The impact of an endometrial receptivity array on personalizing embryo transfer for patients with infertility: a meta-analysis

Objective: To investigate the effectiveness of the endometrial receptivity array (ERA) test on in vitro fertilization (IVF) outcomes. Evidence Review: The PubMed/MEDLINE, ScienceDirect, and Scopus databases were searched. We included studies investigating IVF outcomes between patients who underwent standard embryo transfer and personalized embryo transfer (PET) guided by the ERA results. The main outcome measures were the implantation rate, clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, and live birth rate (LBR). The random -effects model was applied to pool data. We evaluated cohort and randomized controlled trial studies using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines and the Cochrane Collaboration tool. Results: Seventeen studies (7,052 patients, 4 randomized controlled trials, and 13 cohort studies) were included in this meta -analysis. Personalized embryo transfer on the basis of ERA was not found to optimize the gestational outcomes, including the implantation rate (risk ratio [RR], 1; 95% confidence interval [CI], 0.83-1.2), clinical pregnancy rate (RR, 0.99; 95% CI, 0.85-1.15), ongoing pregnancy rate (RR, 0.99; 95% CI, 0.89-1.11), and miscarriage rate (RR, 1.12; 95% CI, 0.81-1.54). Further subgroup analysis indicated that patients undergoing PET in the first IVF cycle had a markedly increased LBR (RR, 1.24; 95% CI, 1.03-1.49). Conversely, PET among patients with a history of recurrent implantation failure did not enhance the LBR (RR, 0.86; 95% CI, 0.64-1.36). Conclusion: Endometrial receptivity array shows no significant improvement in IVF outcomes except in the LBR for patients undergoing the first IVF cycle. Additional research is required to ascertain the efficacy of ERA before achieving wider usage. PROSPERO Number: CRD42021255124. (Fertil Steril Rev (R) 2022;3:157-73. (c) 2022 by American Society for Reproductive Medicine.)