The ERA test – does it really work?
The ERA test, or endometrial receptivity array test, is a new way to address implantation issues. But is it any good? A number of our fertility patients have had it. Some then had successful pregnancies, perhaps thanks to the ERA test’s recommendations. So let’s have a closer look.
The ERA test examines a sample of endometrial tissue to try to pinpoint the optimal moment for your embryo transfer. The makers of the test call this the ‘window of implantation’. The ERA test is primarily aimed at patients having fertility treatment. It’s quite expensive (around £850).
The ERA test claims to work out how receptive your endometrium is by assessing, at the genetic level, its readiness for implantation. If you’re a fertility patient with recurrent implantation failure, particularly after transferring good-quality embryos, it might be worth considering. The ERA test claims a 73% pregnancy rate.
What does the ERA test actually quantify? It measures the ‘receptive profile’ of your endometrium five days after starting your progesterone support. You’ll take HRT medication (estrogen and progesterone) up to your ERA test biopsy day – when a blastocyst (day 5) embryo transfer normally takes place. You’ll also need a monitoring scan around day 10, before you add in your progesterone.
You’ll get the written report a week or so after your ERA test biopsy. The key recommendation is the timing of your embryo transfer in relation to when, precisely, you start your progesterone. The advice might be: have your embryo transfer 126 hours, plus or minus three hours, after the start of your progesterone. So if you start your progesterone on your main cycle at 8 am, you should have your blastocyst transfer five days later, between 11 am and 5 pm, and ideally at 2 pm.
One thing your ERA test report might also say is that it’s only applicable on ‘the same type of cycle treatment’ on your main cycle as for the biopsy (mock) cycle. So if you’re having an FET, a donor-egg or donor-embryo cycle and are therefore on an HRT protocol, that’s okay. But what about IVF cycles using your own eggs? Not sure.
An ERA test can’t guarantee a future pregnancy. Other factors, such as poor embryo quality, blood disorders or immunology factors, can cause implantation failure. So it’s an objective, extra tool for guiding clinics towards greater success.
The key findings come from a 2013 study, which found that patients with repeat implantation failure are around 25% more likely to have a ‘displaced’ window of implantation. Hence why a personalised test that times your embryo transfer may help.
Another study in 2015 was also supportive. But a 2018 study found that, for FET patients, the ERA test didn’t seem to improve the pregnancy rate for good-prognosis patients. It concluded, like the 2015 study, that a large-scale trial was needed.
So should you have the ERA test? The best person to ask is your fertility doctor. It’s pricey. It’s uncomfortable. Our verdict? The ERA test’s genetic approach is certainly a step in the right direction. It may well improve outcomes for certain patients. But it’s not revolutionary – yet.
Kaleigh
My doctor suggested the ERA to me and I ended up doing it twice – it showed post-receptive, so my doctor changed the timing of my progesterone. When I did the ERA again, it showed post-receptive again, but my doctor felt confident that she knew from these two tests what my implantation date should be. And it was worth it – I’m 14 weeks pregnant. I just wanted to share my story with ERA in case anyone is trying to decide whether or not to do it. The drawbacks for me were that it was painful, like severe menstrual cramps, and expensive. It was worth it though, and I’m so glad I took my doctor up on the suggestion.
Anna
Hello im in the process of having a ERA test my scan is this week. I have 2 failed donar embroys failed and I’m 39. I’m worried about it and have 1 embroy left. Any advice? I’ve had a huge number of blood tests and just this era left to fo before going for another go. I’m desperate for this to work. X
Torri
Congrats!!! How long after the era did you cycle start
Connie
Is an ERA recommended for those who have had trouble staying pregnant or had biochemical pregnancies or just for those who are unable to get any positive tests? I’m just wondering because I’ve undergone four transfers so far. My first one failed to implant. I miscarried my second one at a little over 5 weeks. My third and fourth were biochemical pregnancies so they at least implanted or started to implant. They were all PGS tested so I’m looking at any options that may help. Not sure if this is covered by my insurance and/or counts as a cycle towards my fertility cap but don’t want to waste time if it won’t help. Also, how soon after an ERA can you start a transfer cycle?
Thanks
Ibar
Hi. Thank you for the info.
Does anyone know whether the average GBP850 ERA price includes the medication/drugs (estrogen and progesterone) or exclusive of the drugs? If not included, what is the average cost of the drugs?
Can you do the ERA test in a natural cycle without taking the estrogen and progesterone drugs/hormones if you plan to have FET in a natural cycle?
(I do not like the drugs; they make me depressive; I wonder about their long term effects. I am considering asking the doctor for a natural cycle attempt next time.)
Andrea
I’m not sure of your location, but I’m in the US and my insurance did not cover my ERA test. I paid $599 (US Dollars) and was reimbursed 60% from my insurance company (UN Hhealthcare) for out of network cost. The Estrogen and Progesterone were order by my doctor and cost $275. I am preparing for a FET from Donor Embryos. To answer you question I don’t see why not, but I caution you that if the doctor does not like your levels you’ll probably end up repeating the test.
gynecologist in tambaram
good one thanks
Sarah
We had two failed FETs with three grade A blastocysts. Both negative. Got Era results today, I was 12 hours pre receptive on the day of the Era(Day 20).
Here’s hoping it will work this time around.
Pain was bearable, very similar to the Scratch I had done before.
Mel
Thank you for sharing. I’m 38 and have had 4 failed good embryo transfers (failed to implant). Everything always looks great and there’s no seen issues with my eggs or sperm.
We have 6 frozen embryos and everything has been delayed because of covid and mixed messages re the tests (I normally have natural cycles) Hoping the tests work ❤️❤️
Good luck xx
Belize
I had my ERA test 2 weeks ago and I will do a FET in two weeks. The results say Im pre receptive and need an additional 12 hours. I’m doing a natural cycle (no meds until after transfer).
