Is IVF Just Not Working Out?
In vitro fertilization (IVF) is an innovative process that combines the best of science and medicine to help infertile individuals achieve pregnancy. While IVF has contributed to hundreds of thousands of live births, the procedure is not foolproof. Failed cycles are common, and statistics show that many couples need multiple cycles to see success. For some, however, repeated IVF failure is a devastating, distressing concern. The solution is to find the root cause and provide alternatives for the hopeful couples. An endometrial receptivity analysis (ERA) is a straightforward test that can unveil possible health challenges and provide potential solutions.

Common causes of IVF failure
An IVF cycle can fail for many reasons. After embryo transfer into the endometrium, the fertility team will perform a pregnancy test approximately 14 days later. If the test is negative, the IVF cycle will be declared unsuccessful. The fertility team will then suggest another implantation attempt at a later date. More importantly, the team will strive to figure out the reason for the failure. IVF failures are often due to poor embryo quality, chromosomal abnormalities, or incorrect timing of embryo transfer. Endometrial receptivity, or the uterine lining’s ability to receive the embryo, may be another contributing factor that can lead to a failed pregnancy.
A new ERA
For a successful IVF cycle to occur, a healthy, synchronized environment between embryo and endometrium is necessary. An endometrial receptivity analysis can help determine if the uterine lining is ideal for embryo implantation. There is often a small window of implantation when the hormones estrogen and progesterone create the optimal environment for receptivity. An ERA can help identify this window or any genetic challenges disrupting implantation by measuring the thickness of the lining.
What to expect during a receptivity analysis
The first step in ERA is to emulate the endometrial lining necessary for implantation. The patient will perform a mock cycle by taking the same recommended estrogen and progesterone medication that is used to prepare the uterine lining during a real IVF cycle. Instead of transferring an embryo, the doctor will use transvaginal ultrasound and blood tests to monitor progress. At the appropriate time, the medical team will call in the patient to perform an endometrium biopsy. Specific tests are then performed to assess the receptivity of the endometrium. These tests may include a gene expression profile for more details. The ERA results can provide critical information on how to proceed with the next embryo transfer.
ERA’s role in addressing IVF failures
The ERA test will reveal if the uterine lining was receptive or non-receptive during the biopsy. Receptive responses mean the uterine lining is ready and able to receive an embryo. Non-receptive responses mean the uterine lining is not prepared for implantation. This result can then be further broken down into pre-receptive and post-receptive responses. A pre-receptive result means the embryo transfer took place too early, and the lining needs more time. Post-receptive responses mean the ideal time has passed, and the transfer is taking place too late.
What’s next?
The medical lab and fertility team will provide recommendations based on the results and when the hormone medication was started. The recommendation can be to perform the transfer later or earlier. If the timing seemed ideal, the fertility team will move on to investigate embryo quality. A preimplantation genetic test (PGT) may be required to identify any chromosomal abnormalities within the embryos. The team can then identify the best embryos and timing, significantly increasing success rates.
Don’t give up hope
Repeated implant failures can be distressing. The emotional, physical, and financial investment can take a toll on hopeful couples. An ERA is recommended for patients with multiple failures despite having healthy embryos. Studies also show that women with a high body mass index (BMI) have an increased rate of implantation failures. These women should consider an ERA and make changes to improve success rates. After multiple failed attempts, other avenues for pregnancy, such as gestational surrogacy, can be discussed. With this additional information, fertility clinics can significantly improve success rates. Consider an ERA and unlock the missing piece of a complex fertility puzzle.