The ERA (Endometrial Receptivity Analysis) test identifies your personalised window of implantation — the exact hours when your endometrium is most receptive to an embryo. It is recommended for women with 2 or more failed IVF transfers despite good quality embryos. At Mother Hospitals, Boduppal, we offer the ERA test as part of our recurrent implantation failure investigation. Call 97059 93366.
Good embryos. Failed transfers. If this is your story, the ERA test may hold the answer. Find your personalised window of implantation at Mother Hospitals & IVF Center, Boduppal.
MBBS, DGO, PG Diploma in ART – Kiel University, Germany | 20+ Years Experience | TGMC Reg: 50624
The ERA (Endometrial Receptivity Analysis) test is a genetic diagnostic test that analyses the expression of 248 genes in the uterine lining to determine whether the endometrium is in a "receptive" state at the standard embryo transfer time — or whether it needs to be shifted earlier or later.
Developed by Igenomix (now part of IVIRMA Global) and validated in peer-reviewed studies including the IGENOMIX ERA trial, the test has become a standard investigation for couples with recurrent implantation failure (RIF). It is not a replacement for embryo quality assessment — it specifically addresses the timing of transfer in relation to the endometrium's readiness.
The window of implantation is the narrow period — typically 12–48 hours — during each cycle when the endometrium becomes receptive enough to allow an embryo to attach and implant. In a standard frozen embryo transfer (FET) cycle, this window is assumed to fall on Day P+5 (5 days after starting progesterone). However, research published in Fertility and Sterility shows that up to 30% of women with recurrent implantation failure have a displaced window — meaning their WOI opens earlier or later than the assumed standard timing. The ERA test locates this window precisely for each individual woman.
Conventional IVF protocols assume all women have their window of implantation at the same time after progesterone starts. This is true for most — but not all. A woman with a post-receptive endometrium who receives her embryo on Day P+5 is essentially receiving the embryo after her best window has already passed. Her embryo may be of perfect quality, her lining may look ideal on ultrasound, yet implantation fails because the biological timing is off. The ERA test directly addresses this mismatch, which is why it is specifically indicated for women with multiple failed transfers despite good embryos — not as a routine first-line test.
The ERA test is not a routine investigation for all IVF patients. It is specifically indicated in the following situations — discussed with Dr. E. Prashanthi Reddy at your consultation.
You have had two or more frozen embryo transfers (FET) with good quality embryos (Day 5 blastocysts, preferably euploid) that have not resulted in pregnancy. This is the primary indication for ERA testing worldwide. Before a third transfer, ERA can determine whether timing was the missing factor.
Defined as failure to achieve clinical pregnancy after transfer of at least 3 good-quality embryos. RIF investigations typically include ERA test alongside other tests like EMMA, ALICE, hysteroscopy, thrombophilia screening, and immunological evaluation. ERA addresses the timing component of RIF.
Your embryos have been graded as good or excellent quality — possibly confirmed euploid by PGT-A — yet transfers have failed. When embryo quality, uterine structure, and hormonal preparation all appear normal, window displacement is the next variable to investigate.
Women with thin endometrium who have achieved adequate lining on oestrogen supplementation but have experienced repeated implantation failures may benefit from ERA testing to ensure the window is not also displaced.
Note: ERA is generally not recommended as a first-line test before a first IVF attempt, or when embryo quality is the likely primary cause of failure. Dr. Prashanthi will advise based on your full history.
The ERA test is performed in a dedicated "ERA cycle" — a mock frozen embryo transfer cycle in which everything is prepared exactly as for a real transfer, but instead of transferring an embryo, a biopsy of the endometrium is taken for analysis.
Oestrogen tablets or patches are started from Day 2–3 of your period, exactly as for a frozen embryo transfer cycle. Serial ultrasound scans monitor the growth of the uterine lining. Once the lining reaches ≥7 mm with a trilaminar (triple-line) pattern, progesterone is started — this is designated Day P+0.
On Day P+5 (five days after starting progesterone), you attend the clinic for an endometrial biopsy. A thin, flexible Pipelle biopsy catheter is gently inserted through the cervix into the uterine cavity. A small sample of the endometrial lining is aspirated. The procedure takes under 5 minutes. Most women describe it as similar to mild menstrual cramp discomfort — no anaesthesia or sedation is required. You can resume normal activities the same day. The biopsy sample is immediately placed in a preservation buffer and shipped to the ERA laboratory.
The laboratory extracts RNA from the biopsy sample and measures the expression levels of 248 specific endometrial genes known to be differentially expressed between receptive and non-receptive states. A computational predictor tool (machine learning algorithm trained on thousands of samples) classifies the result. This is the same NGS technology used in genomics research — applied specifically to endometrial biology. Results arrive within 3–4 weeks.
The ERA report classifies your endometrium into one of three categories at the time of biopsy (Day P+5): Receptive — your standard window is correct; Pre-receptive — your window has not yet opened, transfer should be delayed; Post-receptive — your window has already closed, transfer should be brought forward. The report also specifies the exact adjusted timing in hours.
In the next FET cycle, the frozen embryo is transferred at the exact personalised time identified by the ERA report — rather than the assumed standard Day P+5 timing. This is called personalised embryo transfer (pET). Published data from IVIRMA shows that pET guided by ERA improves ongoing pregnancy rates in RIF patients compared to standard timing.
Your ERA report will state one of three results. Here is what each means and how your next transfer will be planned:
Studies report that approximately 25–30% of RIF patients show a displaced window. A Receptive result in an RIF patient means timing was not the cause of failure and further investigation is needed.
