Strategies for Improving Success Rates in ART PART

Proprietary and confidential — do not distribute
Strategies for Improving
Success Rates in ART
DR SHALINI CHAWLA
PART - 2

Strategies for Improving
Success Rates in ART
• Tailoring Controlled Ovarian Stimulation
• Strategies for Luteal Phase in ART cycles
• Endometrial Receptivity Array

The success of IVF depends on obtaining a sufficient number of eggs to create
high‐quality embryos for uterine transfer, without exposing the patient to the risks of
excessive ovarian stimulation 1
Ovarian stimulation (OS) is defined as pharmacological treatment with the intention of
inducing the development of ovarian follicles 2.
It can be used for two purposes:
(i) for timed intercourse or insemination and
(ii) in assisted reproduction, to obtain multiple oocytes at follicular aspiration.
Stimulation protocols
1. Macklon NS, The science behind 25 years of ovarian stimulation for in vitro fertilization. Endocrine Reviews 2006;27:170‐207. 2. Zegers-
Hochschild F, The International Glossary on Infertility and Fertility Care, 2017. Hum Reprod 2017;32:1786–1801

Ovarian Stimulation Protocols
Jirge PR. J Hum Reprod Sci. 2016;9(2):63–69.
DHEA: Dehydroepiandrosterone; DOR: Diminished ovarian reserve; FSH: Follicle-stimulating hormone; GnRH: Gonadotropin releasing hormone; hCG: Human chorionic gonadotropin; HMG: Human menopausal gonadotropin; IU: International unit; IVF: In vitro
fertilization; rFSH: Recombinant follicle stimulating hormone; rLH: Recombinant luteinizing hormone.
1. High-dose
gonadotropins
(300–450 IU/day) HMG,
rFSH, rFSH + rLH, rFSH +
hCG (100–200 IU/day),
Luteal FSH start
3. Natural cycle or minimal stimulation
• Natural cycle
• Modified natural cycle (antagonist +
small dose of FSH)
• Minimal stimulation
(Letrozole/clomiphene + antagonist +
FSH)
2a. GnRH antagonist protocols
Fixed multiple dose
Flexible multiple dose
2b. GnRH agonist protocols
Short agonist, microdose flare,
ultra-short, long agonist
4. Adjuvants
Growth hormone,
DHEA, testosterone,
aspirin

High-Dose Gonadotropins
1. Data on File (1). Last accessed on 18 January 2021. 2. Jirge PR. J Hum Reprod Sci. 2016;9(2):63–69.
COS: Controlled ovarian stimulation; FSH: Follicle-stimulating hormone; hCG: Human chorionic gonadotropin; HMG: Human menopausal gonadotropin; IU: International unit; rLH: Recombinant luteinizing hormone.
Luteal start of FSH has been used to influence the recruitment of follicles without any reported clinical benefit.2
Ovarian COS protocols: Stimulation with high
doses of FSH (300–450 IU/day).2
The available evidence regarding addition of recombinant
LH to FSH is inconclusive.2
Low-dose hCG supplementation or addition of pure HMG
has shown some improvements in the oocyte yield.2
Poor oocyte quality
Patient discomfort
Gonadotropin associated
side effects
Drawbacks of high dose-
gonadotropins1

GnRH Agonist and GnRH Antagonist Protocols
• Shorter duration of the analogue treatment
• Shorter duration of stimulation with FSH
• Lower risk of developing OHSS
• Lesser number of injections required
GnRH antagonists are, however,
associated with lower ongoing
pregnancy rates when compared to
long protocol agonists.
Long GnRH agonist treatment is perhaps
still the approach of choice.
Lambalk CB, et al. Hum Reprod Update. 2017;23(5):560–579.
FSH: Follicle-stimulating hormone; GnRH: Gonadotropin releasing hormone; OHSS: Ovarian hyperstimulation syndrome; PCOS: Polycystic ovary syndrome.
Pituitary desensitization with prolonged
daily administration of a GnRH agonist
Long protocol
Preferred option in PCOS and
poor responders
An instant blockade of the pituitary
secretion with a GnRH antagonist
Short protocol

