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!

@ForeverAintEnough12 is this your ERA cycle? If so definitely don’t have sex, they’re going to be doing a procedure on your uterus and removing endometrium. They made me do a pregnancy test on the day.

You will be taking everything the same as your future medicated FETs. In my case that involved estradiol, with scans to check my ovaries were quiet and the lining was building up, they’ll then say when to start progesterone giving you a specific time and 5 days later they’ll do the endometrial biopsy.

@seven201 how have you got on today? Did it go ok? And more importantly did you get some cake?!

Hello ladies, I’ve seen quite a lot of talk about thin lining on this thread, so I thought I’d add in my experience. I also have thin lining due to a coil, but a copper one. According to my doctor, it caused a low grade infection (which went unnoticed because it was low grade) which led to some scarring. I had the scarring removed a few years ago but my lining still was’t growing properly (it is at least smooth now, appearing as a straight line when I have an ultrasound versus a bumpy line before the operation). This could be because the coil actually destroyed some of my lining’s basal layer. Anyway, after much trial and error (estrogen pills, viagra, etc.), I found that the only thing that would thicken my lining are stims, as they get my body to produce more of its own estrogen. So every cycle, I have Gonal F to thicken my lining. I usually get it up to 8mm like this. One thing I found out is that to “cure” thin lining you first need to find what is causing it. Low blood flow = viagra or pentoxyfiline. Body has trouble absorbing estrogen = Gonal F. Insufficient estrogen = estrogen pills or patches. Good luck to all the ladies on here with investigations!

@Gardenlady543 yes I’m hoping I can go ahead with the ERA this cycle - still haven’t gotten my meds however so hoping to get them this evening to start the down regulation spray.

Do you remember overall how long it took from your day 1 until the biopsy was done roughly? I’m just wondering if it’s going to be similar to Stims so over in ten days or if it’s longer?

Thanks for the info and accepted on the sex! Unfortunately we’re heading into this straight from an IVF cycle so it’s been a while 🙈🙈😂

Thanks @Tarsette some great advice there! I’ve been reading about dry Ashermans in the Ashermans online forum. What’s your opinion on PRP? there seem to be some big fans for this in cases like yours, although it doesn’t seem to be available anywhere in the UK. I’m even thinking maybe I should train in in it if it’s likely to help people and they can’t get it elsewhere. Mr Trew said it’s unlikely I have dry Ashermans, I hope not, it doesn’t seem to be an easy fix.

@ForeverAintEnough12 so I’m usually on FET without downregulation, the biopsy normally falls around day 21, with estradiol throughout that time and 5 days of progesterone before the biopsy. I’m not too sure about downregulated FET but assume that you’ll take the downregulation and then have an additional 21 days similar to my cycle once that’s finished.

@ForeverAintEnough12 I’ve done a FET with downreg but I started sniffing on day 21 of period and then started oestrogen once I had my af and a scan on day 3-5 of that period . Not sure how u do it whilst ur on oestrogen - maybe ring and check. Main thing is that you do the same on ur era cycle.
If ur lining behaves u just need one scan day 12-16 can be flexible and then one appt for the biopsy. From starting oestrogen to biopsy mine was 18 days but can be anywhere up to 28 or so if lining not behaving or u can’t make certain dates. Main thing is with a fet there is flexibility and many less scans .

@Gardenlady543 good luck tmrw. Hope it goes ok.

@seven201 hope all went well and what cake did u have

I’m day 4 of oestrogen nothing much going on!

@ForeverAintEnough12 sorry I don't know much about downreg cycles. I had my era today on cd 25. I started on estrogen and viagra on cd 4.

What is this no sex thing? Presumably it just means you need to use a condom? I hope I've not been breaking rules although non ttc is a very rare event here!

@Tarsette thank you so much for that info. Really useful.

@Cream123 I had a brownie! I kind of wish I'd gone to find a posh cake shop instead of the nearest cafe. There's always tomorrow!

Procedure went fine I think, she didn't say it didn't! I just need to wait for the results now. It felt so good to take off the estrogen patches! No more drugs for a good while for me. I felt so happy when I came out of the clinic I bought an ovusense monitor thingy! Just because we'll be trying naturally next month and we've had so many cycles of having sex for every other day until my period arrives as opks don't always show I've ovulated, and basal temping never worked for me. I've decided it's worth it, even if only saves us from one extra sex session we're not in the mood for!

@seven201 condoms should be fine, for the HSG they only book them in the first half of the cycle and say complete abstinence so I think I’m a bit over the top about it. As I’m then merging that advice with the fact they made me do a pregnancy test on the say day of the biopsy. On the off chance that something has implanted before the biopsy then obviously the outcome is going to be pretty bad since part of the endometrium is being removed. But saying that in my case there was no chance of anything implanting as my ovaries were silent on the the meds.

