探讨子宫内膜容受性检测(ERA)对胚胎反复种植失败(RIF)患者妊娠结局的影响。

选择2018年1月至2021年12月于徐州市中心医院生殖医学中心接受体外受精-胚胎移植(IVF-ET)治疗的231例胚胎RIF患者为研究对象。对其中171例接受ERA的RIF患者，根据ERA结果分别纳入种植窗(WOI)位移组(n＝68，发生WOI位移)及WOI正常组(n＝103，WOI未发生位移)；将拒绝进行ERA的60例RIF患者纳入对照组。WOI位移组中，根据患者ERA检测的WOI结果，确定其采取个体化胚胎移植(pET)时间；另2组患者按照内膜转化日后3 d或者5 d进行卵裂期或者囊胚期ET。采用方差分析及χ²检验，对3组患者一般临床资料、ET情况及妊娠结局进行统计学比较。本研究经本院生殖伦理委员会通过(审批文号：XZZXYY-SZZX-20170918-002)，并经患者及家属知情同意。

①本组171例接受ERA的RIF患者中，WOI位移率为39.8%(68/171)，其中WOI推后者占98.5%(67/68)。②3组患者卵裂期和囊胚期平均移植胚胎数目和流产率分别比较，以及囊胚期临床妊娠率比较，差异均无统计学意义(P>0.05)。③WOI位移组卵裂期胚胎种植率、临床妊娠率分别为39.7%、50.0%，均分别高于WOI正常组的20.8%、29.0%和对照组的17.3%、25.0%，并且差异均有统计学意义(χ²＝4.06、P＝0.044，χ²＝4.70、P＝0.030；χ²＝4.40、P＝0.036，χ²＝4.76、P＝0.029)。④WOI位移组囊胚期胚胎种植率为42.1%，分别高于WOI正常组的19.1%和对照组的20.5%，并且差异均有统计学意义(χ²＝7.50、P＝0.006；χ²＝4.51、P＝0.034)。

对于胚胎RIF患者，采取ERA后的pET方案，可改善其IVF-ET临床妊娠结局。

To explore the effect of endometrial receptivity array (ERA) on clinical pregnancy outcomes in patients with embryo repeated implantation failure (RIF).

A total of 231 embryo RIF patients who received in vitro fertilization embryo transfer (IVF-ET) in the Reproductive Medicine Center of Xuzhou Central Hospital from January 2018 to December 2021 were selected as the research subjects. The 171 patients who implemented ERA were divided into implantation window (WOI) displacement group (n=68, with WOI displacement) and WOI normal group (n=103, without WOI displacement) based on ERA results; and 60 RIF patients who refused to undergo ERA were included into control group. In WOI displacement group, subjects underwent personalized embryo transfer (pET) based on the WOI determined by ERA results; The other two groups of subjects underwent ET at the cleavage stage or blastocyst stage 3 or 5 days after the endometrial transformation date. One-way ANOVA and chi-square test were conducted to statistically compare the general clinical data, ET situation and pregnancy outcomes among three groups of subjects. This study was approved by the Reproductive Ethics Committee of our hospital (Approval No. XZZXYY-SZZX-20170918-002), with the informed consents of patients and their family members.

① Among 171 RIF patients received ERA, the WOI displacement rate was 39.8% (68/171), of which 98.5% (67/68) were delayed by WOI. ② There were no significant differences among 3 groups in the average number of transferred embryos and abortion rates of cleavage stage and blastocyst stage, respectively, also clinical pregnancy rate of blastocyst stage (P>0.05). ③ The embryo implantation rate and clinical pregnancy rate of cleavage stage in WOI displacement group were 39.7% and 50.0%, respectively, which were higher than those of 20.8% and 29.0% in WOI normal group and 17.3% and 25.0% in control group, and the differences were statistically significant (χ²=4.06, P=0.044; χ²=4.70, P=0.030. χ²=4.40, P=0.036; χ²=4.76, P=0.029). ④ The embryo implantation rate of blastocyst stage in WOI displacement group was 42.1%, which was higher than that of 19.1% in WOI normal group and 20.5% in control group, respectively, and the differences were statistically significant (χ²=7.50, P=0.006; χ²=4.51, P=0.034).

For women with embryonic RIF, pET after ERA can improve the clinical pregnancy outcomes of IVF-ET.