Abstract
This study aimed to investigate potential improvements when implementing endometrial receptivity analysis (ERA)-guided personalized embryo transfer (pET) using euploid blastocyst in patients with one or more previous failed embryo transfers. A total of 270 patients with one or more previous failed embryo transfers were enrolled between 2017 and 2021 in this multicenter retrospective study. These patients were divided into two groups: study cases (ERA-guided pET) (n = 200) or controls (standard embryo transfer) (n = 70). Clinical outcomes compared were pregnancy rate (PR), implantation rate (IR), ongoing pregnancy rate (OPR), and live birth rate (LBR). Clinical results in terms of PR, OPR, and LBR were significantly higher when performing ERA-guided pET (PR: 65.0%; OPR: 49.0%; LBR: 48.2%) compared to standard embryo transfer (PR: 37.1%; OPR: 27.1%; LBR: 26.1%) (P < 0.01). Logistic regression was applied to examine the correlation between ERA and the primary outcome measured, OPR, including demographic variables as covariates. The effect of ERA was significantly associated with OPR (P = 0.002; aOR 2.8, 95% CI 1.5-5.5); furthermore, OPR decreased significantly when body mass index (BMI) values increased (P = 0.04; aOR 0.9, 95% CI 0.8-0.98). These findings support the potential of ERA-guided pET to improve clinical outcomes and address the challenges encountered by patients with previous implantation failures.