EndometrialBiopsy
&ERA
If good-quality embryos haven't implanted, an Endometrial Biopsy or ERA checks for hidden inflammation and pinpoints the exact day your lining is most receptive to a transfer. It's done in a mock cycle that mimics your actual transfer protocol, so the lining is prepared exactly as it would be for the real thing. Timing Window Purpose. Outpatient Setting.
Understanding Endometrial Biopsy & ERA
The endometrium is only receptive to an embryo for a narrow span of time in each cycle, known as the window of implantation. Standard practice assumes that window falls at the same point for everyone and schedules transfer accordingly. For most women that holds true. For a minority it does not — their window sits earlier or later by a day or more, which means a perfectly healthy embryo can be transferred into a uterus that simply is not ready to receive it.
Endometrial Receptivity Analysis exists to identify those cases. A small sample of endometrial tissue is taken during a mock cycle that mirrors exactly the hormonal preparation of a real frozen embryo transfer. That sample is analysed for the expression pattern of a large panel of implantation-related genes, and the result reports whether the lining was receptive at the moment of biopsy, or pre-receptive or post-receptive.
Where the window proves shifted, the correction is precise rather than dramatic: the next transfer is moved forward or back by the number of hours indicated. This is called a personalised embryo transfer, and it replaces an educated guess about timing with a measured one.
The biopsy itself is a brief outpatient procedure requiring no anaesthesia, comparable to having an IUD inserted, with cramping for a short while afterwards. Because it must be done in a mock cycle, it adds one cycle before the transfer that follows.
This is not a routine part of IVF and should not be presented as one. It is aimed at a specific group: women with repeated implantation failure, where good-quality embryos have been transferred into a normal-looking cavity and still not implanted, once the more common explanations have been ruled out. Offering it to everyone adds cost and delay without benefit, and you deserve to be told plainly whether your history actually fits the indication.
When To Consider This
Two or more failed transfers of good-quality embryos
Repeated implantation failure with no clear explanation
Suspected chronic endometritis or hidden inflammation
Planning a frozen embryo transfer after previous disappointment
Seek Care Promptly If
- Heavy bleeding after the biopsy
- Fever or foul-smelling discharge in the days following the procedure
- Severe or persistent pelvic pain
What's Involved
Expert Video Guides
ERA Testing: Stop Guessing Your Transfer Day
Motherhood After 4 Years
Frequently Asked Questions
If you have had repeated IVF transfer failures with good embryos, it helps us check for hidden inflammation and pinpoints the exact day your uterine lining is most receptive to an embryo.
It feels similar to an endometrial biopsy or a Pap smear — a brief cramping sensation during sample collection, which resolves quickly. No anaesthesia is needed.
In a mock cycle that mimics your actual embryo transfer protocol, so the endometrial lining is prepared exactly as it would be for a real transfer.
Typically after two or more transfers of good-quality embryos have failed to implant, since ERA is a targeted test rather than a routine first step.
No, the receptive window identified by ERA is generally stable for a patient and is used to plan future transfers without repeating the test each time.