You’re in the fertility clinic waiting room. You know the one — bright lights, a stack of magazines you’ve already read a million times, and that familiar mix of stress, excitement, and maybe even a little (or a lot) of overwhelm. Then, you hear the words "endometrial biopsy," and you think, “Wait, seriously? Another thing?”

Don’t worry, you’re not alone. It’s completely normal to feel a little nervous.

An endometrial biopsy is basically a check-up for your uterus. But do you need one before IVF? In most cases, no, it’s not required — unless your provider specifically recommends it. That said, there are certain situations where it makes sense. Let’s dive into the details.

doctor using an anatomical model to demonstrate how an endometrial biopsy works

What exactly is an endometrial biopsy?

An endometrial biopsy is a procedure some fertility specialists use to determine the best timing for embryo transfer during an IVF cycle. It involves taking a small tissue sample from your uterine lining (the endometrium) and sending it to a lab for analysis. There, experts examine the cells to assess how your uterus is responding.

The procedure itself is quick and done right in your provider’s office. You might feel some cramping, but it’s typically over in just a few minutes.

Who might need an endometrial biopsy — and why?

While endometrial biopsies can provide valuable insights, they aren’t a routine part of IVF for most people. Your fertility specialist might recommend one if they need to:

  • Assess the health of your uterine lining
  • Confirm the best timing for embryo transfer
  • Ensure your uterus is receptive to implantation
  • Rule out potential factors that could affect fertility or pregnancy

A key focus in IVF is endometrial receptivity, and now, there are specialized tests designed to measure it. Both the EMMA/ALICE tests use biopsy to evaluate the microbiome, but the one we’re focusing on today is:

"Studies show that up to 30% of women experiencing infertility have pathogenic bacteria detected in their endometrium that cannot be detected by vaginal ultrasound or other traditional diagnostic techniques."

— Lauren Hurst

BA, BSN, RN, Medical Science Liaison, Igenomix

Meet the Endometrial Receptivity Analysis (ERA®) test

ERA® is a specific type of biopsy that helps pinpoint your "window of implantation" — the ideal time for an embryo to implant and (hopefully!) develop into a healthy pregnancy.

With strong clinical backing, ERA helps providers create personalized embryo transfer plans with high accuracy. In fact, over 200,000 women worldwide have taken the test, and its AI-powered algorithm continuously refines itself using real-world data from successful pregnancies. Pretty impressive, right?

woman and her doctor discussing the era test

How does the ERA test work?

The ERA test analyzes the expression of specific genes in your endometrial tissue. These genes act as a molecular clock, telling your provider exactly when your uterus is most receptive to implantation — like a personalized fertility timer designed just for you.

ERA and IVF: Is it always necessary?

While the ERA test sounds like a game-changer, it’s not for everyone. In fact, recent research suggests that for most people — especially those trying IVF for the first time — ERA doesn’t significantly improve success rates.

One study found that using ERA to time embryo transfer didn’t result in higher live birth rates compared to standard IVF timing. This means that while the test can be beneficial in certain cases, it’s not essential for all IVF patients.

woman reading the results of an endometrial biopsy

When might an endometrial biopsy be recommended?

While not always necessary, your provider may suggest an endometrial biopsy if:

  • You’ve had multiple failed IVF cycles despite having good-quality embryos
  • There’s a suspected issue with your uterine lining
  • You’ve experienced recurrent pregnancy loss
  • You’re dealing with unexplained infertility, and your provider wants more information

Every fertility journey is unique, and what’s right for one person may not be needed for another. Your provider will consider your medical history, past treatments, and specific challenges before recommending additional tests like an endometrial biopsy.

woman and her doctor discussing endometrial biopsy before ivf

Making informed decisions about your fertility

With so many tests and procedures, it’s natural to want to explore every possible option. But it’s just as important to trust your medical team’s expertise. Every test has its pros and cons — whether it’s discomfort, cost, or the emotional toll of waiting for results.

If you’re unsure, ask questions! Understanding why a test is (or isn’t) recommended can help you feel more informed, confident, and in control of your journey.

Whether or not an endometrial biopsy is part of your IVF plan, you’re taking a courageous step toward parenthood. Every path to motherhood looks different, and yours is just as valid and promising as anyone else’s. Stay informed, ask questions, and above all, be kind to yourself.

Blair Sharp is a freelance writer who lives in Minnesota with her husband and son. Her words have been published in various publications, including Parents, SheKnows, The Bump, and Insider. You can find her watching reality TV and sharing too many reels with her friends when she's not writing. To connect with Blair, find her on LinkedIn and Instagram, or head to her website www.blairsharp.com.