ERA testing after multiple implantation failures. Anyone had it done?

[seven201]

I've had four transfers so far (first 3 from 1 batch, fourth from a second egg collection) and 4 BFNs. I have a naturally conceived 4 1/2 year old and had a natural pregnancy with early miscarriage a bit over 3 years ago. My lining struggles to get to thickness, I have polycystic ovaries (on sukkarto), a fibroid, slightly high thyroid thingy (on levothyroxine), high bp (on meds) and a midline septum (ridge/divide in the uterus). I had surgery to unblock a tube 2 years ago. I'm in the healthy weight range.

My clinic have suggested PGS testing (we have 5 embryos in the freezer) but I'm really not keen on it as I've read about actually fine embryos being shown as poor and therefore being disposed of.

They also suggested ERA (endometrial receptor assessment). Has anyone had that done and found it useful? I just hate anything that delays the next FET but I think maybe it will be worth it?

Any other suggestions? Last FET I was on lots of estrogen, extra progesterone injections, clexane, neupogen infusion, aspirin and probably a whole load of other stuff I've forgotten.

I am so fed up with it all!

I forgot to mention I've had a mini thrombophilia screen and that was clear. They put me on aspirin and clexane in case there was something else. Also neupogen for the same reason (and to help thicken my lining a littl)

Hi @seven201 wow your clinic has put you on a lot! I have had 2 unsuccessful transfers. I have decided to pause and have investigations before having any more transfers. I had 7 in the freezer so asked for them to be PGT-A tested, 1 didn’t survive the thaw of the remaining 6, 5 were euploid.

I’m having level 1 recurrent implantation failure bloods tests at the moment, which is a thrombophilia screen and autoantibodies and me and DH are having a C4M2 test. I’m having a mock cycle with an ERA starting in about 2 week time.

It’s up to you what you chose to do, I felt the same, I didn’t want to stop and get tests because I was counting down the expected due date for each transfer and I wantEd to get on and have success as soon as possible. But at the same time there is clearly something wrong in my case, I’ve never ever had a BFP in my life. I know there’s something wrong and I don’t want to put myself through another unsuccessful cycle and lose another embryo in the process. For me pausing and working on getting things right seems to be the best decision.

@Gardenlady543 congratulations on the PGT-A results, that's great!

I've had the thrombophila but not the autoantibodies or the cm42 so I'll ask about those, thank you.

Yes, was on all the drugs. My bum is still recovering from the patches and injections! I was also on viagra I just remembered!

I think you're right. It's worth the wait to see if they do find a problem. Everything just takes soo long and I'm getting old! Thank you for the reply.

Thanks @seven201 unfortunately it opened a can of worms, since the embryos seem to me normal, everything is suggesting I have an implantation issue. I think my clinic would need to see an issue before starting me on anything extra though m. It sounds like you’re on a lot of the stuff already, which clinic are you with out of interest?

If there are autoantibodies present then they usually start steroids so it might be worth asking for that to be tested. I think the C4M2 test is specific to Care fertility clinic, if it’s positive then the treatment is heparin, which you’re already on, so probably not worth paying for that. The ERA is useful to specify the timing of the progesterone so that could be helpful. If you have a good amount of embryos in the freezer then I would consider the PGT-A testing. How old are you?

@Gardenlady543 sorry it opened a can of worms for you. I wish there was a magic diagnosis button we could press! I think I have some kind of implantation issue, but don't know for sure.

I'm with care too but I guess different area clinics have autonomy over treatment plans. I asked about steroids but they said during covid they can't prescribe it unless a test specifically shows it would help. I will definitely ask about the autoantibodies test, thank you.

I'm 38 and we have 5 embryos in the freezer. I'm not keen on the PGT-A testing so think I'd like to put that off for as long as possible. Maybe if the ERA doesn't show anything then I'd consider again.

Thanks again for your help.

@seven201 yeah I think that’s a plan, PGT-A can provide some reassurance that a euploid embryo is putting back, but it won’t make the embryos normal, and there are risks, I put my embryos through an extra thaw and freeze and the best one didn’t survive it. I’m 35 so not far off your age and the rates of euploid embryos are still good at our age.

That’s interesting that you’re at Care and they’ve put you on all that. In case I end up needed it.

