Abstract Purpose To assess whether the endometrial receptivity analysis (ERA) captures receptivity changes attributed to endometrial aging and whether it may be useful for older patients undergoing fertility treatment. Methods Retrospective cohort study of patients who underwent ERA testing at an academic center (01/2019–05/2024). The ERA inferred transcriptomic levels of canonical receptivity markers from biopsies obtained at standard timing. Demographic and treatment-related variables were analyzed by age group. The proportion of non-receptive ERA results (pre- and post-receptive combined) was compared using Fisher’s exact test. Univariable and multivariable logistic regression assessed associations between predictors and non-receptive ERA. Results Of 210 patients, 205 were included. Age distribution was < 35 ( n = 35, 17%), 35–37 ( n = 58, 28.3%), 38–40 ( n = 53, 25.8%), and ≥ 41 ( n = 59, 28.8%). Overall, 166 (81.0%) ERAs were receptive, 33 (16.1%) pre-receptive, and 6 (2.9%) post-receptive. BMI, infertility diagnosis, and prior implantation or miscarriage history did not differ by age. Non-receptive ERA proportions were 20% (< 35), 17.2% (35–37), 17.0% (38–40), and 22.0% (≥ 41) ( p = 0.52). In multivariable analysis adjusting for BMI and number of prior failed euploid transfers, age was not associated with non-receptive ERA (aOR 0.98, 95% CI 0.34–2.30, p = 0.97). Conclusion Uterine age was not associated with increased odds of non-receptive ERA, suggesting that the test does not capture age-related changes in endometrial receptivity. Although endometrial aging is implicated in reduced embryo transfer success, the ERA should not be ordered solely on the basis of uterine age. The ERA may not reliably detect age-related endometrial differences in the window of implantation at a clinical level.
Schwartz et al. (Mon,) studied this question.