decline in pregnancy rates and the effect of ovarian function. Fertil Steril. 1993; 60(2):314-8. DOI: 10.1016/s0015-0282(16)56104-4. View

12.

Cimadomo D, de Los Santos M, Griesinger G, Lainas G, Le Clef N, McLernon D . ESHRE good practice recommendations on recurrent implantation failure. Hum Reprod Open. 2023; 2023(3):hoad023. PMC: 10270320. DOI: 10.1093/hropen/hoad023. View

13.

Palomba S, Vitagliano A . Is the era of the endometrial scratching finished?. Fertil Steril. 2022; 118(3):603. DOI: 10.1016/j.fertnstert.2022.06.019. View

14.

Ohara Y, Matsubayashi H, Suzuki Y, Takaya Y, Yamaguchi K, Doshida M . Clinical relevance of a newly developed endometrial receptivity test for patients with recurrent implantation failure in Japan. Reprod Med Biol. 2022; 21(1):e12444. PMC: 8967283. DOI: 10.1002/rmb2.12444. View

15.

Liu S, Diao L, Huang C, Li Y, Zeng Y, Kwak-Kim J . The role of decidual immune cells on human pregnancy. J Reprod Immunol. 2017; 124:44-53. DOI: 10.1016/j.jri.2017.10.045. View

16.

Wu J, Sheng J, Wu X, Wu Q . Ultrasound‑assessed endometrial receptivity measures for the prediction of in vitro fertilization‑embryo transfer clinical pregnancy outcomes: A meta‑analysis and systematic review. Exp Ther Med. 2023; 26(3):453. PMC: 10443051. DOI: 10.3892/etm.2023.12152. View

17.

Liu Z, Liu X, Wang M, Zhao H, He S, Lai S . 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. PMC: 9092494. DOI: 10.3389/fphys.2022.841437. View

18.

Tan J, Paria B, Dey S, Das S . Differential uterine expression of estrogen and progesterone receptors correlates with uterine preparation for implantation and decidualization in the mouse. Endocrinology. 1999; 140(11):5310-21. PMC: 4280800. DOI: 10.1210/endo.140.11.7148. View

19.

Shan J, Li D, Wang X . Towards a Better Understanding of Endometriosis-Related Infertility: A Review on How Endometriosis Affects Endometrial Receptivity. Biomolecules. 2023; 13(3). PMC: 10046640. DOI: 10.3390/biom13030430. View

20.

Moffett A, Colucci F . Uterine NK cells: active regulators at the maternal-fetal interface. J Clin Invest. 2014; 124(5):1872-9. PMC: 4001528. DOI: 10.1172/JCI68107. View