The ERA test is only applicable to frozen embryo transfer (FET) cycles — not fresh IVF transfers. This is because the ERA result is used to adjust the progesterone exposure timing, which is precisely controlled in FET cycles. In a fresh transfer cycle, the progesterone surge is triggered by ovulation and cannot be adjusted. The ERA test is therefore most relevant to couples who:
At Mother Hospitals, the ERA test is offered as part of a comprehensive recurrent implantation failure (RIF) investigation package. Dr. Prashanthi will advise whether ERA should be combined with other endometrial tests (EMMA, ALICE) or structural investigations (hysteroscopy) based on your history.
The ERA biopsy sample can simultaneously be tested for two other endometrial conditions using the same tissue — EMMA and ALICE — at no additional biopsy discomfort.
Tests the timing of the window of implantation. Detects displaced windows in 25–30% of RIF patients. Guides personalised embryo transfer timing.
Tests the bacterial environment (microbiome) of the uterine cavity. An endometrium with low Lactobacillus dominance has been linked to lower implantation rates. EMMA can identify imbalance and guide antibiotic or probiotic treatment before transfer.
Detects the bacterial species responsible for chronic endometritis — a subclinical uterine infection that standard culture misses in up to 50% of cases. Chronic endometritis is found in 14–67% of RIF patients and responds to targeted antibiotic therapy. ALICE can identify the specific pathogen.
All three tests — ERA, EMMA, ALICE — can be performed from a single biopsy sample, submitted to the laboratory together. Ask Dr. Prashanthi whether the combined ERA + EMMA + ALICE panel is appropriate for your situation.
The ERA test involves a laboratory analysis fee (charged by the testing laboratory, such as Igenomix/IVIRMA) plus the clinic's procedure fee for the mock FET cycle preparation and endometrial biopsy. As prices can change and packages vary, we do not publish a fixed cost. Please contact us directly for current pricing and package information.
Dr. E. Prashanthi Reddy trained at Kiel University, Germany, in Advanced Reproductive Technology — gaining exposure to ERA protocols and evidence-based RIF investigation frameworks used in leading European IVF centres.
We do not offer the ERA test in isolation. It is part of a structured recurrent implantation failure (RIF) workup that includes hysteroscopy, immunological screening, thrombophilia testing, and embryo quality review — ensuring no cause is missed.
Many patients come to us after failed transfers at other clinics. We welcome second opinions. We will review your previous cycle records and advise whether ERA is genuinely indicated or whether another investigation is more likely to find the answer.
With over two decades of IVF practice in Hyderabad and more than 10,000 families treated, Mother Hospitals has extensive experience managing recurrent implantation failure — including cases where ERA guidance led to successful transfer after multiple prior failures.
The ERA test has been validated in multiple clinical studies. In a prospective clinical trial published in Fertility and Sterility (Ruiz-Alonso et al., 2013), ERA-guided personalised embryo transfer significantly improved ongoing pregnancy rates in RIF patients. However, the ERA test identifies window displacement as one cause of implantation failure — it does not address embryo quality, immunological factors, or uterine structural issues. Its accuracy in identifying the timing of receptivity is high, but it should be interpreted as part of a broader RIF investigation, not as a stand-alone solution.
Yes. The ERA biopsy samples your own endometrium — the lining of your own uterus. The test measures the gene expression pattern of your personal endometrial tissue. There is no donor material involved. The biopsy is taken from the inner surface of the uterus using a thin Pipelle catheter during the ERA cycle.
Most women only need one ERA test. Studies show that the window of implantation is consistent between cycles in the same woman — meaning if your ERA result shows the window at Day P+5.5, it will reliably be at Day P+5.5 in future cycles as well. A repeat ERA is only occasionally needed if your protocol changes significantly (e.g., switching from hormonal to natural FET cycle, or a very different progesterone preparation).
For women with a displaced window of implantation, personalised embryo transfer guided by ERA has been shown to improve ongoing pregnancy and live birth rates in RIF patients. However, ERA cannot improve outcomes if the cause of failure is embryo quality, immunological rejection, uterine structural issues, or other factors unrelated to timing. About 70% of RIF patients tested show a Receptive result — meaning timing was not the issue — and further investigation is needed for them. ERA is one important piece of the RIF puzzle.
The ERA biopsy involves passing a thin Pipelle catheter through the cervix into the uterine cavity, which can cause brief cramp-like discomfort similar to menstrual pain. It takes under 5 minutes. Most women tolerate it well without any anaesthesia. Taking a standard painkiller (such as ibuprofen) 30–60 minutes before the procedure helps manage discomfort. The procedure does not require hospitalisation or sedation.
Yes — ERA can technically be performed in a natural (unmedicated) cycle, timed to a specific day after LH surge (natural ovulation). However, most ERA tests are performed in a medicated/hormonal FET preparation cycle because this exactly replicates the conditions in which the frozen embryo transfer will subsequently be performed. Dr. Prashanthi will advise which cycle type is appropriate based on whether your FET cycles are hormonal or natural.
The ERA biopsy sample is sent to the laboratory (Igenomix or equivalent ERA-certified lab), where next-generation sequencing and analysis takes approximately 3–4 weeks. You will receive the report as a PDF directly from the laboratory, which Dr. Prashanthi will then review with you and use to plan your personalised embryo transfer timing.
A "Receptive" ERA result means your window of implantation is at the standard timing — timing was not the cause of your implantation failure. This is important information, but it means the cause of failure lies elsewhere: possibly embryo quality (even morphologically good embryos can be chromosomally abnormal), immunological factors (natural killer cell activity, antiphospholipid syndrome), uterine issues (thin lining, endometritis, polyps, adhesions), or sperm DNA fragmentation. A Receptive result guides Dr. Prashanthi to investigate these other pathways rather than focusing on timing.
Dr. E. Prashanthi Reddy · TGMC Reg: 50624