Endometrial Receptivity
In today's discussion, Dr. Laura Eisman talks about Endometrial Receptivity and what it has to do with fertility and IVF pregnancies.
Featured Speaker:
Dr. Eisman is an author of over 25 research publications, abstracts and presentations. She is a junior fellow of the American College of Obstetrics & Gynecology and a member of the American Society for Reproductive Medicine. Her special interests include uterine factor infertility and fertility preservation.
When Dr. Eisman isn’t at the clinic, she enjoys baking, running and spending time with her husband and two daughters.
Laura Eisman, MD, RE
Dr. Laura Eisman received her doctor of medicine from Jefferson Medical College in Philadelphia before completing her residency in obstetrics and gynecology at Abington Hospital-Jefferson Health in Abington, PA. She rounded out her education at Cedars-Sinai Medical Center in Los Angeles where she completed her fellowship in reproductive endocrinology & infertility. Dr. Eisman earned many honors and awards throughout her educational career including Resident Research Award, cum laude, Dean’s List and Benjamin Franklin Scholars Honors Program.Dr. Eisman is an author of over 25 research publications, abstracts and presentations. She is a junior fellow of the American College of Obstetrics & Gynecology and a member of the American Society for Reproductive Medicine. Her special interests include uterine factor infertility and fertility preservation.
When Dr. Eisman isn’t at the clinic, she enjoys baking, running and spending time with her husband and two daughters.
Transcription:
Endometrial Receptivity
Host: So what is endometrial receptivity and what does it have to do with the window of implantation when it comes to an IVF pregnancy? Well, let's find out with Dr. Laura Eisman, a physician at the Reproductive Science Center of the San Francisco Bay Area.
This is the Fertile Edge, a podcast by Reproductive Science Center of San Francisco Bay Area. I'm Bill Klaproth. So Dr. Eisman, thank you so much for your time. We appreciate it. So let's start with this, explain to us what is endometrial receptivity.
Dr. Laura Eisman: Endometrial receptivity is the ability of the uterine lining to allow an embryo to attach and invade. In a woman's menstrual cycle, there are three to six-day periods of receptivity called the window of implantation. And the window of implantation occurs in the second half of the menstrual cycle after ovulation, usually starting around day 19 or 20 of the normal menstrual cycle.
Host: All right. So let me ask you this, when would it be important to know the window of implantation or the period of receptivity?
Dr. Laura Eisman: It's useful to know when we do IVF so that we know the optimal time to transfer the embryo into the uterus to make sure the endometrium is receptive to the embryo at the time of transfer. The majority of women will have a receptive endometrium after five full days of progesterone. However, some women may need fewer or more days of progesterone prior to the transfer for optimal conditions.
Host: So then is there a test for receptivity?
Dr. Laura Eisman: Yes, the ERA or endometrial receptivity array is an analysis of the endometrium, the lining of the uterine cavity. It analyzes the expression levels of 248 genes in the endometrium to determine if the endometrium is receptive. So we take a biopsy of the endometrium and, using the ERA, we can determine if it was receptive at the time the biopsy was taken. And the results we get are classified as pre-receptive, receptive, or post-receptive.
Prior to the ERA, we used to look at the biopsy of the endometrium under the microscope to try to determine where in the cycle a woman was, but it was shown not to have accuracy or precision to reliably distinguish a narrow interval of days due to variability between patients, within a single patient and between observers. So the ERA was developed and it's more accurate and consistent than looking under a microscope at a tissue.
Host: So then Dr. Eisman, who might benefit from an ERA?
Dr. Laura Eisman: We think that it could be beneficial for women who have a history of recurrent implantation failure where multiple good quality embryos have failed to implant, especially when those embryos were chromosomally normal, but still failed to implant. We still don't have a randomized control trial that has looked at this as of yet, but we think that it has the potential to benefit women in this population, where there seems to be a uterine factor involved.
There is some controversy over whether women without a history of recurrent implantation failure should also have the ERA test done. And we're waiting for further studies to hopefully provide us with answers if using the ERA test translates into an improvement in outcomes.
Host: So then are there other tests available to look at whether the endometrium is ready for implantation?
Dr. Laura Eisman: Yes, there are some other tests mainly that look at inflammatory factors. It's thought that inflammation can also cause implantation issues. The Receptiva test detects a certain protein that's present in the setting of inflammation. And it's overexpressed in women with endometriosis. And then treatment is recommended if you have a positive test, either medical or surgical treatment for endometriosis.
There's also the idea that chronic inflammation from bacteria can affect implantation. An endometrial biopsy can be done. The tissue is looked at under the microscope to see if certain immune cells are present. And if so, then the patient is treated with antibiotics. It's debatable whether these tests will become routine treatment, but these are tests we consider if women have a history of implantation failure.
Host: So let's talk more about the ERA test. What is involved in the ERA test and how long does it take and how soon do you get the results?
Dr. Laura Eisman: So the ERA test is a biopsy on the day that we would typically do an embryo transfer. And there are different types of embryo transfer cycles for frozen embryos. There are medicated cycles as well as natural cycles. And medicated cycles involve typically two weeks of estrogen therapy followed by adding progesterone and on the sixth day of progesterone, which is thought to be the optimal window of implantation for most women, that's when we do the biopsy.
