Primary Infertility of 3 Years with Failed Ovulation Induction and IUI Cycles and Failed Implantation in IVF
A couple around 30 years of age, married for 3 years, visited Dr Aanchal Garg in Lucknow with an issue of primary infertility. They had tried several cycles of ovulation induction and 2 cycles of Intrauterine Insemination (IUI), which had failed. They decided to go for an IVF. The IVF cycle was performed and the embryos formed were frozen. The 1st frozen embryo transfer was done, but unfortunately, it was unsuccessful.
The couple, who were desperate to conceive, had many questions in their mind. They wanted to know the reasons for failure. Dr Aanchal understood them and explained that there could be many reasons for a failed implantation. One of the common reasons for a failed implantation in IVF cycles is the timing of the transfer. Dr Aanchal explained to the couple about the ERA test (Endometrial Receptivity Array).
What is Primary Infertility?
Primary infertility is a term used to describe a condition where a couple has not been able to conceive even after one year (or twelve months) of sexual intercourse without birth control measures. The causes of primary infertility can be physical, emotional, or both. Also, the cause of primary infertility in a couple can be due to the man, the woman, or sometimes both.
Primary infertility in a woman can occur due to disorder of the fallopian tubes, uterine disorders, disorders of the ovaries, or hormonal imbalance in the body. In a man, primary infertility can be caused due to problems in ejaculation of sperm, low sperm levels, poor sperm morphology, or inadequate mobility.
What is an ERA Test, and When is it Done?
The implantation of an embryo is complex, and many factors govern it. Successful implantation depends upon the receptivity of the endometrium (the lining of the uterus), and this needs to happen at the correct stage of endometrial development. This time frame is called the ‘Window of Implantation’ and usually occurs 8-10 days after ovulation.
Endometrial Receptivity is also governed by 200 genes, and knowing its status guides infertility specialists like Dr Aanchal about the best time for embryo transfer to maximise the chances of implantation. Endometrial receptivity can be checked using the Endometrial Receptivity Array test (also called the Endometrial Receptivity Analysis) or ERA test.
The couple wanted to undergo this ETA test before their next embryo transfer. The ERA test was performed, and the report showed the endometrium as Pre-Receptive. This means that the woman’s endometrium was receptive ahead of the estimated time. The next frozen embryo transfer was a personalised transfer, according to the report of the ERA test. The woman conceived with that transfer, and she gave birth to a healthy baby last year.
Effectiveness of ERA Test
The patient had just one failed cycle, but still, the ERA test was done as the woman was depressed with the failure of implantation and wanted better chances with the next transfer. ERA test is a useful test for personalised embryo transfer. It is usually done for recurrent implantation failure. The patient opted for it early to improve her chances of conception and also due to her financial constraints.