Endometrial Receptivity Array

Endometrial Receptivity Array

Genetic testing to assess the lining of your womb.

What is the ERA Test?

The Endometrial Receptivity Array ‘ERA’ is a genetic test that can be used to assess when the lining of the womb is most receptive to the embryo. This test was developed in order to try to improve the likelihood of the embryo implanting in women who have had several failed embryo transfers.

The technique evaluates the womb lining by analysing 236 genes involved in its receptivity. These genes were identified by scientific research as being important for implantation. The analysis helps determine the window of implantation, enabling personalised embryo transfer (pET) to be performed. Although a lot of basic research has been carried out, we are still unsure if the test improves outcomes of fertility treatment. If you’d like to know more about the Endometrial Receptivity Array Test at Manchester Fertility, contact our Patient Advisors on 0161 300 2730.

HFEA, the Human Fertilisation & Embryology Authority, investigates treatment add-ons regularly and assigns them a level with a traffic light system. The traffic-light rated list of add-ons consists of three colours that indicate whether the evidence, in the form of high-quality RCTs, shows that a treatment add-on is effective at improving the chances of having a baby for someone undergoing fertility treatment.The HFEA rates the Endometrial Receptivity Array as a RED add-on.

How much does it cost?

ERA testing is an add-on and costs £1260 in addition to your standard treatment cost. The final cost of your treatment will depend on your circumstances, existing medical conditions, and overall health. 

What is the process?

1

Initial Biopsy

To perform this analysis, it is necessary to take an endometrial biopsy at a time corresponding to the phase of endometrial receptivity.

The biopsy is performed by passing a thin catheter into the womb. This procedure is mostly tolerated very well . We advise taking some pain relief of your choice (such as Paracetamol 1g or Ibuprofen 400 mg) 30 minutes before or directly after the procedure.

2

Additional Tests

We will also perform an ultrasound scan to check the thickness of the endometrial lining, and a blood test.

3

Receive your results

The test results from the analysis can take up to 2 weeks to be available. The results of the ERA test will advise on the timing of your next embryo transfer. Future embryos should be transferred in a similar cycle as that in which the test was carried out. (i.e. natural or hormone supported transfer)

When is it recommended and why?

The ERA test is not routinely recommended as it has not been shown to make a difference to the outcomes of fertility treatment in most people. However, in women with repeated failure of implantation, there may be a benefit from performing an ERA test to identify the best time for transferring the embryo.

Since the evidence for this test is not conclusive, we do not advise this as a mandatory test. Rather, we advise that this should be discussed between the patient and doctor. Patients should understand that the evidence for this test is uncertain.

What are the advantages of ERA?

This test indicates the window of implantation, with the aim of optimising the timing of embryo transfer. This approach is also called ‘personalised embryo transfer’ (pET). The test is more likely to benefit women who show a displaced window of implantation. However, implantation is complex and depends on a number of factors. Hence, there is no guarantee of a successful outcome after ERA and personalised embryo transfer. Importantly, there are no good research studies proving that the test improves the chance of having a baby from treatment.

What are the disadvantages of ERA?

The test carries an additional cost and the ERA test is not included in your treatment cycle cost.

You have to take hormone medications which may include hormonal side effects. In addition to the medication, you will undergo a biopsy of the womb lining, which is mildly invasive and can cause discomfort. Undergoing the test may delay your treatment by at least one menstrual cycle.

There may be an inconclusive result and in this case, you may have to undergo repeat testing.

The procedure itself can cause discomfort and abnormal bleeding in the form of spotting and there is a small risk of pelvic infection.

There is no conclusive proof that embryo transfer based on ERA test results improves the outcome of treatment, because, at present, there are no randomised controlled trials on this subject. Although evidence does not support the routine use of endometrial injury for women undergoing IVF, your doctor may advise that the procedure may be helpful during your treatment.

What are the EMMA and ALICE tests?

EMMA and ALICE are tests which look at bacteria that is present in the womb lining (Endometrium).  Research shows that bacteria are normally present in the endometrium and scientists are working on establishing the normal pattern of bacteria in different stages of a woman’s life and menstrual cycle.

EMMA stands for ‘Endometrial Microbiome Metagenomic Analysis’.  This genetic test is designed to identify the balance of bacteria in your genital tract.

ALICE stands for ‘Analysis of Infectious Chronic Endometritis’.  This test identifies if there are bacteria present that can cause chronic endometritis or inflammation of the womb lining.  It is known that chronic endometritis may reduce the chance of successful implantation and that it is difficult to diagnose by traditional methods of bacterial culture.

Research is ongoing around the presence of bacteria in the womb lining.  We do not know for sure whether these tests improve the outcome of fertility treatment.

What is the process?

To perform this analysis, it is necessary to take an endometrial biopsy.  The biopsy should be taken in the second half of the menstrual cycle.

The biopsy is performed by passing a thin catheter into the womb.  This procedure is typically tolerated very well, however, we advise taking some pain relief of your choice (such as Paracetamol 1 g or Ibuprofen 400 mg) 30 minutes prior to or directly after the procedure has taken place.

The test results will take up to two weeks to be available.  Please be aware that in some cases a repeat test may be required.

Should I have these tests?

We do not recommend the EMMA and ALICE tests, as they have not been shown to improve the outcome of fertility treatment. The evidence for having these tests is still uncertain.

What are the possible advantages of these tests?

In some women with recurrent implantation failure these tests may show evidence of an abnormal bacterial population in the womb lining.  Antibiotics and probiotics can be administered to correct this. However, it is not known at present whether this improves the chance of success of fertility treatment.

What are the disadvantages of having these tests?
  • The tests carry an additional cost as they are classed as a treatment add-on.
  • A biopsy of the womb lining is invasive and can cause discomfort.
  • Undergoing the test may delay your treatment by at least one menstrual cycle.
  • In case of an inconclusive result, you may be required to undergo repeat testing.
  • The procedure itself can cause abnormal bleeding in the form of spotting.
  • There is a small risk of pelvic infection.
  • At present there is no good evidence to show that treating the endometrial microbiome found by these tests improves the outcome of treatment because at present, there are no randomised controlled trials on this subject.
Do you recommend the EMMA or ALICE test?

The use of EMMA and ALICE is not recommended by Manchester Fertility as there is no evidence from randomised controlled trials (RCTs) to show that they are effective at improving the chances of having a baby for most fertility patients.

If you’d like to know more about endometrial microbiology tests at Manchester Fertility, contact our Patient Advisors on 0161 300 2730.

What are add-ons?

At Manchester Fertility, we do charge for ERA. 

Add-ons are optional extras that we offer in addition to your normal fertility treatment; these may incur an additional cost. Some clinics may include specific add-ons with their treatment packages, while others charge separately. This add-on is an optional extra and is not included as part of your standard treatment plan. It can be paid for as an additional part of your treatment.

Your doctor will be able to provide you with the complete information and risk associated with any of these add-ons. We offer these add-ons after a discussion with our experts and after your specific individual circumstances have been considered.