Hyaluronan-enriched transfer media in PGT-A cycles: a stratified cohort analysis

Research question: Can hyaluronan-enriched transfer medium (HETM) improve reproductive outcomes in frozen single euploid blastocyst transfers after preimplantation genetic testing for aneuploidy (PGT-A)? Design: Retrospective analysis of 445 patients (549 cycles), who had PGT-A embryo transfers that used HETM (EmbryoGlue) versus standard medium. Subgroup analyses were conducted based on blastocyst morphology, maternal age and previous implantation failure. Results: No significant differences were found between HETM and control groups in the main reproductive outcomes, including positive HCG rates (72.27% versus 70.23%, P = 0.648), clinical pregnancy (80.23% versus 84.11%, P = 0.440), live birth rates (66.28% versus 72.85%, P = 0.237), and miscarriage rates (13.95% and 11.26%, P = 0.404). Subgroup analyses by blastocyst cohort quality, maternal age and previous implantation failure showed no statistically significant benefit of HETM. On transfers of poor morphology (C-grade) blastocysts, HETM was associated with a significantly higher HCG-positive rate (79.17% for HETM versus 52.94% for the control group, P = 0.021), but this did not translate into improved clinical pregnancy (52.63% HETM versus 68.89% control group; P = 0.231) or live birth rates (47.37% HETM versus 62.22% control group; P = 0.284). Conclusions: HETM did not provide a significant advantage in reproductive outcomes after single euploid blastocyst transfer. Its limited benefit in specific subgroups, such as poor morphology embryos, warrants cautious use and further research.