Era Endometrial Receptivity Array

Some couples may be unable to conceive after repeated cycles of IVF, a condition known as implantation failure. In certain situations, testing is recommended, and the ERA test is one option to consider. The Endometrial Receptivity Array (ERA) is a medical test that determines the ideal time for implantation in assisted reproductive technology (ART) treatments. 

This advanced approach evaluates the endometrium, providing information about the uterus's readiness for embryo implantation. At Apollo Fertility, you are not just getting a test. You are getting a team that listens, customizes your treatment, and uses the latest technology to give you a better chance at success. If IVF hasn’t worked so far, the ERA test might just be the piece that’s been missing.

What is Endometrial Receptivity Analysis (ERA)?

Endometrial Receptivity Analysis (ERA) refers to a molecular diagnostic procedure that examines a biopsy sample of the endometrial lining to determine the function of endometrium receptivity. It predicts the best day to transfer the embryo during an in vitro fertilization (IVF) cycle. 

ERA technology is clinically developed to identify the window of implantation for embryos (blastocysts) specific to each patient, administer progesterone before the transfer, and personalize the most suitable time for embryo transfer in the uterus. 

What is Endometrial Receptivity?

Endometrial receptivity is the state in which the lining of the uterus is thick enough to support the implantation of an embryo and offers nourishment to a developing embryo. The window of receptivity, also known as endometrial receptivity, is transient and short-lived.

To facilitate embryo implantation, the endometrium will undergo structural modifications, gene expression changes, and chemical release between days 20 and 24 of a normal 28-day menstrual cycle. The embryo must reach blastocysts on days five or six with a regular set of chromosomes (euploidy) in order for implantation to be effective. Aneuploid (abnormal) embryos will either fail to implant or miscarry early. The following conditions will result in a failed pregnancy:

• Missed receptivity window.
• The embryo is not mature enough to be implanted.
• There are chromosomal abnormalities in the embryo.
• The endometrium is either not in a receptive state or does not express and activate the proper genes.

Both in vitro fertilization (IVF) and natural conception are affected by this window of receptivity. Depending on the endometrial gene expression patterns and progesterone levels, it differs for each individual.

Should I Consider an ERA Test?

If you are under the age of 37 and have had unsuccessful treatment after transferring a high-quality day five embryo, you should consider ERA. The test is also useful if you have limited options for future treatments due to financial constraints or if you have concerns about the future availability of viable embryos. 

For example, 

• If you only have one embryo ready to transfer.
• You are using donated gametes in a situation where future embryo availability is unknown. 
• When a surrogate is receiving embryo transfers. 

One of the most important steps of your IVF procedure is embryo transfer. If you think this might be a problem, doctors may recommend an endometrial receptivity analysis. Speak with a local clinic or get in touch with us for assistance if you are still not sure if it might be a possibility. 

Endometrial Receptivity Analysis (ERA) Procedure at Apollo Fertility 

The ERA cycle lasts around four weeks, beginning with initial testing and completing with results. The cycle takes roughly 16 days, with an additional 14 days to receive findings. An ERA cycle is completed in the same way as a patient would prepare for a frozen embryo transfer (FET). However, an endometrial biopsy is carried out in place of an actual embryo transfer. The biopsy evaluates whether an embryo transfer would have resulted in a receptive uterine lining. The step-by-step timeline of the procedure includes: 

• Pills of estrogen are taken for ten days, or until the lining is at least 7 mm thick and the levels of estrogen are adequate. 
• After that, progesterone is prescribed for six days. The duration of progesterone exposure determines receptivity to implantation. 
• Longer or shorter progesterone exposure periods may be beneficial for a subgroup of patients. 
• After performing an endometrial biopsy, the lab looks for over 200 genes in tissue samples to identify when it would be ideal to implant the embryo into the uterus.
• The best time to transfer an embryo is then determined by adjusting the frozen embryo transfer (FET) technique and the time of progesterone exposure. 
• To improve the chances of a successful pregnancy, the doctor will modify the progesterone doses and delay the embryo transfer to the next cycle if the embryo is not receptive.

What are the Possible ERA Test Outcomes?

With the ERA test, individuals will get three types of possible results. These results are as follows:

• Receptive Result: This indicates that the patient got the right amount of progesterone exposure and that the endometrium is in the best possible condition for embryo implantation. The endometrium is prepared for the transfer of embryos.
• Pre-receptive Result: The endometrium is not receptive to the embryo because the patient did not receive enough progesterone. Before transferring embryos, a 12- or 24-hour progesterone exposure is required.
• Post-receptive Result: Progesterone was given to the patient too early in the menstrual cycle. To determine the proper timing for initiating progesterone, a repeat biopsy is required.

How to Prepare for the ERA Test and What to Expect 

Preparation is essential for every stage, process, and appointment in the IVF process, including the ERA test. Here are some tips that will help you feel prepared and confident. 

• Consult your fertility specialist: The clinic will provide you with advise on when to get an ERA test, what to expect during the procedure, and whether it is right for you. 
• Plan the test for the recommended cycle phase: For natural cycles, the biopsy is often planned 7–9 days after ovulation. It typically occurs on day six of progesterone usage for hormone-regulated cycles. 
• Avoid certain medications: The clinic will recommend which hormone medications to take. Tell your doctor about any additional medications you use, such as steroids or antibiotics. 
• Expect some minor discomfort: The ERA test may cause discomfort similar to menstrual cramps. If you are worried about any discomfort, talk to your doctor. You might be able to take pain medication before the biopsy.
• Take time for rest: Stick to your doctor's instructions regarding rest. They usually advise you to get lots of sleep and stay away from strenuous activities. 

Choose Apollo Fertility for an Accurate ERA Test!

Apollo Fertility offers you complete control over the condition of your embryos for a more consistent, accurate, and reliable embryo grading process. Do you want to be sure that the treatments you are selecting will increase your chances of a healthy pregnancy? To begin the process right now, visit an Apollo fertility center today!