GnRH Agonist Protocols
Pituitary desensitization with
prolonged daily administration of a
GnRH agonist
Long protocol
Long agonist protocol increases both duration of
treatment and total dose of gonadotropins necessary
to effect follicular development in poor responders.2
Short agonist protocol where agonist administration is
initiated in the early follicular phase before
gonadotropin administration is one of the most widely
used agonist protocols in poor responders.2
Agonists due to their initial flare effect may help in
recruitment of the follicles.2
Microdose flare and ultrashort protocols are preferred
by some clinicians, to minimize the pituitary
suppression, but have not shown to improve the clinical
outcomes.2
1.Data on file (1). Last accessed on 18 January 2021. 2. Jirge PR. J Hum Reprod Sci. 2016;9(2):63–69.
FSH: Follicle-stimulating hormone; GnRH: Gonadotropin releasing hormone; GnRHa: GnRH agonists.
GnRH agonist protocol1
Long agonist protocol increases both duration of
treatment and total dose of gonadotropins necessary to
effect follicular development in poor responders.2
Agonists due to their initial flare effect may help in
recruitment of the follicles.2
GnRH agonist protocol1

Proprietary and confidential — do not distribute 1.Data on file (1). Last accessed on 18 January 2021. 2. Jirge PR. J Hum Reprod Sci. 2016;9(2):63–69.
GnRH Antagonist Protocols
Gonadotropin
GnRHantagonist
hCG OPU ET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Single-dose regimen (French protocol)
hCG
GnRHantagonist
E2 >1000pg/mL
follicle 20mm
Gonadotropins
OPU ET
Menses
4
3
2
0
Multiple-dose protocol (Lubeck protocol)
Amp.
hMG
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
ET: Embryo transfer; hCG: Human chorionic gonadotropin; LH: Luteinizing
hormone; OPU: Ovum pick-up; GnRH: Gonadotropin releasing hormone.
Antagonists provide an effective way
of preventing premature LH surge
without prolonging the treatment
duration.
Pregnancy rates achieved are similar
to short agonist protocol.2
GnRH antagonist protocol1

Natural/Minimal Stimulation:
Alternative to High-Dose FSH Protocols
1. Jirge PR. J Hum Reprod Sci. 2016;9(2):63–69. 2. Data on file (1). Last accessed on 18 January 2021.
FSH: Follicle-stimulating hormone; IVF: In vitro fertilization; POR: Poor ovarian response.
Stimulation cycle types: Natural cycle IVF, modified natural cycle IVF(antagonists plus small doses of FSH), minimal
stimulation (letrozole or clomiphene citrate plus small doses of FSH plus antagonist)1
1
2
3
4
Abnormal follicular maturation
Premature ovulation of the single follicle
Failed fertilization
Failed oocyte retrieval, or empty follicle at retrieval
Natural/ minimal
stimulation is
associated with a
high risk of
cancellation due to
following reasons:2

• It is essential to be able to predict the response of the women to the hormones, to
choose the best protocol to produce a major number of follicles, which at the same
time allows the retrieval of a greater number of oocytes.
• Based on the response to standard stimulation regimens with stabilized doses of
gonadotropins, women can be classified into three classes:
Predicting Ovarian Response
Normal-responder
Poor-responder
High-responder
Pacchiarotti, Alessandro et al. “Ovarian Stimulation Protocol in IVF: An Up-to-Date Review of the Literature.” Current pharmaceutical
biotechnology vol. 17,4 (2016): 303-15.

A step towards personalized medicine:
Individualized COS (iCOS) determined by the use of biomarkers to test ovarian reserve
has the potential to optimize outcomes and reduce safety issues by adapting treatment
protocols according to each patient’s specific characteristics.
As new objective endocrine, paracrine, functional and/or genetic biomarkers of response
are developed, iCOS can be refined further still, and this will be a significant step towards
a personalised approach for IVF.
Individualized controlled ovarian stimulation
Bosch and Ezcurra. Individualised controlled ovarian stimulation (iCOS): maximising success rates for
assisted reproductive technology patients Reproductive Biology and Endocrinology 2011, 9:82

