P-128 Role of PGT-A and ERA to optimise reproductive outcomes of couples with recurrent implantation failure. (30th June 2022) - Mathew, S.T
Abstract: Study question: In couples with Recurrent Implantation Failure (RIF), can Pre-implantation Genetic Testing for Aneuploidy (PGT-A) or Endometrial Receptive Array (ERA) help to optimise the reproductive outcomes? Summary answer: In RIF patients PGT-A or ERA individually do not seem to optimize outcomes. PGT-A in-combination with ERA seems to be a beneficial intervention. What is known already: Role of PGT-A and ERA to optimize reproductive outcomes has been ambigious. In this current study we wanted to evaluate their efficacy in RIF patients. Study design, size, duration: This is a retrospective data of couples undergone treatment for RIF at our private fertility centre from January 2014 to July 2019. The study population was divided to four groups based on the treatments offered: Group A: ERA (n = 47) Group B: PGT-A (n = 54) Group C: ERA+PGT-A (n = 49) Group D: No PGT-A/ No ERA (n = 189) Participants/materials, setting, methods: Couples with minimum two failed transfers were recruited. ICSI was the method of insemination. Blastocysts were subjected to genetic testing through Next-Generation Sequencing(NGS). All embryo transfers performed in a Frozen Embryo Replacement Cycle(FET). ERA was done as per our institutes Standard Operating Procedures(SOP) and for ERA patients ET was done as per the receptivity status. Elective Single Euploid Blastocyst transfer (eSET) was done in grpB&C un-screened double Blastocyst Transfer (DET) was done in grpA&D. Main results and the role of chance: Clinical Pregnancy Rate (CPR), Miscarriage Rate (MR) Implantation Rate (IR), Multiple Pregnanacy rates (MPR) and Live Birth Rate (LBR) was evaluated in all groups. Outcomes of groups A, B, C & D were as follows: CPR – 68.09% Vs 62% Vs 68.42% Vs 70% IR – 48.89% Vs 47.50% Vs 65.22% Vs 45% MR – 12.77% Vs 9.25% Vs 5.26% Vs 17.89% MPR – 16% Vs 0% Vs 0% Vs 17% LBR – 51.06% Vs 46.8% Vs 63.16% Vs 45% CPR was comaparble between all groups ERA & PGT-A group seems to have the best IR, LBR with least miscarriage rates. For RIF patients role of PGT or ERA when offered individually, doesn't seem to optimize outcomes. PGT-A in-combination with ERA seems to be beneficial to optimize outcomes. Limitations, reasons for caution: This data is retrospective and there is a need for a well designed RCT to further validate the conclusion of this study. Caution needs to be exercised while offering PGT and ERA as they incurr additional financial burden to the patients. Wider implications of the findings: Embryo Transfer cycles with a personalised window of implantation and transfer of a single Euploid embryo can help RIF patinets to have the best reproductive outcomes and can also help shorten the time to pregnancy. Trial registration number: Not applicable