I used an ovusense for a bit, I was getting annoyed with the variations in BBT, I could take three readings in a row and get 3 completely different results. The ovusense takes so many measurements during the night, that you get a much more accurate temperature reading and end up with a much smoother more readable curve!

@Gardenlady543 I'm so glad you found the ovusense useful. I was worried I was wasting money!

That makes sense for the no sex. I think my ovaries were silent but we have loved having a month off sex so no risk of a pregnancy here.

Only 2 more days until your hsg!

@seven201 ah thanks, 2 more sleeps to go until I can have it!

I ummed and ahhed about the ovusense as it seemed so expensive, but now I’ve spent so much on IVF it suddenly doesn’t seem that expensive!!

I’m sticking to the Clear Blue fertility monitor now, it detects the oestrogen rise so you get a few days of warning before the LH surge.

@Tarsette thanks for ur message can I ask is ur lining triple stripe now u have had surgery?

@Gardenlady543 and @seven201 do u know we have spoken before on a thread about my embryos! I was wondering what the 8/10 etc meant from the embryoscope...

@Cream123 they pick the best embryo based on the caremaps embryoscope score which trumps the grading (e.g. 2,2).

Each score out of ten corresponds with the percentage chance of a live birth, 8/10 has a 36% chance of a live birth, that’s a very good embryo, better than the national average.

Yes @Gardenlady543 u kindly explained that to me on a thread in October. I couldn’t find much data on it though. I have a 9/10 and a 8/10 to transfer (pgs normal) my 2 10/10 were abnormal!

@Gardenlady543 even the fancy ovulation sticks don't always work for me. You've got to go with what works for you I think.

@Cream123 ha! No I didn't know that

@Cream123 the 9/10 is 41%, you won’t find any info on it because the embryologists aren’t supposed to tell people what percentage the score corresponds with. The first embryologist involved with my case told me the percentage of 2 of my embryos and when I asked another one for the other scores out of 10 percentages, they said they weren’t supposed to give out that information but told me since I already had some information they would.

These scores are purely based on the embryoscope score, you can add a greater chance of success on for them being PGT-A normal.

I had 3 x 10/10 which are all gone now: one was my unsuccessful FET (not PGT-A tested), one didn’t survive the thaw to biopsy and the last one was my only aneuploid embryo.

I have 5 euploid embryos left: 2 x 9/10, 2 x 8/10 and 1 x 5/10.

@Cream123 I read your message wrong, I thought you were saying we haven’t spoken about embryos, as in lets have a chinwag about our embryos lol!!

No they three of us have already had a chinwag back in October !!! And now chinwagging again

Yes I asked my embryologist about the data and she said they didn’t know. But main thing is they r pgs normal but tbf I don’t think the embryo is my issue. It’s my lining I just have to hope though not great it’s good enough for the embryo.....

@Cream123 yeah I’m in the same position, great looking embryos but I can’t control my endometrium. It sounds like you’re in a much better position now, hopefully I’ll get there too!

@Gardenlady543 if only! My lining still is very poor quality. Mr Lower thinks some of it just can’t be fixed :( it’s always been thick since my son even pre ashermans op but just looks terrible on scans. It’s better to be thinner and god quality (which I know as I was always 6ish but always oregnant before)

Ah @Cream123 that’s annoying, I think all we can do is try to get things as good as we can and then hope for the best. The main thing I try to focus on, is that at least the embryos are good, imagine having issues getting good embryos and implantation issues. Sounds like you have 2 dealt good ones!

2 really good ones!

They r both 2.2 which is average I guess. But I’ve had 12 blasts at care and all 12 have been 2.2! And one was my son so I’m
Not too bothered they r not too pretty!

@Cream123 don’t worry about the grading, it isn’t as important as the embryoscope score, my 5/10 is graded better than a number of my higher embryoscope scoring ones, that will be picked ahead of it. Mr Trew said to me that he’s not interested in grading, he said if it’s good enough to be frozen then it’s good enough. An 8/10 and 9/10 is great!

@Gardenlady543 yes I did look into PRP but I am based in Hong Kong and they don’t do it here. My doctor in general is not really in favour of any of the unproven methods to thicken lining. She really pushed me to try stims (which I was very skeptical about initially) and that worked. So I’m sticking to that for now!

@Cream123 yes the lining is now triple stripe but with no stims only goes up to 5mm. With stims, I can usually (not always, I have had a few cycles cancelled due to thin lining) get it up to 8mm. An interesting point is that last November I weirdly got pregnant naturally (it was a chemical) so I’m starting to revise my focus on my lining. Many women do get pregnant with a very thin lining...

@Gardenlady543 I had asked about PRP on another board if you want I can PM you the info a girl PM’d me who had it done.