A Novel Tool in Identification of Low Prognosis Patients in ART
1. Esteves SC, et al. Front Endocrinol (Lausanne). 2018;9:461. 2. Conforti A, et al. Front Endocrinol (Lausanne). 2019;10:387.
AFC: Antral follicle count; AMH: Anti-Mullerian hormone; ART: Assisted reproductive treatment; IVF: In vitro fertilization; ng/mL: Nanogram per milliliter; OS: ovarian stimulation; POSEIDON: Patient-Oriented Strategies
Encompassing Individualize D Oocyte Number.
1. Age 3.
Ovarian biomarkers
(AMH and/or AFC)
No. oocytes retrieved
in previous OS cycle
<35
AFC<5
AMH <1.2ng/mL
<35
AFC≥5
AMH ≥1.2ng/mL
Subgroup a: <4
Subgroup b: 4–9
≥35
AFC<5
AMH <1.2ng/mL
≥35
AFC≥5
AMH ≥1.2ng/mL
Subgroup a: <4
Subgroup b: 4–9
2.
GROUP 1 GROUP 2
GROUP 3 GROUP 4
Advantages of Poseidon
criteria1
• Improves the ART
outcomes
• Promotes a patient-
tailored approach
• Maximizes IVF
success rates
Patient - Oriented Strategies Encompassing Individualized
Oocyte Number (POSEIDON)

Based on POSEIDON Criteria
What should be done if
ORT results are positive?
Best Practice in POSEIDON groups 1 and 2
Consider ART calculator and Genotype screening
Consider androgens in selected patients (in particular, POSEIDON group 2 with ovanan reserve
markers in the lower limits)
POSEIDON group 1 (Age <35) POSEIDON group 2 (Age ≥35)
POSEIDON group 2 (Age 35-
39)
Consider Duo-Stim approach
rLH 150 IU daily from stimulation day 1 in both
agonist and antagonist regimens
Recombiant FSH dose of 300 IU daily
Increase recombinant FSH dosage
• 50-75 IU if no variants
• 75-150 IU if FSH-R variants (maximum daily dose of 300
IU)
Consider adding rLH
2:1 ratio of rFSH and rLH from the ﬁrst stimulation day in
women who consumed more than 3,000 IU or with a history
of follicular stagnation
Consider antagonist regimen, GnRHa trigger, and elective embyo freezing in cases of AFC >16 and/or AMH
>3.36 ng/mL
Consider preimplantation genetic testing for aneuploidy (PGT-A) in Poseidon group 2 (in particular, patients
aged >38)
Consider single blastocyst embryo trasfer
Pre-treatment
protocol
Stimulation
protocol
Trigger/Retrieval
Conforti A, et al. Front Endocrinol (Lausanne). 2019;10:387.
AFC: Antral follicle count; AMH: Anti-Mullerian hormone; ART: Assisted reproductive treatment; FSH: Follicle-stimulating hormone; GnRHa: Gonadotropin releasing hormone agonist; IU: International unit; IVF: In vitro fertilization;
POSEIDON: Patient-Oriented Strategies Encompassing Individualize D Oocyte Number. rLH: Recombinant luteinizing hormone; rFSH: Recombinant follicle-stimulating hormone; ng/mL: nanogram per milliliter.
Stimulation Protocols for low prognosis patients

• The ‘short’, ‘ultrashort’, ‘micro-flare’ and ‘stop’ GnRH agonist protocols involve adjusting
the timing and dose of GnRH agonist administration, so that the patient benefits from the
initial flare-up of endogenous follicle stimulating hormone (FSH) and luteinizing
hormone (LH) that may ‘jump start’ the follicles, in addition to the action of exogenous
gonadotropins.
• Another modification to the standard long protocol involves changing the combination of
gonadotropins.
• For example, the addition of LH has been shown to improve cycle outcomes in poor
responders and patients > 35 years old.
• Moreover, pre-treatment with testosterone, estrogens or letrozole has also been proposed
to increase ovarian response in this particular population.
Bosch and Ezcurra. Individualised controlled ovarian stimulation (iCOS): maximising success rates for
assisted reproductive technology patients Reproductive Biology and Endocrinology 2011, 9:82
Adjusting the standard protocols for COS

Proprietary and confidential — do not distribute Durdag et al.Turk Ger Gynecol Assoc 2021
The efficacy of Dydrogesterone use to suppress premature luteinizing hormone surge on cycle
outcomes in controlled ovarian stimulation
• Dydrogesterone 2x20 mg/day was started when
the dominant follicle reached 12 mm in
diameter or serum estradiol was over 300
pg/mL and continued till trigger day
• 105 women participated in the study, of whom
52 were included in the dydrogesterone group
and 53 in the GnRHant group
• Duration of pituitary suppression was longer in Dydrogesterone group.
• Premature ovulation was observed in 11.5% (6/52) and 0% in the Dydrogesterone and GnRHant groups, respectively.
• Collected oocyte counts and metaphase II oocyte counts were found to be similar between the groups.
• Dydrogesterone can be used as an alternative to antagonist regimen in patients where embryo transfer is not planned
in the same cycle.
Progesterone primed ovarian stimulation

