Hyaluronan-enriched transfer medium increases live birth rates in biopsied euploid blastocyst transfers

To evaluate whether hyaluronan-enriched transfer medium (HETM) is associated with improved live birth rates in biopsied euploid blastocyst transfers.

Retrospective cohort study.

A total of 1,221 single frozen euploid blastocyst transfers performed between January 2011 and December 2024.

Embryo transfer using HETM compared with standard zwitterionic-buffered transfer medium. All embryos underwent trophectoderm biopsy.

Live birth rate. Secondary outcomes included biochemical pregnancy and clinical pregnancy rates.

Hyaluronan-enriched transfer medium was associated with significantly higher live birth rates compared with standard medium (59.1% vs. 43.2%; absolute difference 15.9%, 95% confidence interval 10.3%-21.5%; relative risk 1.37, 95% confidence interval 1.22-1.54). Clinical pregnancy and biochemical pregnancy rates were also significantly higher in the hyaluronan group. Sensitivity analysis restricted to first transfers per patient (n = 715) confirmed persistence of the live birth benefit (61.2% vs. 47.1%; absolute difference 14.1%, 95% confidence interval 6.9%-21.3%; relative risk 1.30, 95% confidence interval 1.13-1.49). Maternal age was comparable between groups.

Use of HETM is associated with a clinically meaningful increase in live birth rates in biopsied euploid blastocyst transfers. Zona pellucida disruption created during trophectoderm biopsy may facilitate enhanced embryo-endometrial interaction, improving implantation efficiency. However, these results should be interpreted with caution, given the potential for unmeasured confounding variables and require validation in prospective randomized trials.