@seven201 if your lining doesn’t thicken up and you have previously had a miscarriage please have a hysteroscopy to check you don’t have any scarring.
I’ve got this problem following a fail of 2 pgs embryos and a hysteroscopy showed ashermans. My clinic kept saying my lining looked fine but it didn’t in retrospect. Also go to a specialist as many gynae say it rare won’t happen and can’t recognise it!
My periods are norma but I had significant scarring

(Just to add I’m doing an era now I’ve had my scarring cleared about to start it and I’m also on lots of immune drugs too)

@Cream123 is a hysteroscopy the same thing as a HyCoSy? I've had one of those to check stuff. I do have a c-section scar that they can see on scans. I've also had lots of kidney surgeries and it's all in a similar area so it's possible that's caused some damage. I had surgery to unblock a tube and for ovarian drilling so they'd (different doctor) probably have seen it then. I'll ask them about it though, thank you.

Good luck with your ERA. I'm glad you have the drugs to help too.

I had a hycosy before I had my 2 ivf cycles as I had had a section and it was missed on that....hence I happily did my 2 cycles.

Only a hysteroscopy can diagnose it. But in some women a hycosy and uss can see it

It’s just with a lining which doesn’t thicken you should at least go to a specialist who can do a special more detailed USS and suggest if you may have it or not. They may say you don’t in which case you have ticked it off your list. But a thin lining is a huge symptom of scarring and no pgs era or immunes is going to work if that’s the case. Hopefully it’s not that but it’s certainly worth looking into . Good luck

Ps ovarian drilling I think is done via a laparoscopy. You need a hysteroscopy (or least a review from an lining specialist to rule this out or to suggest you need one)

Ps I also have a section niche - is this what you have? My consultant also corrected that during my ashermans op to try reduce toxic fluid floating around which the embryo won’t have liked . Jury is out in if this should be done or not but as I was going under he did a small procedure to try improve it

@Cream123 oh wow. Thank you for all of this. Yes my drilling and tube clearing was done via laparoscopy. I don't know if it's a section niche or not. They did once mention fluid gathered there though so possibly. I don't know how I'd find someone to do a hysteroscopy but I can try and find out. Thank you

@seven201 where are u based I can suggest some People then. U could at least have a consult and see if they think u need the hysteroscope.

Yes sounds like a niche - some
People think it might cause infertility others don’t. I actually was blaming that for my failed cycles (as before that I would get preg walking into a clinic quite literally but miscarry). But turned out my entire uterus was full of scars! It’s more usual for women to have a thin lining with scarring but for some reason mine isn’t which is what put me off looking into it

@Cream123 oh thank you, that would be great if you did know anywhere. I'm in north Kent so not far from london.

It's all such a frustrating mystery isn't it! I'm
glad your scaring has been cleared up and you have the immune drugs too.

So you can see mr trew or mr lower (this is who I see). I hope I’m Leading you Up the wrong path but a consult and scan with mr lower will be enough for him to suggest a hysteroscopy or not. Hopefully he will think it’s not needed.
What is ur lining thickness on fEt?
It’s not 100 percent clear yet he’s going to see me again to check how things are looking during Era.

@Cream123 thank you so much! Which hospital or clinic are they based in? I'm glad he's being so thorough with you.

It usually gets to 6 something. I had a cycle cancelled because it wouldn't get beyond 4.5 one month. On my first egg collection round I think it might have got to 8, I also did acupuncture then.

Thanks x

Ah ok so that’s reassuring you get to 8 on a fresh. It’s prob ok...maybe you don’t respond to oral oestrogen. Some women need a mini stim cycle to build their lining up.
I’m with care Manchester but just see mr lower for my scarring and also mr Gorgy for my immunes. I did pgs with care to have my son and it worked first time after 6mc but who knows if it was that!

Thank you very much. I think it might have been 7.5 actually but still not awful. I had estrogen in patches, oral and vaginally last time. Along with the aspirin, viagra and neupogen infusion - all to help with thickening and it got to just over 7 that time. So many drugs! I had a natural FET last year and I don't think there was a huge difference so it's hard to know if all the drugs are making a difference or not.

Ohhh it’s not that thin! U can’t prob ignore everything I said!!! I hope it works for u soon x

I Eman’s hopefully u can ignore eveything I said!

Oh ! I'll ask my ivf consultant when I have an appt in a couple of weeks if she thinks I should get it looked at further. I think it prob averages mid 6's, sometimes as low as 4.5 but with a lot of work and/or luck can get to just over 7. I really do appreciate your help.

Sorry I totally derailed what ur thread was asking! I’ll report back after my era which will start next week

@Cream123 how is you ERA going? I hope it's going well for you.

Hi seven201. I’m just on day 7 - having a scan on wed then will plan the actual era. All takes so long!
What did you decide to do....