Treatment options for LPS in IVF
hCG
GnRHa: Gonadotropin releasing hormone agonist; hCG: Human chorionic gonadotropin; IVF: In vitro fertilization; OHSS: Ovarian hyperstimulation syndrome.
1. Karakaş Yılmaz N, et al. Turk J Obstet Gynecol. 2018;15(4):217–221. 2. Rashidi BH, et al. Asian Pac J Reprod. 2016; 5(6):490–494.
Standard approach
for IVF cycles1
OHSS
risk1
Premature endogenous
LH surge2

Proprietary and confidential — do not distribute 1. Griesinger G, et al. Hum Reprod. 2018;33(12):2212–2221.
2. Griesinger G, et al. Reprod Biomed Online. 2019;38(2):249–259.
Choosing the right progesterone
Oral micronized progesterone
Low bioavailability, adverse reactions such as
drowsiness, dizziness, and headache1
Intramuscular progesterone
Injection-site pain and abscesses1
Micronized vaginal progesterone
Associated with administration-related side effects,
such as vaginal irritation1
Oral dydrogesterone
Potent oral progestin with improved bioavailability1,2

Oral Dydrogesterone: Better and Convenient Option
Approved in threatened and recurrent miscarriage and other
progesterone deficiencies1
Greater bioavailability2
Effective at lower dose and causes endometrial
transformation2
Minimizes the activation of receptors other than progesterone
receptor, and thus minimizes unwanted effects2
Shifts cytokine balance from T-helper (Th)1 toward Th2 cytokine
production that is conducive to the success of pregnancy3
Suppression of T-cell and killer-cell activity6
Induces nitric oxide synthesis that improves endometrial
receptivity and pregnancy outcomes3,4
Increases progesterone-induced blocking factor production
thereby improving pregnancy success rates5
1. Prescribing information of Duphaston®. Available at: https://data.health.gov.il/drugs/alonim/Duphaston_dr_1410193172635.pdf. Last accessed on 25 January 2021. 2.
Schindler AE, et al. Maturitas. 2003;46(Suppl 1):S7–S16. 3. Raghupathy R, et al. Am J Reprod Immunol. 2015;74(5):419–426. 4. Abdel-Razik M, et al. J Reprod Infertil.
2014;15(3):142–146. 5. Kalinka J, et al. Am J Reprod Immunol. 2005;53(4):166–171. 6. Faust Z, et al. Am J Reprod Immunol. 1999;42(2):71–75.

Proprietary and confidential — for internal use
*Lotus I and Lotus II trials. †Total number of patients in all groups included in the study.
IVF, in vitro fertilization; LPS, luteal phase support; MVP, micronized vaginal progesterone
1. Tournaye H, Sukhikh GT, Kahler E, et al. Hum Reprod. 2017;32(5):1019-1027. 2. Griesinger G, Blockeel C, Sukhikh GT, et al. Human Reprod. 2018;33(12):2212-2221. 3. Vaisbuch E, Leong M, Shoham Z. Reprod Biomed Online.
2012;25:139-45. 4. Chakravarty BN, Shirazee HH, Dam P, et al. J Steroid Biochem Mol Biol. 2005;97:416-420. 5. Crinone 4% and 8% progesterone gel US Physician Information, June 2017. 6. Crinone 8% progesterone gel
Australian Product Information, 2 March 2011. 7. Utrogestan 200mg Australian Product Information, 12 July 2016. 8. Utrogestan vaginal 200 mg capsules. UK Public Assessment Report MHRA (Medicines and Healthcare
Products Regulatory Agency), October 2015. 9. Kleinstein J. Fertil Steril. 2005;83(6):1641-1649. 10. Progesterone 400 mg pessaries. UK Public Assessment Report MHRA (Medicines and Healthcare Products Regulatory
Agency), March 2017. 11. Doody KJ, Schnell VL, Foulk RA, et al. Fertil Steril. 2009;91(4):1012-1017. 12. Endometrin Australian Product Information, 19 September 2012. 13. Lockwood G, Griesinger G, Cometti B, et al. Fertil
Steril. 2014;101(1):112-119. 14. Baker VL, Jones CA, Doody K, et al. Hum Reprod. 2014;29(10):2212-2220. 15. Lubion 25 mg powder for solution for injection. Lubion 25 mg solution for injection. UK Public Assessment Report
MHRA.
Dydrogesterone is an effective and well tolerated oral
option for LPS in IVF1,2
MVP was used in almost two thirds of IVF
cycles worldwide,3 but is associated
with administration-related side effects
as well as less patient acceptance4
Oral dydrogesterone was evaluated
in two large randomized controlled trials and
was found to be at least equivalent to MVP for
pregnancy rate and live birth rate1,2 Oral
dydrogesterone
Lotus Program*1,2
238
430
768
1211
1483
2065
Number of patients in registration trials†
Subcutaneous
progesterone
injection13-15
MVP
insert11-12
Progesterone
pessary10
MVP
gel 8%5-6
MVP
capsule7-9

