Endometrial Receptivity Array (ERA)對於凍胚植入frozen embryo transfer 懷孕率無明顯助益

Endometrial Receptivity Array Before Frozen Embryo Transfer Cycles: A Systematic Review and Meta-analysis

 https://doi.org/10.1016/j.fertnstert.2022.11.012

 Importance

There is a lack of consensus regarding the use of Endometrial Receptivity Array (ERA) for increasing the success rate of In Vitro Fertilization (IVF) cycles, mainly in terms of the live birth rate.

Objective

To investigate the impact of ERA prior to frozen embryo transfer (FET) in patients undergoing IVF.

Data Sources

PubMed, Web of Science and Embase were searched from inception up to February 15, 2022.

Study selection and synthesis

Only comparative studies evaluating pregnancy rates of patients undergoing FET cycles with or without prior ERA were included. Inter-study heterogeneity was also assessed using Cochrane’s Q test and the I2 statistic. The random-effects model was used to pool the odds ratio (OR) with the corresponding 95% confidence intervals (CIs). Subgroup analyses were performed to investigate the impact of ERA on pregnancy rates according to the number of prior embryo transfer (ET) failures (≤ 2 previous failed ETs vs > 2 failed ETs, defined as recurrent implantation failure). Separate analyses were performed according to the study design and adjustment for confounders.

Main outcome(s)

The primary outcomes of the study were livebirth rate and/or ongoing pregnancy rate. Implantation rate, biochemical pregnancy rate, clinical pregnancy rate, and miscarriage rate were considered secondary outcomes.

Result(s)

Eight studies (representing data on n=2,784 patients; n=831 had undergone ERA and n=1,953 without ERA) were found to be eligible for this meta-analysis. The live birth or ongoing pregnancy rate for the ERA group was not significantly different compared to the non-ERA group (OR 1.38, 95% CI 0.79-2.41, P 0.25, I2 83.0%), nor was a difference seen in subgroup analyses based on the number of prior failed ETs. The rates of implantation, biochemical pregnancy, clinical pregnancy and miscarriage were also comparable between the ERA and the non-ERA groups. After separate analyses according to the study design and adjustment for confounding factors, overall pooled estimates remained statistically non-significant.

Conclusion(s) and Relevance

The findings of the current meta-analysis did not reveal a significant change in the rate of pregnancy after IVF cycles using ERA and it is not clear whether ERA can increase the pregnancy rate or not.