JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):153
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263936

P-141. Implantation failure rate in transfers performed with euploid embryos

Rafael Nogueira Chame Silva¹, Palmério Brito Pacheco², Ana Gabriela Menezes Carvalho¹, Letícia Alves Costa Franco¹, Tatianne Rosa Santos¹

¹ IDOMED - Rio de Janeiro - RJ – Brasil
² EVA Medicina Reprodutiva - São Luís – MA - Brasil

Objective: To determine the embryonic implantation failure rate in transfers performed with euploid embryos tested by preimplantation genetic testing for aneuploidies (PGT-A).
Methods: This is a retrospective observational study based on the review of medical records of patients who underwent in vitro fertilization (IVF) cycles with PGT-A in a specialized clinic between January 28, 2022, and July 8, 2025. All patients within this period who had at least one euploid embryo available for transfer following PGT-A were included, provided they also presented with an endometrial thickness ≥7mm and serum progesterone >10 ng/mL at the time of transfer. Data collected included maternal age, number of euploid embryos, and serum β-hCG outcome, which was used as a marker of embryonic implantation. Patients with canceled transfers or incomplete records were excluded. Based on this information, the implantation failure rate was calculated as the proportion of euploid embryo transfers that did not result in a positive β-hCG, divided by the total number of patients who underwent euploid embryo transfers. Descriptive statistical analysis was conducted, including simple and relative frequencies. Results were stratified by maternal age and, when applicable, by embryo morphology.
Results: Data from 137 patients who underwent euploid embryo transfers after PGT-A were analyzed. The overall implantation failure rate—defined by the absence of a positive serum β-hCG following embryo transfer—was 29.20%, corresponding to 40 failed implantations out of 137 transfers. When stratified by maternal age, relevant differences in failure rates were observed:<35 years: 19 patients, 4 implantation failures — failure rate: 21.05% 35–37 years: 45 patients, 14 implantation failures — failure rate: 31.11% 38–40 years: 48 patients, 15 implantation failures — failure rate: 31.25% > 40 years: 25 patients, 7 implantation failures — failure rate: 28.00% The 38–40 years group showed the highest proportion of implantation failures, whereas the group under 35 years had the lowest failure rate.
Conclusion: The findings of this study indicate that, although the use of PGT-A to select euploid embryos represents a significant advancement in reproductive medicine, implantation failure remains clinically relevant, affecting 29.20% of transfers. Age-stratified analysis revealed a progressive increase in implantation failure starting at age 35, peaking between 38 and 40 years. These results suggest that euploidy alone is not the sole determinant of successful implantation. Maternal age, embryo morphology, endometrial receptivity, and uterine environment may all influence reproductive outcomes. Interestingly, patients over 40 years of age had a slightly lower failure rate than those in the 38–40 age group, possibly reflecting selection bias, where only patients with better prognostic factors proceeded to transfer. Thus, while PGT-A improves IVF outcomes by reducing time to pregnancy, a more comprehensive and individualized evaluation is still required to maximize success, particularly in older patients.