Why the new expensive endometrial receptivity tests are useless


We all know that one of the key variables which affects IVF success is endometrial receptivity. Often the only test which most doctors use to check whether the endometrium is receptive or not is a vaginal ultrasound scan. We check the thickness as well as the texture, and if the uterine lining is more than 8 mm in thickness and trilaminar , we conclude that the endometrium is ready to accept the embryo, and proceed with the embryo transfer.

However, when the cycle fails, a lot of women feel it's because their endometrium rejected the embryo. They're not very happy that we use such a simple test such as a vaginal ultrasound scan to judge endometrial receptivity , because they feel it's too basic and very crude. They want us to do more complex tests in order to drill down and really assess the quality of the uterine lining.

This is why tests such as ERA (endometrial receptivity assay) have become popular - because they allow the doctor to check the genetic markers which signal receptivity. However, the reality is that all these complex tests are expensive and useless, because they don't provide any additional useful information.

They just generate a lot of genetic jargon which most IVF doctors can't interpret . They don't really have a clue as to what the results mean, but they are happy to do the test , because it's very useful as an additional tool to sell to their patients. After all, it gives patients the impression that the doctor is being very thorough in his approach, and that additional tests will increase the chances of their next IVF cycle succeeding when they try again.

Patients want doctors to do something - anything ! They naively feel that more is better , and that the doctor can use this additional information to improve their chances of getting pregnant. Doing an endometrial receptivity assay is one of the easiest things for the doctor to do. It's easy to do , costs a lot of money, and has been "validated" by medical research.

The truth is more nuanced. Yes, an ultrasound scan is a crude test , but it's good enough , because it correlates so well with pregnancy rates. When you have a simple inexpensive test which gives us the information we want, then what's the point in spending a lot more money on an expensive invasive test which doesn't provide any additional useful information ?

Sadly, we seem to have learned very little from the "endometrial dating" fiasco. A few years ago, "luteal phase defects " were one of the most popular diagnosis which infertility specialists used to make - and these have been proven to be completely wrong ! However, thousands of infertile patients were misdiagnosed and mistreated .

This is why good doctors don't use endometrial receptivity tests, because it really doesn't change the patient's treatment plan.

Do you find your doctor is wasting a lot of your money on pointless tests ? Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.