This test is to see when is the probable time for egg to get released from the ovary (Ovulation). This is needed for women who try naturally, those who are planning IUI treatment and also in women planning for IVF or ICSI or test tube baby treatment . It is performed using an internal scan (transvaginal ultrasound) to measure the growth rate of the follicle,which is a water filled structure in the ovary which contains the egg. This scan is done starting from day 2 of starting of periods in women who are trying naturally or IUI and is then performed at a regular interval. It helps in knowing the good time to try naturally,to do IUI and also to take the eggs our for IVF or ICSI. The follicular growth may need some medications in women who are undergoing IUI. The IUI cost may vary from 10000 INR to 30,000 INR or more. Giving tablets instead of injections for follicular growth can keep the IUI treatment cost

What are the chances of pregnancy after tubal patency test ?

Pregnancy chances depend upon various complex factors like

• Age of woman
• Ovarian reserve
• Duration of infertility
• Whether block is in proximal (uterine end) or distal (ovarian end) part of tube
• The quality of sperm
• Experience of surgeon if any corrective surgery is planned.

Endometrial Receptive Array

What is ERA ?

-ERA is an abbreviation for Endometrial ReceptivityArray or Analysis.

-This is specialised  genetic test carried out on a tiny portion of the woman’s uterine  lining to determine  the most appropriate day to transfer embryo during an IVF cycle.

Who can benefit from ERA?

Endometrial Receptivity Array test is done in couple with repeated implantation failure.

How is ERA test done?

• Endometrial biopsy for ERA test can be done in natural ovulation cycle or after giving hormonal treatment.
• After endometrial biopsy the genetic material is extracted from the endometrial tissue.
• The extracted genetic material (RNA ) is tested for 236 genes which are normally expressed during implantation window.
• The result of ERA is reported as pre receptive or non-receptive
• ERA test may be repeated in some cases when report is pre or post receptive.
• This guides us to decide the most suitable day for embryo transfer.

Is there any limitation of ERA test?

• A normal ERA test (receptive) does not guarantee delivery of a healthy baby.
• Pregnancy may fail to start & continue if there is embryo abnormality.
• ERA checks the receptivity of endometrium during physiological implantation window.
• Similarly ERA cannot tell us about condition of uterus to carry pregnancy till healthy delivery.

Decreased Ovarian Reserve

Ovarian reserve is the number as well as quality of the remaining eggs in both ovaries at a given age.

Egg quality directly affects embryo development & the ‘take home baby ‘rate.

Ovarian Reserve Test ( ORT ) helps to determine the chances of natural conception as well as with treatment.

It is very important to identify women with low ovarian reserve so that they can take important decisions regarding their own fertility in a timely manner.

Following are the risk factors for Decreased ovarian reserve :

• Family history of early menopause
• Ovarian surgery especially for endometrioma.
• Surgical removal of part of ovary (for cystectomy) or removal of one whole ovary (Oophorectomy )
• Cancer survivors after pelvic surgery , chemotherapy or radiotherapy
• Smoking
• Ovarian inflammation -endometriosis & pelvic infection etc.
• Unexplained infertility
• Poor response in previous IVF cycle
• Known case of certain genetic conditions like Turner syndrome & mutation carriers like Fragile X /FMR1 /BRCA -1

Ovarian reserve should be tested in following conditions also :

• Planning fertility preservation
• Candidate for IVF
• Planning to delay pregnancy for personal reasons

Ovarian reserve can be determined with Ovarian Reserve Test ( ORT ):

• USG for Antral Follicle Count (AFC scan) – Good for number of eggs.
• Blood test for determination of Anti Mullerian Hormone ( AMH ) – Good for number of eggs & quality to some extent.
• Blood test to assess function of ‘Hypothalamic -Pituitary -Ovarian axis’ – Follicle Stimulating Hormone (FSH,) Luteinising Hormone (LH) & Estradiol.

Caution while interpreting result of ORT :

• None of above test can predict the chance of pregnancy with 100 % accuracy.
• Most important factor determining chance of conception is quality of oocyte which cannot be assessed precisely with any available test.
• A woman with good ovarian reserve may face difficulty in having a healthy baby due to issues in sperm quality or implantation issues.
• Woman with low AMH & AFC also can conceive with individualised treatment protocol.
• Women with low ovarian reserve should consult a fertility specialist to discuss their treatment choices.