Case Study

Endometrial Receptivity Array (ERA) increasing the chances of pregnancy

Rakhi a 23-year-old woman and Tushar a 33-year-old male were married for 5 years. They were trying to start a family for the last 3 years of their marriage but were unsuccessful. The preliminary fertility tests had shown that Tushar had normal semen parameters while Rakhi had a diminished ovarian reserve with bilateral atrophic ovaries and an irregular menstrual cycle.

Rakhi had undergone a hysteroscopic adhesiolysis and a laparoscopy procedure, which showed that she had a bilateral tubal block, so clipping was performed. Over the years, they had undergone 2 IVF failures with donor oocytes. Despite these initial failures, the couple never lost their hopes and visited the Oasis Fertility center in Pune. Routine investigations were performed confirming that Tushar had a normal DFI (which reflects the integrity and damage of sperm DNA) value of 15%.

Given the past IVF failures and the reduced ovarian reserve, an egg adoption cycle was planned and two Day 5 blastocysts were transferred, but this too turned out to be negative.

When pregnancy fails to take place more than 3 times, despite using good quality embryos, it is referred to as recurrent implantation failure. In such cases, an anatomic assessment is usually performed – testing for blood clotting and genetic testing as these factors are associated with implantation failures. However, not all cases of failure are attributed to them; a specific uterine environment is required for a pregnancy to succeed which also needs to be evaluated in cases of implantation failures. This is done by an endometrial receptivity array (ERA) test which assesses over 200 genes that play a role in the endometrium (lining of the uterus) becoming receptive. The test deduces whether the endometrium is receptive or not and predicts a woman’s window of implantation. The goal of ERA is to determine an ideal day of embryo transfer, thereby decreasing the implantation failure.

How is ERA performed?

An ERA is performed using a biopsy of the uterine lining. Progesterone is a hormone that helps the endometrium to become receptive during an IVF cycle and an embryo transfer is ideally performed after five days of progesterone administration.

An ERA is performed in a mock cycle and once the biopsy is attained, the genes involved in the receptivity are analyzed and the ERA predicts the endometrium to be either- “receptive” or “non-receptive.”

Receptive – The embryo transfer can be performed at the same timing in the future cycle.

Non-receptive – Indicates that a woman’s endometrium is displaced and an embryo transfer has to be performed after altering the progesterone timing.

Once the correct window of implantation is identified, then a personalized embryo transfer can be planned for in the subsequent month. Research has shown that by employing ERA in cases of women with recurrent implantation failures, a successful pregnancy rate of more than 70% can be achieved.

In Rakhi’s case, her endometrium was displaced, so an alteration in the progesterone administration was performed with a personalized embryo transfer where two blastocysts were transferred based on the ERA results. The transfer was successful and she conceived, fulfilling her dreams of motherhood.

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