ERA Test (Endometrial Receptivity Analysis)

ERA stands for endometrial receptivity analysis. A small sample of your womb lining is taken during a mock cycle, and a laboratory measures the activity of a panel of implantation-related genes in it — 238 genes in the original array version, 248 in the current version.

The pattern is compared against a reference profile and classified as receptive, pre-receptive or post-receptive. The aim is to estimate whether your personal window of implantation sits where standard protocols assume it does.

It is a timing test, not a test of whether your lining is healthy. It does not look for polyps, fibroids, adhesions or infection — a hysteroscopy or pelvic scan does that.

The ERA test is £1,100. The £300 gynaecology consultation is required first and is charged separately, so it is £1,100 for the test plus £300 for the consultation — we do not quote it as one bundled figure, because the consultation happens whether or not you go on to have the test.

If you decide at the consultation not to proceed, you pay the £300 and nothing else. Current prices across our gynaecology services are on the fees page.

The best available evidence has not shown that it improves outcomes. A double-blind randomised trial of 767 patients published in JAMA in 2022 found live birth rates of 58.5 per cent with receptivity-guided timing versus 61.9 per cent with standard timing — a difference of −3.4 percentage points that was not statistically significant. The authors concluded that, in patients whose IVF cycle produced a euploid blastocyst, receptivity-guided timing did not significantly improve the rate of live birth.

The HFEA rates endometrial receptivity testing red, and ESHRE’s 2023 recommendations say there are insufficient data to recommend routine use of any commercial receptivity test.

We will not tell you it improves your chances, because we do not have evidence that it does.

The HFEA’s red rating means: “There are potential safety concerns and/or, on balance, the findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness.”

It reflects the fact that the one high-quality randomised trial did not demonstrate a benefit, and that a lower-quality study pointed towards a reduced chance of a baby. Red is the regulator’s way of saying the moderate-to-high quality evidence is not on this test’s side.

You can read the rating and the HFEA’s reasoning on the HFEA website.

For most people it is a strong period-type cramp that peaks briefly while the sample is taken and then eases. NHS patient information for endometrial biopsy describes period-type cramps that can be sharp and may last a few hours, passing quite quickly for most women; very rarely, discomfort continues for a few weeks.

We ask you to take paracetamol or ibuprofen about an hour beforehand. The sampling takes under a minute, though the appointment is around half an hour in total.

If you want us to stop at any point, we stop. You do not need to give a reason.

It has to replicate the exact timing of a real embryo transfer, so it is taken in a medicated or monitored mock cycle rather than at a convenient moment.

In a hormone-replacement cycle the sample is taken after five full days of progesterone. In a modified natural cycle it is taken seven days after the LH surge or trigger.

This is why the test adds a whole cycle to your timeline: the mock cycle offers no chance of pregnancy in itself.

Weeks rather than days. The sample goes to Igenomix for sequencing and computational analysis, and turnaround varies with laboratory workload.

We confirm the current timescale with the laboratory when you book, so you can plan whether the next transfer cycle is realistic or whether you will be waiting a further month.

It means the gene activity pattern in your sample matched an earlier (pre-receptive) or later (post-receptive) phase than the reference profile for the moment it was taken. The laboratory then suggests shifting a future transfer by a specified number of hours of progesterone exposure.

Where the displacement is large, a second confirmatory biopsy in another mock cycle is sometimes recommended — which means another cycle and another procedure.

It is important to keep this in proportion: a displaced result is a statistical classification of a tissue sample, not a demonstrated cause of your previous transfers failing.

Yes, always. Every endometrial receptivity test here requires a gynaecology consultation with our team first. It is £300, and the £1,100 test fee is charged on top only if you go ahead.

There is no route that skips it. A test carrying a red regulatory rating should not be bought from a booking page without a clinician having assessed whether it is sensible in your particular circumstances.

Book the gynaecology consultation and bring your previous cycle records if you have them.

It would not be meaningful. The whole purpose of the test is to adjust the timing of an embryo transfer by a matter of hours, which is only possible in a controlled frozen transfer cycle.

In natural conception the timing of implantation is not something anyone can adjust, so a receptivity result has nothing to act on.

If you are trying to conceive naturally and things are not happening, trying to conceive and our fertility health check-up are the relevant places to start.

They are different analyses, often run on the same biopsy sample. ERA looks at gene activity to estimate transfer timing. EMMA looks at the balance of bacteria in the lining. ALICE looks specifically for bacteria associated with chronic endometritis. EndomeTRIO is all three combined at £1,450.

Their regulatory positions differ. ERA — and therefore EndomeTRIO, which contains it — is rated red by the HFEA. EMMA and ALICE are not currently on the HFEA’s rated list at all, which means they have not been assessed rather than that they have been approved.

Every one of them requires the £300 consultation first, with the test fee charged on top.

This is the situation in which it is most often raised, and it is a fair question. The argument some clinicians make is that if you have transferred several good-quality euploid embryos into a well-developed lining, with everything else investigated and normal, a displaced window is one of the few remaining untested explanations.

That is an argument about residual uncertainty, not evidence that the test works — and ESHRE’s 2023 recommendations on recurrent implantation failure specifically do not endorse routine receptivity testing.

Before considering it, we would want your cavity properly assessed by hysteroscopy and your history reviewed in full. If your losses have been pregnancies rather than failed transfers, recurrent miscarriage investigations are the more appropriate pathway.

No. It is classified as a treatment add-on rather than part of standard NHS fertility care, and its red HFEA rating makes NHS funding very unlikely.

That is worth sitting with for a moment: the same regulator that publishes the ratings is telling you the evidence does not support it. Private availability reflects what clinics may sell, not what has been shown to work.

We would always encourage you to keep your NHS fertility care and your referring clinic fully in the loop about anything you have privately.

In most cases, investigations with a better evidence base and a lower price. A hysteroscopy assesses and can treat the cavity directly; saline infusion sonohysterography and a HyCoSy scan outline the cavity and tubes; a pelvic scan picks up fibroids and adenomyosis.

An endometrial lining scan and follicle tracking show how your cycle is actually behaving, and our fertility health check-up gathers the common tests into one appointment.

And declining an add-on the HFEA rates red, as it does this one, is a legitimate choice — the evidence does not suggest it costs you anything, and no one should make you feel otherwise. Add-ons are not all alike, though: the regulator rates each one separately, so it is worth asking your clinician what the rating is for each thing you are offered.