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Endometrial Receptivity Analysis(ERA)
Endometrial Receptivity Analysis (ERA) is a test. It checks the thickness of the uterine lining and genetic factors. This helps to see if the endometrium is ready for embryo implantation. It helps identify the ideal timing for implantation.
Couples facing repeated implantation failure (RIF) during IVF often experience significant stress and anxiety. Advanced diagnostic tools like ERA offer hope by improving the chances of successful conception for those struggling with infertility.
What is ERA?
Endometrial Receptivity Analysis (ERA) is a test. It checks the thickness of the uterine lining and genetic factors.
This helps to see if the endometrium is ready for embryo implantation. It finds the best time to give progesterone before embryo transfer. This increases the chances of successful implantation, pregnancy, and live birth. This is crucial because implantation can only happen during the specific "window of receptivity".
What is the Endometrium?
The endometrium is the tissue lining the inside of the uterus. It has two layers.
The stratum basalis is close to the muscle layer. It stays the same during the menstrual cycle. The stratum functionalis thickens and sheds during menstruation.
Estrogen and progesterone control the growth of the endometrium. These hormones help thicken the lining, preparing the uterus for embryo implantation.
What is Endometrial Receptivity?
Endometrial receptivity is when the uterine lining becomes thick enough to support embryo implantation and nourish a developing embryo. This "window of receptivity" is brief and occurs between days 20 and 24 of a regular 28-day menstrual cycle.
During this time, gene expression, molecule secretion, and the endometrium's structure change. These changes prepare the body for implantation. The embryo must be a day 5 or 6 blastocysts with normal chromosomes (euploid) for implantation to succeed. Embryos with abnormal chromosomes (aneuploid) will either fail to implant or result in early miscarriage.
When Does Pregnancy Fail?
Pregnancy may fail under the following conditions:
- The window of receptivity is missed.
- The embryo does not develop enough for implantation.
- The embryo has chromosomal abnormalities.
- The endometrium does not activate the necessary genes or is not in a receptive state.
This window of receptivity is crucial for both natural conception and in vitro fertilization (IVF). Its timing varies for each individual, depending on progesterone levels and the gene expression profile of the endometrium.
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When Should Women Undergo ERA Testing During IVF?
Dr Arockia Virgin Fernandos recommends Endometrial Receptivity Analysis (ERA) for women who have experienced recurrent implantation failure or multiple unsuccessful IVF cycles. This test analyses the expression of 236 genes to identify the exact window of receptivity for embryo implantation.
For most women (80%), the ideal receptivity window occurs between the 19th and 23rd day of the menstrual cycle. However, in about 20% of women, this window may fall earlier or later. Knowing whether the window is open or closed before embryo transfer is essential. This helps increase the chances of a successful pregnancy.
What are the Steps of the ERA Procedure?
- Take the prescribed oral or self-injected medications to stimulate the growth of the uterine lining. Dr Arockia Virgin Fernandos monitors the response using transvaginal ultrasounds and blood tests.
- Dr. Arockia Virgin Fernando performs an endometrial biopsy to analyse the gene expression profile of specific genes.
- Based on the biopsy results, Dr Arockia Virgin Fernando determines whether the endometrium is receptive or non-receptive to embryo implantation.
This gives us an opportunity for personalized embryo transfer.
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What are the Possible Outcomes of an ERA Test?
The ERA test can produce three main results:
- Receptive: The endometrium is optimal for embryo implantation, with the patient receiving the correct amount of progesterone. The uterus is ready for embryo transfer.
- Pre-Receptive: Due to insufficient progesterone exposure, the endometrium is not yet ready for implantation. The medical team needs to administer additional progesterone for 12–24 hours before the embryo transfer.
- Post-Receptive: The patient received progesterone too early in the cycle, making the endometrium non-receptive. Dr Arockia Virgin Fernandos requires a repeat biopsy to identify the correct timing for progesterone administration.
Endometrial Receptivity Array (ERA) Success
The Endometrial Receptivity Array (ERA) helps increase the chances of successful embryo implantation. This is especially true for women who have trouble getting pregnant again after previous attempts. This includes women with recurrent implantation failure (RIF) and those who have had several unsuccessful IVF cycles. By identifying the precise "window of receptivity," the ERA allows Dr Arockia Virgin Fernando to time embryo transfer accurately, significantly enhancing the likelihood of pregnancy.
Studies show personalized embryo transfer (pET) based on ERA results leads to better outcomes. This method has higher implantation rates, pregnancy, and live births than standard embryo transfer protocols. The success of ERA comes from its ability to customize treatments for each patient's unique endometrial receptivity profile. This offers hope to couples who are facing infertility.
Differences between Endometrial Receptivity Array (ERA) and Endometrial Biopsy:
| Aspect | Endometrial Receptivity Array (ERA) | Endometrial Biopsy |
|---|---|---|
| Purpose | To assess the molecular receptivity of the endometrium for embryo implantation. | To check for abnormalities in the endometrium, such as infections, inflammation, or pre-cancerous conditions. |
| Method | Genetic analysis of the endometrial tissue to evaluate gene expression. | A tissue sample is taken from the endometrial lining for histological examination. |
| Timing | Done during the window of implantation, typically a few days after ovulation. | It is done at various menstrual cycle stages, often in the luteal phase. |
| Outcome | Determines whether the endometrium is in a receptive or non-receptive phase for implantation. | Identifies infections, inflammation, hormonal imbalances, or abnormal cell growth. |
| Technology Used | Advanced genomic technology to analyze gene expression patterns. | Standard histological examination of the tissue sample. |
| Use in Fertility Treatments | Primarily used to optimize embryo transfer timing in IVF. | Used to diagnose uterine conditions affecting fertility. |