Abstract
BACKGROUND: Assisted reproductive technology still presents a significant challenge when it comes to repeated implantation failure (RIF). To address this issue, personalized embryo transfer (pET) has been suggested as a potential solution. pET involves guiding the embryo transfer process based on an analysis of endometrial receptivity, known as endometrial receptivity analysis (ERA). However, the clinical value of this approach remains uncertain. METHODS: We conducted a comprehensive analysis of 14 studies pertaining to pET guided by ERA in patients with RIF. The outcomes evaluated in these studies encompassed the clinical pregnancy rate (CPR), implantation rate, and live birth rate (LBR). In addition, we performed subgroup analysis by considering different definitions of RIF and utilizing various ERA techniques, such as traditional and optimized gene-enhanced approaches. RESULTS: In general, the utilization of ERA-guided pET did not have a substantial impact on CPR (relative risk [RR], 1.25 [95% CI, 0.85-1.84]), implantation rate (RR, 1.59 [95% CI, 0.89-2.82]), or LBR (RR, 1.55 [95% CI, 0.96-2.50]) compared with standard transfer. However, the implementation of optimized gene-enhanced ERA methods demonstrated significant enhancements in CPR (RR, 2.04 [95% CI, 1.53-2.72]) and LBR (RR, 2.61 [95% CI, 1.58-4.31]). CONCLUSION: While ERA-guided pET shows limited efficacy in improving pregnancy outcomes in patients with RIF, there lies potential in optimizing gene-enhanced ERA techniques to augment both clinical pregnancy rates and LBRs.