P-188 Preimplantation Genetic Testing for Aneuploidy and Endometrial Receptivity Assay in Recurrent Implantation Failure: A Systematic Review and Meta-Analysis of In Vitro Fertilisation Outcomes

Abstract Study question Does PGT-A, with or without an ERA, enhance pregnancy outcomes in patients with recurrent implantation failure undergoing IVF when compared to traditional morphological assessments? Summary answer PGT-A improves implantation, clinical pregnancy and live birth rates in RIF patients, while adding ERA does not significantly enhance outcomes. What is known already Recurrent implantation failure (RIF) is a major challenge in assisted reproductive technology (ART). Preimplantation genetic testing for aneuploidy (PGT-A) is commonly used to improve implantation by selecting euploid embryos. Endometrial receptivity assay (ERA) aims to optimise embryo transfer timing. However, the effectiveness of PGT-A and ERA in improving pregnancy outcome to RIF patients remains debated, with inconsistent findings across studies. Study design, size, duration Relevant studies published between January 2004 and January 2025 were systematically retrieved from PubMed, Embase, and the Cochrane Library databases. A total of 17 studies involving 7,240 cases met the inclusion criteria. Using a random-effects model, odds ratios (ORs) were calculated to assess key outcomes, including implantation, clinical pregnancy, ongoing pregnancy, live birth, and miscarriage rates. Participants/materials, setting, methods The analysis evaluated 7,240 recurrent implantation failure (RIF) cases across 17 studies. A random-effects model was employed to determine odds ratios (ORs) for implantation, clinical pregnancy, ongoing pregnancy, live births, and miscarriage rates. The study compared patients who underwent preimplantation genetic testing for aneuploidy (PGT-A) only against those who received PGT-A along with the endometrial receptivity assay (ERA), in contrast to traditional morphological assessment of embryos alone. Main results and the role of chance The findings revealed that PGT-A significantly increased implantation rates (OR = 1.75, 95% CI: 1.27-2.40, p = 0.00), clinical pregnancy rates (OR = 1.67, 95% CI: 1.17-2.37, p = 0.00), and live birth rate rates (OR = 1.74, 95% CI: 1.30-2.31, p = 0.00). However, the procedure did not significantly decrease miscarriage rates (OR = 1.30, 95% CI: 0.79-2.14, p = 0.30). Furthermore, incorporating ERA into PGT-A protocols did not yield any significant improvement in outcomes for RIF patients (implantation rates OR = 3.94, 95% CI: 0.70-22.15, p = 0.12; clinical pregnancy rates OR = 2.42, 95% CI: 0.56-10.33, p = 0.23; live birth rates OR = 1.15, 95% CI: 0.35-3.77, p = 0.82; miscarriage rates OR = 0.34, 95% CI: 0.11-1.05, p = 0.06). Notable heterogeneity was present across studies (I2 = 45%-92%). Limitations, reasons for caution Significant heterogeneity across studies (I² = 45%-92%) may affect result reliability. Differences in study design, patient characteristics, and PGT-A/ERA protocols could introduce bias. Wider implications of the findings PGT-A improves implantation, clinical pregnancy, and live birth rates in RIF patients, supporting its role in embryo selection. However, adding ERA does not enhance outcomes, suggesting limited benefit in routine use. These findings may guide clinical decision-making in ART, emphasising the need for individualized treatment approaches. Trial registration number No