And natural cycles, we use the patient's own ovulations. Six days after ovulation, that's when we would do the biopsy. So it ends up being about 20 days after a woman starts her period that we would perform the test for either regimen.
Host: Well, that is very interesting. And I know this is a topic that women are interested in. So thank you for talking to us about endometrial receptivity. This has been really informative, Dr. Eisman. Thank you so much again. We appreciate it.
Dr. Laura Eisman: Thank you very much. I appreciate it. Bye-bye.
Host: That's Dr. Laura Eisman. And to get connected with Dr. Eisman, please visit our rscbayarea.com. That's R-S-C Bay Area dot com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Fertile Edge by Reproductive Science Center of San Francisco Bay. I'm Bill Klaproth. Thanks for listening.
Endometrial Receptivity
Host: So what is endometrial receptivity and what does it have to do with the window of implantation when it comes to an IVF pregnancy? Well, let's find out with Dr. Laura Eisman, a physician at the Reproductive Science Center of the San Francisco Bay Area.
This is the Fertile Edge, a podcast by Reproductive Science Center of San Francisco Bay Area. I'm Bill Klaproth. So Dr. Eisman, thank you so much for your time. We appreciate it. So let's start with this, explain to us what is endometrial receptivity.
Dr. Laura Eisman: Endometrial receptivity is the ability of the uterine lining to allow an embryo to attach and invade. In a woman's menstrual cycle, there are three to six-day periods of receptivity called the window of implantation. And the window of implantation occurs in the second half of the menstrual cycle after ovulation, usually starting around day 19 or 20 of the normal menstrual cycle.
Host: All right. So let me ask you this, when would it be important to know the window of implantation or the period of receptivity?
Dr. Laura Eisman: It's useful to know when we do IVF so that we know the optimal time to transfer the embryo into the uterus to make sure the endometrium is receptive to the embryo at the time of transfer. The majority of women will have a receptive endometrium after five full days of progesterone. However, some women may need fewer or more days of progesterone prior to the transfer for optimal conditions.
Host: So then is there a test for receptivity?
Dr. Laura Eisman: Yes, the ERA or endometrial receptivity array is an analysis of the endometrium, the lining of the uterine cavity. It analyzes the expression levels of 248 genes in the endometrium to determine if the endometrium is receptive. So we take a biopsy of the endometrium and, using the ERA, we can determine if it was receptive at the time the biopsy was taken. And the results we get are classified as pre-receptive, receptive, or post-receptive.
Prior to the ERA, we used to look at the biopsy of the endometrium under the microscope to try to determine where in the cycle a woman was, but it was shown not to have accuracy or precision to reliably distinguish a narrow interval of days due to variability between patients, within a single patient and between observers. So the ERA was developed and it's more accurate and consistent than looking under a microscope at a tissue.
Host: So then Dr. Eisman, who might benefit from an ERA?
Dr. Laura Eisman: We think that it could be beneficial for women who have a history of recurrent implantation failure where multiple good quality embryos have failed to implant, especially when those embryos were chromosomally normal, but still failed to implant. We still don't have a randomized control trial that has looked at this as of yet, but we think that it has the potential to benefit women in this population, where there seems to be a uterine factor involved.
There is some controversy over whether women without a history of recurrent implantation failure should also have the ERA test done. And we're waiting for further studies to hopefully provide us with answers if using the ERA test translates into an improvement in outcomes.
Host: So then are there other tests available to look at whether the endometrium is ready for implantation?
Dr. Laura Eisman: Yes, there are some other tests mainly that look at inflammatory factors. It's thought that inflammation can also cause implantation issues. The Receptiva test detects a certain protein that's present in the setting of inflammation. And it's overexpressed in women with endometriosis. And then treatment is recommended if you have a positive test, either medical or surgical treatment for endometriosis.
There's also the idea that chronic inflammation from bacteria can affect implantation. An endometrial biopsy can be done. The tissue is looked at under the microscope to see if certain immune cells are present. And if so, then the patient is treated with antibiotics. It's debatable whether these tests will become routine treatment, but these are tests we consider if women have a history of implantation failure.
Host: So let's talk more about the ERA test. What is involved in the ERA test and how long does it take and how soon do you get the results?
Dr. Laura Eisman: So the ERA test is a biopsy on the day that we would typically do an embryo transfer. And there are different types of embryo transfer cycles for frozen embryos. There are medicated cycles as well as natural cycles. And medicated cycles involve typically two weeks of estrogen therapy followed by adding progesterone and on the sixth day of progesterone, which is thought to be the optimal window of implantation for most women, that's when we do the biopsy.
And natural cycles, we use the patient's own ovulations. Six days after ovulation, that's when we would do the biopsy. So it ends up being about 20 days after a woman starts her period that we would perform the test for either regimen.
Host: Well, that is very interesting. And I know this is a topic that women are interested in. So thank you for talking to us about endometrial receptivity. This has been really informative, Dr. Eisman. Thank you so much again. We appreciate it.
Dr. Laura Eisman: Thank you very much. I appreciate it. Bye-bye.
Host: That's Dr. Laura Eisman. And to get connected with Dr. Eisman, please visit our rscbayarea.com. That's R-S-C Bay Area dot com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Fertile Edge by Reproductive Science Center of San Francisco Bay. I'm Bill Klaproth. Thanks for listening.