*At 12 weeks of gestation. MVP, micronized vaginal progesterone
1. Tournaye H, Sukhikh GT, Kahler E, et al. Hum Reprod. 2017;32(5):1019-1027.
2. Griesinger G, Blockeel C, Sukhikh GT, et al. Human Reprod. 2018;33(12):2212-2221.
Dydrogesterone achieves non-inferior pregnancy rates
versus MVP capsule or gel at 12 weeks of gestation
Dydrogesterone
30 mg/day
37.6
33.1
0
5
10
15
20
25
30
35
40
MVP capsule
600 mg/day
(187/497)
(158/477)
Dydrogesterone
30 mg/day
38.7
35.0
0
5
10
15
20
25
30
35
40
MVP gel
90 mg/day
(191/494)
(171/489)
Pregnancy
rate
(%)
Pregnancy
rate
(%)
LOTUS I1
Pregnancy rate*1,2
LOTUS II2

Proprietary and confidential — do not distribute Griesinger G. PLoS One. 2020;15(11):e0241044.
Key Findings of Griesinger et al.
Systematic Review & Meta-analysis of Individual Participant Data
Significantly higher pregnancy
rate than MVP capsules and gels.
Significantly higher live birth
rate than MVP capsules and
gels.
Well-established safety profile
with no significant maternal or
fetal safety concerns.
Oral dydrogesterone was associated with
MVP: Micronized vaginal progesterone.

Dydrogesterone for Luteal Phase Support in Programmed FET cycles
Pabuccu et al. conducted a pilot RCT to compare three different routes of progesterone administration in artificially
programmed FET cycles
Outcomes
Treatment with 40 mg/day oral DYD, 180 mg/day progesterone vaginal gel, or 100 mg/day IMP revealed
similar reproductive outcomes in programmed FET cycles.
Oral administration is better tolerated and showed a lower side effect profile per patient when compared
with the other arms
Pabuccu E, et. al. Oral, vaginal or intramuscular progesterone in programmed frozen embryo transfer cycles: A pilot randomized
controlled trial. Reprod. Biomed. Online. 2022
Oral dydrogesterone (20mg BD)
(n = 52)
Progesterone Vaginal Gel 8% (90mg BD)
(n = 55)
Intramuscular progesterone 50 mg/ml in oil BD
(n = 44)
(n = 52)
(n = 44)
(n = 52)
(n = 44)

Individualized luteal phase support using additional oral dydrogesterone in
artificially prepared frozen embryo transfer cycles
Mackens et al.
Rescue strategy when low serum progesterone
concentrations are detected at the moment
of FET in HRT cycles
Micronized Vaginal Progesterone (MVP) - 400 mg twice daily
Serum progesterone concentrations were assessed prior to
FET
147 Patients with low serum progesterone (<8.8 ng/ml)
Received additional oral dydrogesterone supplementation
(10 mg three times daily) from the day after FET onwards
ONGOING PREGNANCY RATE
(p=0.85b)
LIVE BIRTH RATE
(p=0.84b)
Additional oral dydrogesterone supplementation in this context gives rise to comparable live birth rate in
patients with low serum progesterone as observed in patients with normal progesterone concentrations
Mackens S, Pais F, Drakopoulos P et al. Individualized luteal phase support using additional oral dydrogesterone in artificially prepared frozen
embryo transfer cycles: is it beneficial? Reprod Biomed Online. 2023;46(6):939-945
Luteal Phase Support:

