Multiple unsuccessful pregnancies can be mentally and physically draining. The Endometrial Receptivity Array (ERA) is an advanced test that helps determine the optimal time for embryo transfer and achieve high pregnancy rates. The ERA test is an innovative approach to addressing implantation problems.
Even with a healthy embryo and a normal uterine cavity, many couples who try to conceive using assisted reproductive techniques such as in vitro fertilization fail the embryo transfer process. This occurs due to an underlying endometrial health problem (the lining of the uterus) or the inability of the uterus to hold a healthy embryo. During IVF, couples who fail to conceive after three high-quality embryo transfers are said to experience repeated implantation failures.
The ERA test determines endometrial receptivity by assessing the readiness of the endometrium for implantation at the genetic level.
Significance of the ERA test
Until recently, experts believed that embryo quality was the sole determinant of a successful IVF cycle. However, recent studies have discovered that while embryo quality is important, uterine receptivity also plays a key role in determining the fate of the in vitro fertilization cycle. It is now possible to determine the receptivity of a woman’s uterus to an embryo. It is also useful for
The ERA test is unique in that it examines the receptivity of the endometrium as a byproduct of endometrial lining gene expression at specific times during a woman’s ovulatory cycle. We track 238 different genes to determine a transplantation window specific to each patient. ERA highlights high sensitivity and specificity in detecting gene expression profiles associated with receptivity. Therefore, the test offers significant benefits as it reduces the number of IVF cycles that couples must go through to achieve a successful pregnancy and lowers the risk of miscarriage.
What is the window of acceptance?
The receptivity window is the period during which the uterus is ready to receive an embryo that is in a stage of development suitable for implantation, gestation.
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The endometrium, the endometrium, plays an important role within the uterus. The endometrium, in addition to a certain thickness, must express the correct genes that tell the potential embryo that it is ready for implantation. This process is greatly influenced by the hormone progesterone.
On the other hand, the embryo must be mature enough for successful implantation (it must have reached the blastocyst stage, which is day 5 or 6 of development).
Additionally, the embryo must be chromosomally correct in order to implant and continue the pregnancy (abnormal embryos usually fail to implant or lead to miscarriage).
Implantation and pregnancy can occur if both the embryo and the uterus are ready at the same time. However, if the window is missed and the embryo is not at the correct developmental stage by the time it reaches the uterus, it lacks the correct number of chromosomes, or the endometrium is not expressing the correct genes, implantation and pregnancy will fail. It doesn’t happen.
This ‘window of acceptance’ exists in both natural conception and in vitro fertilization.
How is the ERA test done?
A biopsy of the lining of the uterus (endometrium) is taken and sent for analysis. A biopsy is usually done at the same time that the doctor implants the embryo into the patient’s uterus.
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The ‘preparation’ cycle includes procedures similar to the ‘real’ implantation cycle, such as taking oral medications and self-injecting medications to stimulate the endometrium. We recommend that you have a transvaginal ultrasound and blood tests during this preparation cycle to monitor your response to the medication. Your doctor will do a biopsy at the end of the preparation cycle. A biopsy involves inserting a flexible plastic tube into the woman’s uterus (using a speculum) and moving it back and forth to remove tissue from the lining of the uterus.
The procedure is painless and does not require anesthesia, but may cause discomfort that can be relieved with simple pain relievers.
A normal ERA report is termed receptive endometrium and suggests other possible causes of IVF failure.
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Abnormal ERA reports represent pre- or post-receptive endometrium. Patients with abnormal reporting indicate that the endometrium is not ready to accept the embryo for implantation and then take conventional progesterone therapy as the next step.
Previously, doctors were forced to repeat IVF cycles indefinitely until a pregnancy was achieved. ERA is now offering timely transplant opportunities. This increases the chances of a successful pregnancy and minimizes the time required to conceive.