ERA Test: Success Rate, Procedure, Costs, and More

Marie-Claire De Villiers
By Marie-Claire De Villiers
Romi Hector
Edited by Romi Hector

Published May 27, 2022.

A man holding his wife's hand under her pregnant belly

Gynecologists use an ERA Test (Endometrial Receptivity Analysis) to help women undergoing IVF treatments determine if the endometrium is receiving an embryo at the right time. By having this information, it is easier to increase the chance of pregnancy. For a more comprehensive explanation before we answer some wider questions, take a look at our full explanation of what the ERA test is.

How Do I Know if I Need or Should get the ERA Test?

It's important to note that the ERA test is not offered as a standard procedure at most IVF clinics. It is usually offered to women who have already been through a minimum of three failed IVF treatments. RMA research has proved that women with only three normal embryos already have a 95% chance of pregnancy, making the ERA test a procedure for more unusual cases where this doesn't happen.

How Does an ERA Test Work?

The ERA test determines the endometrium's health, identifying problems in the lining of the uterus that might cause a failed implantation. It also assists in figuring out the best time to carry out the zygote implantation procedure. This time frame is known as the window of receptivity. So, in effect, the ERA test determines whether a woman's uterus has already passed its window of receptivity, if it is currently happening, or when it is about to take place. It is essentially an endometrial receptivity analysis.

Sequential hormones, including estrogen and progesterone, must be taken before the procedure. The procedure involves a tiny catheter inserted through the cervix to extract a tissue sample, which is then tested using next-generation sequencing technology.

What Is a Window of Receptivity?

The small timeframe in which the uterus can receive an embryo at the right developmental stage needed for implantation (and thus pregnancy) is called the window of receptivity. It is also known as the lining receptivity or the best window of implantation for IVF treatment.

The length of the window differs from woman to woman, with one important factor being the level of progesterone and the genes excreted by the endometrium.

Read more on the length and how it works in our article about the IVF timeline/procedure.

How Much Will an ERA Test Cost?

An ERA test may or may not be covered by insurance. The test usually costs around $1,000.

Do ERA Tests Work?

The ERA test claims to have a 73% pregnancy rate (1).

Tests thus far have shown that ERA does not necessarily improve the "chances of achieving an ongoing pregnancy from a [frozen blastocyst transfer]" or, more specifically, women without RIF (2). Therefore, women with RIF may still benefit, but additional RCT is needed to determine whether or not this is the case.

The latest articles (April 2022) on case studies and trials concluded: "Considering the approximately one-third of infertile women could suffer from displaced WOI, the ERA test emerged as a promising tool. Although the present meta-analysis demonstrates that patients with a general good prognosis may not benefit from ERA, pET guided by ERA significantly increases the chances of pregnancy for non-receptive patients with RIF of endometrial origin" (3).

Downsides of ERA Tests

  • Inconclusiveness about efficacy
  • Minimum of a month waiting period for the embryo transfer after the procedure
  • The cost is relatively high ($750 - $1,000), which may be too expensive for many women
  • Many clinics do not offer the test at all
  • The uterine biopsy collecting the endometrial tissue can be painful as a general anesthetic isn't used. It is recommended that patients take painkillers beforehand. Many women report pain during and after the procedure, but this will differ between individuals.

In Conclusion

There is much debate between doctors, researchers, and IVF specialists, and numerous large-scale trials are still ongoing. Our experts' brief research into ERA concluded that careful consideration should be taken before committing to the ERA test.

Women should always take an individualistic approach before making a decision—your body and circumstances are always unique. Of course, it is also advised to always consult with a qualified and caring professional before making the leap.