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What is ERA and Do I Need It?

There is no doubt each and every IVF journey is a unique one. Some fortunate couples achieve pregnancy after one or two IVF cycles. And for others it may take a few more tries before pregnancy occurs. Sometimes there are more than a few IVF cycles and still no success. When that happens, it is time to look at possible reasons for the failure.

Many doctors recommend an endometrial receptivity array test or ERA. This test evaluates your endometrium (lining of the uterus) at a specific time in a mock cycle to determine how receptive your uterine lining is to implantation.


What is The Role of The Endometrium?

The role of the endometrium is essential to supporting the growth and development of the pregnancy. During a normal menstrual cycle, the lining of the uterus thickens in anticipation of a fertilized egg. When conception doesn’t occur the lining sheds and passes out of the body through your menstrual period. If during an IVF cycle, implantation fails then your uterine lining sheds in the same fashion.

As part of the IVF cycle doctors routinely check the uterine lining using ultrasound. Now that the ERA test is available, some doctors recommend it for assessing the endometrium prior to implantation. With ERA doctors get a much more in-depth idea of the overall uterine environment. This is especially important in cases of inflammation such as endometriosis or the event of recurrent implantation failure.


What Is Recurrent Implantation Failure?

For a successful pregnancy the embryo must attach to the uterine wall. Once in place, ideally, it grows and develops along with the nourishing and supporting placenta. If the embryos are free from genetic or chromosomal abnormalities (confirmed via PGT) IVF should succeed.

Your doctor determines recurrent implantation failure when you suffer two or more failed IVF.   At that time, they perform advanced blood tests for hormonal issues as well as clotting problems. As success requires a healthy and receptive uterine lining, your doctor may also suggest an ERA.


ERA, Mock Cycle and Receptivity

ERA is a genetic test of the lining of your uterus. This test offers a view into your cycle and the best time for implantation so enabling the doctor to plot a more exact timeline for success. You go through a mock cycle and your doctor performs a biopsy of your endometrium on the day a scheduled embryo transfer would occur, in lieu of an actual embryo transfer.

Prior to an ERA test, you’ll take the typical hormonal medications you’d take for your actual IVF cycle. This enables the doctor a full picture of endometrial receptivity as it is at the point of embryo transfer in your actual IVF cycle. The biopsy occurs at day 5 as this is the day of your embryo transfer. Your doctor monitors you for the next several days possibly adding progesterone around day 10 as would be the course in your actual IVF procedure.


How ERA Works

During the test your doctor inserts a small catheter through your cervix and, using suction, draws out a sample of the tissue lining the uterus. You may experience some discomfort such as mild cramping, and there may be minimal bleeding but there is no need for anesthesia.

The lab tests your sample and determines the receptivity of the lining. Your results fall into one of these three categories:


  • Pre-Receptive: This means the lining is not yet able to support implantation, and your doctor adjusts your schedule.


  • Post-Receptive: Your uterine lining reached the stage for implantation and you are past that stage. Again, your doctor adjusts your IVF cycle according to the optimum receptivity.


  • Receptive: The lining is ready to support the embryo. You may need additional tests in order to determine the reason behind recurrent implantation failure.


Many patients concerned with recurrent implantation failure opt for ERA as the next step. It is important to remember this is just one tool in uncovering what’s behind a failed IVF cycle. Your doctor may advise additional tests depending on the results of your ERA.

ERA is Only One Too

Also, it is important that you recognize ERA is a diagnostic tool used in determining the cause behind recurrent implantation failure and is not always the right test for everyone. There are other reasons behind failed IVF and your doctor is the best one to assess that.

For more information on ERA or any other tests and treatment for failed IVF or infertility treatment please contact our office today. LA IVF strives to treat your fertility issues and together help you realize your goal of growing your family.

TEL: 310-286-2800 | FAX: 310-691-1116