Road to fertility

Your guide to trying to conceive, fertility treatments, genetic testing and your path to pregnancy

What to Know About Endometrial Receptivity Analysis

endometrial receptivity analysis

Endometrial Receptivity Analysis (ERA), also known as Endometrial Receptivity Array, is a genetic test that takes a small sample of a woman’s endometrial lining to determine which day would be the best day to transfer the embryo during an IVF cycle. Performing an Endometrial Receptivity Analysis can be incredibly helpful as as the window of endometrial receptivity can be one of the causes of infertility in women who have had two or more unsuccessful embryo transfers following in vitro fertilization (IVF).

How Does the Endometrial Receptivity Analysis Work?

An endometrial biopsy will be taken by your doctor in a mock embryo transfer cycle prior to your IVF or FET cycle. This sample will then be analyzed to assess endometrial receptivity and the optimal day for embryo transfer. The sample will be sent to a lab where molecular analysis is completed to determine the best time to attempt embryo implantation in a future transfer cycle. There are three potential results.

  • Pre-receptive: This indicates that the endometrium is not quite ready to receive the embryo and transfer at this time may not be ideal.
  • Receptive: This indicates that the moment the endometrial biopsy was taken was an optimal time to transfer the embryo for implantation.
  • Post-receptive: This indicates that the endometrium had reached the stage for optimal embryo implantation but has now gone past it.

Once your test results are complete, and your endometrial receptivity is determined, they will be sent to your physician. He or she can then make any necessary adjustment to personalize your IVF protocol and schedule your embryo transfer around when your endometrium is receptive, and ready for the developing embryo to implant.

The Endometrial Receptivity Biopsy

One of the most frequent questions regarding the Endometrial Receptivity Analysis and taking the endometrial biopsy is if it’s painful. The endometrial biopsy is an outpatient procedure, that does not require admission to a hospital. Some patients have described having either mild discomfort during the procedure or mild cramping after. You can take over-the-counter pain medication to address any discomfort, but you should first consult with your doctor.

What is exciting in the reproductive field is that the technology continues to evolve. In November of 2017, steps towards developing a new, non-invasive method to determine endometrial receptivity were led by Dr. Carlos Simon. This means that a painless method to determine endometrial receptivity, and other applications such as the microbiome, may be on the horizon. The endometrial liquid biopsy will be ready to use in what is being called “the niERA test” (non-invasive ERA), and in what is being called “the EMMA” (Endometrial microbiome metagenomic analysis). This is something to stay tuned on, as these tests may be something that could help you on your path to parenthood in the future.

Should You Consider Endometrial Receptivity Analysis

If you’ve just started trying to conceive, do not have a history of miscarriages, and/or have not previously undergone IVF, it may be early in the process to wonder about your endometrial receptivity. As a female, when you have an initial fertility consultation, the clinical team will first look at your ovarian reserve and ovarian function. They will also typically perform an ultrasound to look at your ovaries, uterus and get a visual of your uterine lining. Assessing  your endometrial receptivity is not something that is performed, unless the doctor feels it’s warranted.If you have concerns or want to discuss this option, you should feel comfortable asking your physician about the ERA test.

Generally, the endometrial receptivity analysis is recommended if you’ve undergone several IVF cycles that were not successful, where the embryos were of good quality. If you have had two miscarriages or more, you may want to ask your doctor if Pre-implantation Genetic Testing for Aneuploidy (previously known as PGS) is something that they suggest, as it can help increase the chances of having a healthy baby and decrease your chances of a miscarriage.

When we think of having a family, we don’t necessarily think of needing technology to help us. However, there are millions who have benefited from these procedures, tests and technologies. There are so many doctors, nurses, geneticists, embryologists, genetic counselors, researchers and more who work tirelessly to find solutions and insight to assist those who are diagnosed with a fertility concern. In the end, knowing what options you have to support you along your reproductive journey can make a powerful difference in helping you have a happy and healthy family!

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