Endometrial Biopsy Testing Options
If you are struggling with infertility, you may have heard of endometrial testing options, such as CD138 for chronic subclinical endometritis, ERA (endometrial receptivity analysis), or Receptiva Dx which claims to diagnose patients with endometriosis. All these tests boast strong claims of significantly improving patients’ chances of carrying a successful pregnancy. Please know that your Spring providers will always recommend any test or intervention that they think will help you be successful. While we are our patients’ strongest advocates, we are also data-driven scientists. This informs why we will recommend CD 138 in specific cases but will not recommend ERA or Receptiva.
Below we break down CD138 and specific cases in which we may recommend:
What is the stated purpose of these tests?
The CD138 test is taken from an endometrial biopsy and tests for a protein called syndecan-1 or CD138. If present in high levels, it is associated with subclinical chronic endometritis. In this scenario, subclinical implies a very mild level of infection without any symptoms such as pain or fever. Of note, there is a natural increase in CD138 cells in the uterus after ovulation; thus, this test must be done prior to ovulation.
Why do we care about endometritis?
Subclinical chronic endometritis is a condition that may dysregulate the uterine environment and shift the window of implantation, which is important for embryo implantation. Studies have shown that chronic endometritis may change the immune environment within the endometrial cavity, leading to implantation failure. If the test is positive, treatment with antibiotics (typically 2 weeks) follow by a test of cure would be recommended before proceeding with future transfers.
What does the data say about the efficacy of these tests?
Data on chronic endometritis, CD138 positive, have demonstrated that patients with recurrent implantation failure tend to have an increased rate of chronic endometritis as determined by a positive CD138 result. Several studies have found that treating chronic endometritis with antibiotics does improve cure rates and/or decrease the amount of inflammation in the endometrium (https://www.fertstert.org/article/S0015-0282(21)00039-X/fulltext). However, there is still debate as to whether treating chronic endometritis ultimately improves pregnancy outcomes, with one study suggesting possible benefit in treatment (https://www.fertstert.org/article/S0015-0282(21)00241-7/fulltext), but a randomized-controlled trial demonstrating no improvement after treatment (https://www.fertstert.org/article/S0015-0282(20)32761-8/fulltext).
What are the costs associated with these tests?
Spring’s price for the endometrial biopsy procedure itself is $315. Other associated costs are test dependent (see below). The biopsy procedure is relatively non-invasive and is an outpatient procedure in which anesthesia is not required. However, it is common to experience moderate discomfort during and following the procedure, including abdominal cramping, and vaginal bleeding.
The CD138 test, through LabCorp, is determined by the lab doing the testing and the time the analysis requires, ranging from $500 to $1,500*.
*Check out LabCorp’s site for the most up to date pricing
Who would benefit from testing?
These tests should only be considered for patients who have failed a minimum of two embryo transfers. With each transfer of a euploid (genetically tested “normal”) embryo ,there is a 55-65% chance of a successful pregnancy. Therefore, while a failed embryo transfer may be devastating, it is not an unexpected or concerning outcome. However, after failing multiple transfers of a euploid embryo, it becomes more statistically significant, and your provider may discuss considering additional endometrial diagnostic testing.