Fertility diagnostics · London
ERA endometrial receptivity - what the current evidence actually says.
A molecular biopsy test (Igenomix, now Vitrolife) that aims to identify your individual window of implantation and personalise embryo transfer timing. Early studies were promising. The randomised trials that followed have not shown a live birth benefit. This page explains where it may still reasonably fit, and where it probably does not.
What ERA is
A gene expression test on a lining biopsy.
ERA analyses the expression profile of implantation-related genes in a small endometrial biopsy, then classifies your lining as pre-receptive, receptive or post-receptive. If it is not receptive at the standard time, the report suggests shifting embryo transfer by roughly 24 to 48 hours earlier or later.
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The mock cycle
Oestradiol builds the lining. Progesterone is started. Five to six days later (P+5) a small biopsy is taken.
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The laboratory step
The sample is sent to Igenomix / Vitrolife. Gene expression is analysed. Results take two to three weeks.
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The result
Receptive means proceed with the same timing. Non-receptive recommends shifting transfer by roughly 24 to 48 hours in a later cycle.
The evidence, honestly
Promising early data. Negative randomised trials.
The story of ERA is a fair example of why randomised controlled trials matter. If you are being offered this test, you should hear the whole story before you agree.
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Early observational data
Uncontrolled series from Igenomix (now Vitrolife) reported higher implantation and ongoing pregnancy rates when embryos were transferred in a "personalised" window identified by ERA, particularly in women with recurrent implantation failure.
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What the RCTs then showed
The larger randomised trials that followed (Simon 2020, Bergin 2020, Yeh 2022) did not confirm a benefit. Live birth rates in ERA-guided transfers were not higher than standard timing, either in unselected IVF patients or in a recurrent implantation failure subgroup.
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Where the professional bodies land
The ASRM 2023 committee opinion and ESHRE conference positions do not recommend routine ERA use outside a research setting, on the grounds that randomised evidence has not shown improved live birth rate.
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Where genuine consideration remains
Highly selected recurrent implantation failure, where all other treatable causes have been excluded, and where the patient is fully informed about the controversial evidence. It is a reasonable individual decision, not a proven step.
Before ERA
Address the causes with better evidence first.
Recurrent implantation failure is defined as three or more failed transfers of good-quality embryos. Before adjusting transfer timing by a few hours, work through the causes that have stronger evidence and often larger effect sizes.
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Embryo quality
PGT-A, extended blastocyst culture, better laboratory. Often the highest-yield step.
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Uterine cavity
Hysteroscopy for polyps, fibroids, adhesions, septum. Cheaper and better evidenced than ERA.
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Endometritis
Chronic endometritis biopsy with CD138 stain, treated with antibiotics.
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Thyroid and metabolic
TSH, prolactin, HbA1c, vitamin D. Correcting these is basic and often overlooked.
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Immunological and thrombophilia
Selective testing where clinically indicated. Not routine.
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Hydrosalpinx
A blocked, fluid-filled tube reduces implantation. Salpingectomy before transfer where present.
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Thin endometrium
Assess and treat before adjusting timing. Timing is not the fix if the lining is inadequate.
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Donor egg
Where age or repeated aneuploidy is the real driver, donor egg outperforms any receptivity test.
Indicative pricing
What ERA actually costs, end to end.
The test itself is one line on a longer bill. The mock cycle delays your real transfer by two to three months, and the transfer that follows carries its own cycle cost.
| Item | Indicative range |
|---|---|
| ERA test (biopsy analysis, Igenomix / Vitrolife) | £900–£1,500 |
| Mock cycle medication (oestradiol, progesterone) | £150–£400 |
| Endometrial biopsy in a mock cycle | £300–£600 |
| Base IVF cycle thereafter (frozen embryo transfer) | £1,800–£3,500 |
| Full fresh IVF cycle (if starting from scratch) | £5,500–£8,500 + medications |
| Repeat ERA (if first result non-receptive) | £900–£1,500 |
Where it is offered in London
HFEA-licensed clinics, honest conversation.
Any clinic offering ERA should discuss the negative randomised evidence with you before the mock cycle. If they do not, ask them to.
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The Lister Fertility Clinic
Chelsea
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CARE Fertility London
Marylebone
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ARGC
Wimpole Street
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TFP The Fertility Partnership
Multiple London sites
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Other HFEA-licensed clinics with Igenomix / Vitrolife or Cooper Genomics partnership
London
Related
Fertility tests and treatments to read next.
FAQs
The six questions patients actually ask.
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What does the current evidence actually say about ERA?
Early uncontrolled studies were promising. The larger randomised controlled trials that followed (Simon 2020, Bergin 2020, Yeh 2022) did not show an improvement in live birth rate, either in unselected IVF patients or in women with recurrent implantation failure. ASRM (2023) and ESHRE do not recommend routine ERA use.
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If the RCTs are negative, why do clinics still offer it?
Because a small subgroup may still benefit, because patients ask for it, and because the test is commercially available. That is not the same as proven benefit. Any reputable clinic offering ERA should discuss the controversial evidence with you before you agree to the mock cycle.
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What should I try before ERA?
Optimise embryo quality (PGT-A, extended culture, a strong laboratory), rule out uterine cavity issues with hysteroscopy, check for chronic endometritis, correct thyroid and metabolic factors, treat hydrosalpinx if present, and address thin endometrium. These have better evidence than personalising transfer timing by a few hours.
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What does ERA cost, all in?
The ERA test itself is roughly £900 to £1,500. The mock cycle around it adds medication (£150 to £400) and the biopsy procedure (£300 to £600). Add the frozen embryo transfer cycle that follows (£1,800 to £3,500) or a full fresh IVF cycle (£5,500 to £8,500 plus medications).
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How does the mock cycle work?
You take oestradiol to build the lining, then start progesterone. Five to six days later (P+5), a small endometrial biopsy is taken. The sample is sent to the lab and analysed for the expression pattern of implantation-related genes. Results take two to three weeks. Your actual embryo transfer is delayed by roughly two to three months.
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Who might reasonably still consider ERA?
A patient with three or more failed transfers of good-quality embryos, where PGT-A, hysteroscopy, endometritis biopsy, thyroid, hydrosalpinx and endometrial thickness have all been addressed, and who understands that the randomised evidence is negative but wants to leave no reasonable stone unturned. That is an informed personal choice, not a standard-of-care recommendation.
Not sure ERA is the right next step?