I did want to comment on the pain of the test. Most people report discomfort, but I had so much pain. Apparently, my cervix is tilted in a way that makes it difficult to get to the uterus. I did know this because my 1st fresh transfer was so painful. We were able to get thru the ERA test by filling my bladder half way and I had to take a valium to relax. Just wanted to add this to the conversation in case anyone has a crazy cervix like me lol
Sarah
Hi Belize, I also have a narrow cervix and have to take a relaxant before any procedures, along with an almost full bladder.
Funny how I was also 12 hours pre receptive aswell.
I’m pretty sure I have a titled cervix aswell.
Wishing you the best of luck.
Keep us updated. X
Kathy
Thanks for sharing this. I hope it went well.
Cate
Hello
How does natural cycle work?
The meds are so expensive and I am trying to find ways to save if possible.
I am scheduled for ERA also. Did you only have to do 1 biopsy? In some videos I have seen ladies had 2 biopsy in 1 cycle.
Thank you
Cate
Ibar
Would you advised against natural cycle?
My doctor did not want to give me that option, but I know the patient has a say and choice.
I have done two cycles with the meds, and now I want to try natural cycle.
Betsy
“You’ll take HRT medication (estrogen and progesterone) up to your ERA test biopsy day – when a blastocyst (day 5) embryo transfer normally takes place.”
Does this mean you take it 5 days typically, and then have the ERA on day 6? I’m asking because I didn’t feel confident in docs answer
Carin B
I just want to add that I had Nolan at 46. If this next transfer scheduled for the first week of Feb is successful, I will b 47 when I deliver. Please don’t let age hinder your decision.
Also the cost to put me out for the ERA was $450.00. It was worth every cent!!
I wish you all the best on your journey
Helen
Could you let me know if you used Ovitrelle in you ERA Or FET? If yes Progesterone used before or after ouvulation ? Thank you very much.
Sofia
I’m about to have an ERA test after 4 failed transfers. I’m 43 and had 9 transfers to date fresh eggs and 2 FET. All negative never once been pregnant in life.
Claire Crew
Hi Sofia, I saw your status on “yourivfjourney.com” website and just thought I’d say hello. I’m 44 and have never had a positive test either with several rounds of IVF.
Diana
I can really recommend the ERA. I did an ERA in Nov this year. It was a bit uncomfortable but not painful as had taken paracetamol 1h before.
All my previous transfers failed (3no) Did an FET straight after the ERA and it worked. We got our BFP.
Aditii
After 2 failed Transfers I decided to go ahead with the ERA test. I have just got a transfer as per ERA Test results. I will get to know in 2 weeks whether it was successful!
Vaishali Devapur
Hi aditi.. My Dr has recommended this since had three failed cycles..
Loop
Hi – I have just had a second failed implantation with donor eggs and thinking about an ERA test. Do you do this in the UK or in Prague? If so is there anyone you would recommend in the UK?
Good luck I have my fingers crossed for you xx
Marie
Was it successful?
Straw
I really recommend this ERA testing I had # 2 failed FET and my embryo’s where Grade A after My ERA I can say proudly I am now 5 weeks Pregnant. I must say the procedure for the ERA Testing is Extremely Painful ( I was literally screaming and I jumped), but well worth the Pain!!!
By the way I have a high tolerance for pain so this is a warning I encourage All to GET THE TEST, but Brace yourself it hurts!!!!
Carin Biagetti
I did it as well, ERA and yes it hurt so bad!!! I as well have a high pain tolerance. It did result in a pregnancy. Nolan is now almost 6 months!! I m preparing to put our last embryo in, Nolan was a result of our 4th transfer, the previous 3 being unsuccessful.
I went through the ERA again and asked to b put out! Just to let you know it’s an option 🙂
Helen
Could you let me know if you used Ovitrelle in you ERA Or FET? If yes Progesterone used before or after ouvulation ? Thank you very much.
Helen
Did you Ovitrelle injection in you ERA / FET please? If yes, did you start Progesterone pilles before or after ouvulation ? Thank you and congratulations.
Jay
Our first FET with a PGS-normal embryo resulted in a BFN. Our RE suggested doing an ERA test which showed that my wife was 24 hours pre-receptive. Our second FET my wife was put on the on same protocol but with an additional day of progesterone, my wife is now 30 weeks pregnant! My wife did not find the ERA procedure that painful, she described it similar to a cramp.
Kami
I did this test after a failed cycle with PGS tested embryos. It should be said in my case the test was EXTREMEMLY painful. However. We found that I was in a displaced window and we made the necessary change to my progesterone and now as of today we are 9 weeks 3 days pregnant. I firmly believed this test helped us figure out the window for
Implantation and was completely worth it. And not that expensive
Daisy
I’m on a mock cycle right now and ERA is on April 1st 2019. My Dr. suggested it because we have only one PGS tested embryo and I am going to be 43 in a few months. We will not be doing IVF again, unless we win the lottery.
I will come back and let you know how it went.
Rachel
Good Luck! We just found out that our embryo tested fine and are deciding on the test. Best wishes. Hope it went well.
Adrienne
Hi Daisy! How did your ERA go? I’m having one today! I have the same situation as you except I’m 38. But I have had two failed transfers and we only have one embryo remaining.
Jean
How did it go? Mine is 5/7 and I’m 43 and we have one pgs embryo and this is our last try after 8 IUIs
Rebecca
I did it. I’ll let you know how it all plannned out.
It was mild cramping and other then blood on the instrument I didn’t bleed. I felt like I use to when I was much younger about to start my cycle.
Jillian L
How did everything work our for you? I had this test done 4 days ago. Ouch!