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Endometrial Receptivity Analysis (ERA) Is Not Helpful

Adapted from "Live birth after transfer of a single euploid vitrified-warmed blastocyst according to standard timing vs. timing as recommended by endometrial receptivity analysis", published in Fertility and Sterility on June 13, 2022.

The issue of uterine lining receptivity and its effect on pregnancy is one of our patients' most frequently asked questions.

Studies implicating uterine receptivity as a significant factor in infertility treatment success are lacking. On the other hand, evidence suggests that the role of uterine lining receptivity as a decisive factor in human conception is limited.

Since women can have ectopic pregnancies (tubal, ovarian, cervical, abdominal), embryos seem to be able to implant in environments that would be considered hostile.

Contemporary data suggests that a pregnancy outcome is determined at the moment of the creation of an embryo (the moment of fertilization) and that the subsequent pregnancy events (embryo hatching, implantation, and further fetal development) are merely playing out of this predetermined outcome.

A just-published study on Endometrial Receptivity Analysis points yet again to the futility of looking at the endometrial lining receptivity for an explanation of failed IVF treatments:

To determine whether Endometrial Receptivity Analysis (ERA) improves live births in patients with and without a history of unsuccessful frozen embryo transfers (FETs).

Retrospective cohort study.

Large reproductive center.

Patients with and without ERA before single FET were included in the analysis.

Subjects in the exposed group underwent ERA and ERA-timed FETs. Subjects in the unexposed group followed a standard protocol FET without ERA. Outcomes were compared between nonreceptive and receptive subjects undergoing an ERA-timed FET and between ERA-timed vs. standard protocol FETs.

Main Outcome Measure
The primary outcome was a live birth; secondary outcomes were biochemical and clinical pregnancy rates.

A total of 307 ERA-timed FETs and 2,284 standard protocol FETs were analyzed. One hundred twenty-five patients (40.7%) were ERA receptive, and 182 (59.3%) were ERA nonreceptive. After adjusting for the number of the previously failed FETs, there was no difference in the proportion of receptive and nonreceptive ERA results. Furthermore, there were no statistically significant differences in live births in patients with ERA-receptive vs. ERA-nonreceptive results (48.8% and 41.7%, respectively). In addition, there were no statistically significant differences in live births in patients with or without ERA testing results before FET (44.6% and 51.3%), respectively.

Patients categorized as receptive vs. nonreceptive by ERA and those without ERA testing had comparable live birth rates with the trend toward higher live births when ERA was not done.

Embryo quality rather than uterine receptivity is the most significant factor influencing the reproductive treatment outcome.

August 2022


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