ERA is a test, which analyze the 238 genes in an endometrial tissue sample obtained by biopsy during a specific
interval in the menstrual cycle2, which has a sensitivity and specificity of 0.99758 and 0.88573, respectively.
Endometrial receptivity array (ERA)
1. Kliman H.J., Frankfurter D. Clinical approach to recurrent implantation failure: Evidence-based evaluation of the endometrium. Fertil. Steril. 2019;111:618–
628. 2. Miravet-Valenciano JA, Understanding and improving endometrialreceptivity. Curr Opin Obstet Gynecol 2015;27: 187–92, 2. Huy Phuong Tran, The impact of an endometrial receptivity
array on personalizing embryo transfer for patients with infertility: a meta-analysis, Vol 3, Issue 3, 2022
Suggests a suitable time for embryo
transfer
Indicates prereceptive or postreceptive moment,
which is not ideal for embryo transfer
After ERA confirms the precise WOI timing, the embryo is
transferred in the subsequent cycle3
Outcome
The endometrial receptivity array (ERA) was first developed in 2011 by Díaz-Gimeno et al1.
Receptive Non
receptive

• By using FET, the embryos are frozen for use in subsequent cycles, thus avoiding
supraphysiologic hormone levels and an asynchronous implantation window,
leading to better outcomes than those seen in fresh transfers.
• The ERA can be used in a modified nFET cycle in an attempt to better guide the
timing of embryo transfer to best match the WOI.
• Administration of hCG is necessary in order to time embryo transfer to when the
endometrium is most receptive.
• The biopsy is taken at either LH +7 or hCG +7, which are considered to be equal
under the ERA protocol, and sent to Igenomix, the medical laboratory that analyzes
the ERA
FET- Fresh embryo transfer
ERA in the Context of Natural Frozen Embryo Transfer
Rubin SC, Abdulkadir M, Lewis J, Harutyunyan A, Hirani R, Grimes CL. Review of Endometrial Receptivity Array: A
Personalized Approach to Embryo Transfer and Its Clinical Applications. J Pers Med. 2023 Apr 27;13(5):749

ERA in the Context of Hormone Replacement Therapy
Frozen Embryo Transfer
In using an ERA to guide the timing for an HRT-FET cycle, a
patient will ultimately need two cycles, the first being an ERA
cycle, and the second being an HRT-FET cycle.
In the ERA cycle, the patient uses the same medications they
would in an HRT-FET cycle, mimicking the uterine conditions
in an eventual transfer cycle
Endometrial biopsy can be performed on day P +5.Then the
ERA results are used to personalize the date of the embryo
transfer to the individual receptivity of each patient’s
endometrium
Rubin SC, Abdulkadir M, Lewis J, Harutyunyan A, Hirani R, Grimes CL. Review of Endometrial Receptivity Array: A Personalized
Approach to Embryo Transfer and Its Clinical Applications. J Pers Med. 2023 Apr 27;13(5):749

• There is an increased percentage of WOI displacement in RIF patients, therefore
leading to the incorporation of the ERA in personalized frozen embryo transfer (pET)
as a therapeutic strategy.
• Multiple studies1,2,3 showed that when pET was employed in specifically RIF patients
with a nonreceptive endometrium, the implantation rate and pregnancy rate increased
to the level of that of receptive RIF patients
• A retrospective cohort study, performed in 2015 at a fertility center in India,
demonstrates this as well1.
• Another study concluded that the ERA is a tool that is beneficial in RIF patients,
increasing implantation and pregnancy rates to levels that are comparable to those of
a non-RIF population4,5
Clinical outcomes using ERA in
Recurrent Implantation Failure (RIF)
1. Mahajan N. Endometrial receptivity array: Clinical application. J. Hum. Reprod. Sci. 2015;8:121–129. 2. Tan J. The role of the (ERA) in patients who have failed euploid embryo transfers. J. Assist. Reprod. Genet. 2018;35:683–692, 3. Kaur S., Naidu P. Why results of
endometrial receptivity assay testing should not be discounted in recurrent implantation failure? Onco Fertil. J. 2019, 4. Rubin SC, Abdulkadir M, Lewis J, Harutyunyan A, Hirani R, Grimes CL. Review of Endometrial Receptivity Array: A Personalized Approach to Embryo
Transfer and Its Clinical Applications. J Pers Med. 2023 Apr 27;13(5):749, 5. Rose B.I. On the utility of the endometrial receptivity assay (era) to correct recurrent implantation failure (rif): Not as simple as it seems. Fertil. Steril. 2020;114:e168.

Proprietary and confidential — do not distribute 26-Mar-24
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