P-452 Clinical impact of hyaluronic acid-based transfer medium on frozen–thawed embryo transfer outcome in recurrent implantation failure patients: a randomized controlled trial

Abstract

Study question Can Hyaluronic acid ( HA) -enriched transfer medium improve the outcome of frozen embryo transfer in women with recurrent implantation failure? Summary answer Hyaluronic acid-based embryo transfer medium significantly improves clinical pregnancy and implantation rates in recurrent implantation failure patients undergoing frozen-thawed embryo transfer. What is known already Recurrent implantation failure (RIF) is a significant challenge in about 10% of patients undergoing assisted reproduction,often influenced by interactions between the embryo and the endometrium,leading to unsuccessful outcomes. Standard embryo transfer media may not adequately support embryo implantation in these patients. Hyaluronic acid (HA) has been proposed as a potential additive to enhance implantation, as it is involved in cellular interactions. Some studies indicate that HA-enriched media may improve embryo attachment and implantation rates, but evidence on its efficacy in RIF patients undergoing frozen-thawed embryo transfer remains limited and inconclusive. Study design, size, duration A prospective randomized controlled trial was conducted at our tertiary IVF Centre from 1st January 2022 to 31st October 2024 to assess the effect of HA-enriched embryo transfer medium on outcomes in recurrent implantation failure (RIF) patients undergoing frozen-thawed embryo transfer (FET). A total of 150 women were randomly assigned to the HA group (n = 75) or the control group (n = 75). Primary outcome was clinical pregnancy while secondary outcome included implantation, miscarriage, and ongoing pregnancy rates. Participants/materials, setting, methods Participants were women under 37 years with normal ovarian reserve and a history of at least three failed fresh or frozen embryo transfers, involving four good-quality embryos across three cycles(RIF). Exclusion criteria included endocrine or uterine disorders, abnormal semen parameters, and use of donor oocytes. A total of 150 women were randomized into either the HA or control group. All underwent hormone replacement therapy (HRT) cycles with transfer of a single grade A thawed blastocyst. Main results and the role of chance Patients in the hyaluronic acid-enriched embryo transfer medium (HA) group showed a statistically significant increase in clinical pregnancy rates (an ultrasonic visualization of at least one gestional sac with or without cardiac activity) compared to the control group (42% vs. 28%, p = 0.035). Furthermore, the implantation rate was higher in the HA group (31% vs. 18%, p = 0.041). However, no significant difference was found in miscarriage rates (12% vs. 15%, p = 0.64) between the two groups. The ongoing pregnancy rate (Pregnancy continuing beyond 12th week ) showed a trend favoring the HA group, though this difference was not statistically significant (38% vs. 32%, p = 0.51). Statistical analysis was performed by the SPSS program for Windows version 25.0. Statistical tests applied according to the distribution of data: for comparing continuous variables-Student t-test and Fisher exact test for categorical variables . The statistical significance was evaluated by calculating the p-value.These findings suggest that HA-based transfer media may offer a potential therapeutic strategy to enhance clinical pregnancy and implantation rates in patients with previous history of RIF. Further research with larger sample sizes and extended follow-up is warranted to confirm these results and evaluate long-term reproductive outcomes. Limitations, reasons for caution This study’s limitations include a relatively small sample size, single-centre design, and limited follow-up period. Additionally, the impact of hyaluronic acid on factors like endometrial receptivity was not explored, which may affect the generalizability of the findings. Wider implications of the findings Hyaluronic acid-enriched embryo transfer medium as an add-on significantly improved clinical pregnancy and implantation rates in recurrent implantation failure patients, suggesting its potential to enhance IVF success in this cohort. Trial registration number Yes