In vitro fertilization (IVF) with embryo transfer, is the single most successful fertility treatment for infertility across all age groups and diagnoses.
When an IVF embryo transfer fails, it is very disheartening and frustrating to patients and providers alike. In a search for answers we consider the embryo itself, which is a combination of sperm and egg, and we also consider the environment in which we are putting the embryo.
The endometrial lining is special tissue in the uterus where an embryo implants and is integral to a successful pregnancy. It traditionally has been assessed primarily by ultrasound. Until recently, there has been little reliable testing available about the endometrium itself to guide us in regards to evaluating endometrial receptivity to optimize the implantation chances for any embryo.
The ERA (Endometrial Receptivity Analysis) is a genetic test that evaluates the expression of genes to evaluate whether the endometrial lining is properly developed to accept an embryo. This technology uses the latest scientific technology available to analyze the expression levels of the 236 genes to assess the optimal time to place an embryo into the uterus to promote a successful implantation and pregnancy. There is a small window of time that is optimal and in approximately 80% of women this window is in the expected time.
After years of research and evaluation of over 12,000 specimens the investigators at Igenomix have found that approximately 20% (1 out of 5) of women have a unique "window of implantation" that requires our standard embryo transfer timing protocols to be altered. The hope and intention of this test is to find the women who have an altered window of implantation and to adjust the timing of medications to lead to a successful pregnancy.
The science of ERA involves probes for these 236 endometrial receptivity genes which are hybridized with RNA (ribonucleic acid). The tissue is obtained from an endometrial tissue sample collected from the uterus through a procedure called an endometrial biopsy. After hybridization, the signal intensities are read by a computerized predictor and the sample is classified as "Receptive” or "Non-Receptive” according to its specific expression profiles. ERA tests can reveal a need for a change in the timing of embryo transfer and permits personalized embryo transfer (pET) timing based on an individual's results.
The ERA test is recommended for women with recurrent implantation failure, defined as women with two or more unsuccessful embryo transfers. The ERA test can increase the possibilities of a successful pregnancy in patients pursuing frozen embryo transfer because we can time the embryo transfer to be within the window of time when implantation is most likely to occur. That is how we can personalize the time of the embryo transfer to each patient. While ERA is not necessary or appropriate for every infertility patient, it has proved to be a key intervention for some patients who were not finding success otherwise.
For more information about the ERA test or to speak with one of our board-certified Reproductive Endocrinologists and infertility specialists, please contact us. We’re here to help.