Endometrial receptivity analysis (ERA) 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 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 whether 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 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 and 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 two
or more 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.
Endometrial Receptivity Analysis Cost
If you’re thinking that the endometrial receptivity analysis test sounds like it may be
something to consider, speak to your doctor about it. Presently, insurance does not
cover the test, but endometrial receptivity analysis costs can range from clinic to clinic
and prices can vary. This is why it’s a smart idea to speak directly to your physician or
the finance department to get an idea so you can best budget ahead of time. In general,
endometrial receptivity analysis cost can be anywhere from $800 to $1,000. While this
is an added expense, if you and your doctor feel it will help improve the outcome of your
next cycle, it is worth the investment.
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
insights 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!