Endometrial Receptivity Analysis: How is it done and why?

May 25, 2022
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It is understandable for couples to get frustrated if they don't get pregnant despite repeated attempts. These couples generally turn towards IVF (in-vitro fertilization) for help. But what if IVF does not work as planned? What can they do?

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Before you conclude that either or both of you have a fertility problem, you should know that there are tests and technology to help reproductive experts provide some of these answers to you and help you find the right path to pregnancy.

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What is Endometrial Receptivity Analysis?

The Endometrial Receptivity Analysis or ERA test is a genetic test which offers new information and new hope to patients coping up with implantation failure during IVF. Implantation failure can be due to anything- like genetic abnormalities, lifestyle choices, uterine receptivity problems, certain health conditions, etc.Here, a small sample of the woman's endometrial tissue (endometrial biopsy) is taken to evaluate if the endometrial lining of the uterus is ready to accept an implanting embryo. This can be very helpful for couples who have been facing implantation failure.


What is the procedure?

ERA starts with collecting samples from the uterine lining of the woman (obtained at a particular time in the cycle) to evaluate the expression of genes which in turn gives an idea whether the endometrial lining of the uterus is adequately developed to accept an embryo or not. The procedure is called endometrial biopsy; it is a quick and a little uncomfortable process.

During an endometrial biopsy a thin catheter is inserted via the cervix into the uterine cavity, and with the help of a plunger (in the catheter) suction is created which helps in drawing a small sample of the tissue (endometrial lining) into the catheter.

The removed sample is sent to the laboratory for further examination. The lab uses the Next Generation Sequencing technology which is a gene sequencing technique for analysis. Here, the expression levels of the 236 genes are analyzed to learn the best time to place the embryo into the uterus for successful implantation and pregnancy.


The process involves probes for these 236 endometrial receptivity genes (which are hybridized with RNA). The samples are isolated from the woman's uterus via endometrial biopsy.

After hybridization, the computer depicts via a signal if the sample is Receptive or Non-Receptive depending on the specific (gene level) expression profiles.


If the signal is non-receptive, the test depicts that there is a need to change the timing of the embryo transfer. Based on an individual's results, the analysis also predicts the correct time for a personalized embryo transfer (pET) or the patient's receptive window.

Why choose Endometrial Receptivity Analysis?

The disappointment and frustration caused by repeated implantation failure after so much emotional, physical, and financial investment are unspeakable. But with ERA test you can now elevate the chances of successful pregnancy in patients experiencing implantation failure or even pursuing frozen embryo transfer. This is because ERA test gives the window of time when implantation is most likely to occur. If you or someone you know is struggling with unexplained failed IVF cycles, consider asking your fertility expert about ERA.