Endometrial Receptivity Testing Before IVF Seen as Unnecessary

Myles Starr

December 12, 2022

Endometrial receptivity testing (ERT) did not increase the chances of achieving live birth in patients undergoing in vitro fertilization.  

The study was promoted by widespread use of the tests in reproductive medicine and earlier conflicting studies regarding its effectiveness. The procedure, in which doctors extract cells from a woman's endometrial lining in an effort to determine the best day to perform in vitro fertilization, requires a biopsy, can take a month to generate results, and costs up to $1000.

But the new study, published online December 6 in the Journal of the American Medical Association, found that embryo transfer based on the timing of ERT was no better than that based on the standard protocol. 

"Endometrial receptivity testing ended up not being beneficial in the population of interest, a good prognosis IVF patient population," said Nicole Doyle, MD, PhD, of Shady Grove Fertility, in Arlington, Virginia, who led the study. "For this particular patient population I would not recommend ERT based on the results of the trial."

"Unfortunately, as is our history in reproductive medicine, we may embrace technology prematurely given patient desperation and physician eagerness to improve pregnancy outcomes," said Mark P. Trolice, MD, director of The IVF Center in Orlando, Florida, who was not involved in the new research.

The double-blind, randomized clinical trial enrolled 726 women treated at Doyle's clinic between May 2018 and September 2020.

All the women underwent ERT. Of those who received adjusted progesterone exposure after the test, live birth occurred in 58.5% of transfers (223 of 381). Among those in a control group who did not have their progesterone adjusted after ERT and underwent IVF on a standardized schedule, 61.9% of transfers (239 of 386) resulted in live birth, according to the researchers.

The differences in rates of clinical (77.2% vs. 79.5% [95% CI, −10.4% to 2.4%]) and biochemical pregnancy (68.8% vs. 72.8% [95% CI, −8.2% to 3.5%]) were not statistically significant between the two groups, Doyle and her colleagues reported.

Women who experienced recurrent implantation failure (RIF), defined as more than two failed embryo transfers, were excluded from the study. "We can't assess the benefit of an endometrial receptivity testing in this particular patient population," Doyle said.

However, she noted that the number of women who undergo RIF is "a very small fraction of all IVF patients, less than 5%." Of those, half are expected to have embryos that are not suitable for implantation, Doyle said.

As a result, she said, "it's really only about 2.5% of IVF patients for which we don't yet have an answer regarding the utility of ERT"

Trolice, also a professor at UCF College of Medicine, expressed certainty that the "one-size-fits-all approach" for ERT has been disproven by the study's failure to find a benefit from the procedure in women with a "good prognosis." But, he added, whether ERT is of value in a subset of patients, such as those with recurrent implantation failure, remains "a question of vital importance."

Doyle and Trolice reported no relevant financial relationships.

JAMA. Published online December 6, 2022. Abstract

Myles Starr is medical journalist based in New York.

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