IVF success depends on having a healthy viable embryo and a normal receptive uterine lining.
10 years ago, the ERA test or Endometrial Receptivity Array,
was developed. Today there are a number of tests to assess the uterine lining.
These tests are expensive and invasive. Should you have any of these tests done? Stay tuned.
The ERA test was used for many years but is no
longer recommended. Watch this video for more information about the recent studies
which have shown that the ERA is not a useful test for people doing IVF.
At IVF1, we currently recommend looking for chronic endometritis which is inflammation of the
uterine lining. The gold standard for diagnosing endometritis is to look for a type of inflammatory
cell called plasma cells. Although testing for endometritis is invasive - it requires a biopsy,
it is very inexpensive and there is good data that shows that people with high numbers of
plasma cells have lower pregnancy rates in IVF and, importantly, treatment to reduce
the number of plasma cells improves pregnancy rates. You can learn more about that here.
Inflammation is commonly due to the presence of bacteria in the uterine cavity. Recently, there
have been two tests that have become available which focus on the type of bacteria in the
uterine cavity. The first test is called ALICE. This stands for AnaLysis of Infectious Chronic
Endometritis. This name is deceiving. ALICE does not actually look for chronic endometritis.
Diagnosing endometritis is made by finding high numbers of inflammatory plasma cells,
The ALICE test looks for bacteria which MAY be associated with chronic endometritis.
This is a very important distinction. The presence of bacteria, even abnormal bacteria,
does not necessarily result in inflammation. In fact,
in their own study, the company that offers this test found there was little correlation
between the results of their test and the presence of chronic endometritis diagnosed
by plasma cells. The ALICE report does not even include an assessment for plasma cells.
So far, there have not been any studies performed that show that an abnormal ALICE result alone
is associated with a lower IVF pregnancy rate. There are also no studies which have shown that
treatment of an abnormal ALICE, in the absence of inflammation, will improve pregnancy rates in IVF.
A second test from the same company is called EMMA. EMMA standards for EndoMetrial Microbiome
Metagenomic Analysis. A microbiome is the sum total of all of the bacteria
in a certain part of the body. There has been much interest in microbiomes in recent years.
It seems that some types of bacteria are important for maintaining our health.
Your bowels have a microbiome. So does the vagina and so does your uterus. This brings up some
interesting questions like do some people have an unhealthy uterine microbiome? If that is true,
can an unhealthy microbiome reduce the chance for pregnancy? Can you change an unhealthy
microbiome to a healthy one? If you do, will that also improve the chance for pregnancy?
The EMMA test is based on one very small study. There are a number of problems with this study.
First, they studied only 35 people who had an embryo transfer. But in three of those,
they were unable to get any data about the microbiome and all three of those people
became pregnant. With such a small study, this could have completely altered their conclusions.
166 different types of bacteria were identified but only levels of one bacteria, lactobacilli,
were seemingly important. Pregnancy rates were higher when 90% or more of the bacteria found
were lactobacilli compared to when it was less than 90%. However, the timing of the biopsy could
change the results. Nearly 20% of the patients saw the percentages change from low to high within a
few days. This study from a different group of researchers also looked at lactobacilli levels
but did not find any difference in the pregnancy rates. Even if we believe there is a difference,
there haven't been any studies showing that any type of therapy can change these outcomes.
Finally, I want to talk about a third test called the Receptiva Dx.
This test looks at a marker called BCL6. The makers of this test claim that high levels of BCL6
are a marker for endometriosis and that the presence of endometriosis will prevent embryos
from implanting. Studies do not seem to support this however. This study compared pregnancy rates
in people with or without endometriosis and found no difference. In addition, this study
found no difference in the pregnancy rates in people with a normal or abnormal Receptiva test
Our Infertility TV bottom line is this. Its great that there is research going on which
is trying to identify uterine causes for IVF failure. At the current time, however,
that's all this is - research. None of these tests have been demonstrated to be a useful test that
will help increase your chances for IVF success. In addition, they are expensive and invasive.