Endometrial Receptivity Analysis Test for IVF

by | Aug 18, 2023 | IVF

What is Endometrial Receptivity Analysis Test in IVF?

The Endometrial Receptivity Analysis (ERA) Test is a crucial component of the in-vitro fertilization (IVF) process, designed to enhance the success rate of implantation during embryo transfer. This test evaluates the receptivity of the endometrial lining to determine the optimal timing for embryo transfer, increasing the chances of successful implantation and pregnancy.


Who Should Consider the Endometrial Receptivity Test?

The ERA test is recommended for couples undergoing IVF treatments, especially those who have experienced repeated implantation failure (RIF). Implantation failure occurs when good-quality embryos fail to attach to the uterine lining during the IVF process. The ERA test is particularly beneficial for individuals who have undergone multiple unsuccessful IVF cycles or for those who have had recurrent miscarriages.


How to Prepare for Endometrial Receptivity Test?

To ensure accurate results, proper preparation is essential for the ERA test:

  1. Consultation: Schedule a consultation with your reproductive specialist to discuss your medical history, menstrual cycle regularity, and IVF treatment details.
  2. Cycle Synchronization: Your menstrual cycle will need to be synchronized with the test cycle. This involves regulating your hormones using medications to simulate a natural cycle or the cycle of your previous IVF attempt.
  3. Medication: Depending on the chosen cycle synchronization method, you might be prescribed medications like oral contraceptives or hormonal injections to regulate your cycle.
  4. Timing: The ERA test is typically performed 5 to 10 days after ovulation, which corresponds to the window of uterine receptivity. Accurate timing is crucial to ensure the reliability of the results.
  5. Patient Comfort: On the day of the test, wear comfortable clothing and plan for a relaxing day as some discomfort or mild cramping might be experienced.


Procedure of the Endometrial Receptivity Test:

Endometrial Receptivity Analysis Test Procedure

Endometrial Receptivity Analysis Test Procedure

The ERA test involves a simple and minimally invasive procedure:

  1. Sample Collection: On the designated day, a small tissue sample of the endometrial lining is collected using a thin, flexible catheter. The sample is retrieved from the uterine cavity under ultrasound guidance.
  2. Sample Analysis: The collected endometrial tissue is sent to a specialized laboratory for analysis. The tissue is evaluated to determine the molecular expression of specific genes associated with endometrial receptivity.
  3. Gene Expression Analysis: The laboratory analyzes the gene expression profile of the endometrial tissue to ascertain the receptivity status. This information guides the optimal timing for embryo transfer.
  4. Customized Timing: Based on the gene expression analysis, the ERA test provides personalized information about the window of implantation for each individual. This helps your reproductive specialist plan the embryo transfer at the precise time when your uterine lining is most receptive.
  5. Embryo Transfer: Armed with the ERA test results, your IVF treatment plan can be adjusted to ensure the embryo transfer aligns with your personalized window of implantation, maximizing the chances of successful implantation and pregnancy.


Interpretation of Endometrial Receptivity Test Results:

The collected endometrial tissue sample undergoes advanced molecular analysis in a specialized laboratory. Gene expression profiling involves studying the activity of specific genes related to endometrial receptivity. These genes are known to play a key role in creating a receptive environment for embryo implantation.

Endometrial Receptivity Analysis Test Result

Endometrial Receptivity Analysis Test Result

Based on the gene expression analysis, the ERA test result will fall into one of three categories:

  1. Receptive: If the gene expression profile indicates that the endometrium is receptive, it means that the optimal window for embryo implantation has been accurately identified. This result confirms that embryo transfer should occur at the standard time.
  2. Pre-Receptive: A pre-receptive result suggests that the endometrial lining is not yet ready for embryo implantation. In this case, the embryo transfer might need to be delayed in subsequent IVF cycles until the lining reaches its receptive state.
  3. Post-Receptive: A post-receptive result indicates that the optimal window for implantation has passed. The embryo transfer should have occurred earlier in the cycle for successful attachment. Adjustments in timing can be made for future IVF attempts.


Clinical Application

The ERA test result guides reproductive specialists in customizing the timing of embryo transfer. By aligning the transfer with the patient’s individual window of implantation, the chances of successful attachment and pregnancy are significantly increased. The personalized approach afforded by the ERA test enhances the precision and effectiveness of the IVF procedure.


How Much Does ERA IVF Cost in Delhi?

The cost of ERA IVF in Delhi, like any medical procedure, can vary depending on several factors. These factors include the clinic’s reputation, location, expertise of the medical team, and the facilities offered. On average, the cost of an ERA test in Delhi can range from INR 15,000 to INR 25,000 or more. It’s important to consult with various fertility clinics to get a clear understanding of the costs involved and the services provided.


How Successful is the ERA Test After IVF?

The success of the ERA test in improving IVF outcomes is significant. When the embryo transfer is timed accurately according to the receptive window identified by the ERA test, the chances of successful implantation and subsequent pregnancy are notably higher. Studies have shown that women who underwent an ERA-guided embryo transfer had increased pregnancy rates compared to those with a standard, non-ERA-guided transfer. The ERA test addresses the challenge of implantation failure, especially in cases of repeated failed IVF cycles or recurrent miscarriages.


How Can I Improve My Endometrial Receptivity?

Several strategies can help improve endometrial receptivity and enhance the chances of successful implantation:

  1. Lifestyle Modifications: Maintaining a healthy lifestyle by exercising regularly, eating a balanced diet, managing stress, and avoiding smoking and excessive alcohol consumption can positively impact endometrial receptivity.
  2. Supplements: Certain supplements, like folic acid, vitamin D, and omega-3 fatty acids, have been associated with improved fertility and endometrial health. Consult with a healthcare provider before adding any supplements to your regimen.
  3. Uterine Preparation: Following the guidance of your reproductive specialist in terms of hormonal medications and cycle synchronization is crucial to create an ideal environment for implantation.
  4. Individualized Treatment: For those with recurrent implantation failure, an ERA test can provide personalized insights. Customizing embryo transfer timing based on the test results can significantly enhance the chances of successful implantation.
  5. Medical Consultation: Regular communication with your fertility specialist is essential to monitor your progress and make necessary adjustments to your treatment plan.



The Endometrial Receptivity Analysis Test plays a pivotal role in enhancing the success rate of IVF procedures. By accurately determining the optimal timing for embryo transfer, it addresses the challenge of implantation failure, especially for individuals with a history of unsuccessful IVF cycles or recurrent miscarriages. Proper preparation, including cycle synchronization and medication adherence, is key to obtaining reliable results. The minimally invasive procedure of collecting a tissue sample followed by sophisticated gene expression analysis provides personalized insights that empower reproductive specialists to customize embryo transfer timing, ultimately increasing the likelihood of a successful pregnancy.



Q: How can I make my uterus receptive to my embryo?

A: Ensuring a receptive uterine environment involves a combination of lifestyle choices and medical interventions. Maintaining a healthy lifestyle, managing stress, following your fertility specialist’s guidance on hormonal medications, and considering supplements like folic acid and omega-3 fatty acids can improve endometrial receptivity.

Q: Is ERA necessary for IVF?

A: While not mandatory, the Endometrial Receptivity Analysis (ERA) test is valuable, especially for individuals with recurrent implantation failure or a history of unsuccessful IVF cycles. The test determines the optimal window for embryo transfer, enhancing the chances of successful implantation and pregnancy.

Q: What causes poor endometrial receptivity?

A: Poor endometrial receptivity can be influenced by factors such as hormonal imbalances, inflammation, uterine abnormalities, and certain medical conditions. Lifestyle factors like smoking, excessive alcohol consumption, and stress can also contribute to poor receptivity.

Q: What foods are good for endometrial receptivity?

A: Foods rich in antioxidants, vitamins, and minerals can support endometrial health. Focus on a balanced diet including leafy greens, fruits, whole grains, lean proteins, nuts, and seeds. Omega-3 fatty acids from sources like fish can also have positive effects on receptivity.

Q: How much does the ERA test cost in India?

A: The cost of the ERA test in India varies based on factors such as the clinic’s location, reputation, and facilities. On average, the cost can range from INR 15,000 to INR 25,000 or more. It’s recommended to contact different fertility clinics for accurate pricing.

Q: How much does ERA improve IVF success?

A: The ERA test significantly enhances IVF success rates by tailoring embryo transfer timing to the individual’s receptive window. Studies have shown improved pregnancy rates when transferring embryos at the optimal time identified by the ERA test.

Q: Is Frozen Embryo Transfer (FET) cheaper than IVF?

A: Generally, Frozen Embryo Transfer (FET) can be less expensive than a full IVF cycle. FET involves transferring previously frozen embryos from a previous IVF cycle, requiring fewer medication and stimulation costs. However, costs can still vary depending on the clinic and individual circumstances. It’s advisable to discuss costs with your fertility specialist.

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    Dr Mona Dahiya

    Dr Mona Dahiya

    IVF Specialist & Consultant

    Dr Mona Dahiya has performed over 5,000+ IVF cycles and is considered a global expert in IVF, ICSI, IUI and male fertility treatment. She is an eminent writer on Infertility Treatment and has over 100 Publications in both International and National Journals. Dr Mona Dahiya has immensely contributed to the field of infertility through her Research and articles.

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