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!

Oh no @Gardenlady543 I’m so sorry. I find the nurses at care much more forthcoming (I know it’s a diff care) are they open can u ring them now? Tell them u have to know if they can just read out the results. The nurse manager read me mine out and was willing to tell me what tx I needed so I could get it sorted in time

All these things make the journey so much more stressful!

@Cream123 they’re shut for the weekend now and the secretary said they are encrypted in the specialist’s email inbox so nobody else has access to them, the company email the consultant the results directly.

I’m so upset, I feel so on edge, months of investigations, the stress of the HSG yesterday and now I have to wait all weekend before I can even speak to anyone about this, with every possible scenario going through my mind. I’ve just has enough, I’m sick of the uncertainty and being constantly prodded and poked and feeling endless worry and stress.

Who on earth would anyone think it’s a good idea to call a patient before the weekend and do this?! Ok fine they want to tell me in an appointment well they may as well have called me to book in an appointment first thing on Monday.

They don’t think. She just thinks ohhh I’ll let her know they back. They don’t realise how much emotional torture that carries! Just no idea that all weekend ur going to be going stir crazy wondering

But I promise u tmrw u will feel less on edge. And make it ur mission on Monday to get ur results. (I was told they went to consultant too but he wasn’t in that day but then nurse managed to get them not sure if she asked my consultant for them but she could tell I was going made for them!!!)

All of this. Waiting. Tests. Appts. More waiting. Bad news. No news. It’s all crap. Have lots of dark chocs and a good cry.

@Gardenlady543 oh gosh I completely understand your upset and anger. I'm sorry. I find the lack of urgency probably the hardest part of ivf. It's always "let's wait and see" or "maybe next month, possibly the one after" that just leaves you clinging on all the time. I hope you get some answers on Monday. X

Thanks @seven201 and @Cream123 I’m really glad I found you both on here, our little complicated fertility gang!

So my begging text message worked and the consultant spoke with me, she said it’s better that we discuss the treatment property and I said that’s fine, I just want to know the results to remove the uncertainty.

She said I’m pre-receptive but she can’t remember the exact number of hours I need to be on progesterone. She also said I have 0 lactobacillius (good bacteria) and I have 2 types of dysbiotic bacteria- gardonella and the other one she can’t remember. So I’ll need antibiotics and probiotics.

So the plan now is to speak on Thursday and organise exactly what I need to take, so I won’t be going straight into the FET which is fine.

Oh wow! I'm so glad you got to speak to her. That's really good they've found some little fixable problems! Try and enjoy your weekend. Not super long until the Thursday appointment. It will be great to start the actual treatment so you feel like you're doing something.

I really like our little era club too!

@Gardenlady543 perfect! So glad u know

So I also had an abnormal bacteria a diff one but I had 70 percent lactobillus so I had 7 days of antibiotics and I’m now doing my 10 days of probiotics while I cycle (which is meant to replenish any lactobillus that I lost) which is due to finish in a few days.
And I was also prerecptive (139 hours)

Great u got an answer! And not a “not enough sample”.

Enjoy ur weekend. U will be armed with a plan soon!

Thanks @Cream123 my friend has sent me her report and she had 50% lactobacillus, my specialists said I have 0 lactobacillus, she didn’t have the report in front of her so wasn’t reading it, so I don’t know if it’s actually 0, but if it is that sounds insane.

Yes zero is crazy and maybe why u have never implanted?! I’ve been on symprove last few months so wonder if that helped my levels....
didn’t have any choc! Mainly coz I’m feeling mega sick today !

@Gardenlady543 did ur friend with the 50 percent have to treat it? Did she get restested or then go into FET.

@Cream123 she is repeating, she has a DOS and has been through months of embryo banking so it seems sensible in her case to check. And if mine really is 0% lactobacillius then it would seem sensible to repeat in my case, I might need more than 1 course if treatment I guess. Did your specialist give you a list like this attached one? My friend sent me it:

I won’t know what mine says until I get the report, hopefully on Monday and then discuss treatment on Thursday. I’m just a bit worried because I has antibiotics on Thursday for the HSG which would have washed everything about. So I’ve ordered some probiotics to take in the meantime:

I’ve ordered these oral ones: www.amazon.co.uk/dp/B0140MJAXG/ref=cm_sw_r_wa_api_glt_fabc_PMFA7A461CJ5XQAAVTBN?tag=mumsnetforu03-21

And these vaginal ones:
www.amazon.co.uk/dp/B01APPUIJC/ref=cm_sw_r_cp_api_glt_fabc_8Z4R8VMBCHKN88WM7498?tag=mumsnetforu03-21

It should tide me over until I get a treatment plan in place. It’s likely I’m going to then stay on probiotics forever more, I don’t want to end up in this situation again.

Yes that’s the list which comes with the ERA report. So I did the metronidazole and now I’m just doing canesflor which was easy to get. And I’m coming to the end of symprove.
I think ideally it’s good to check but I hope that’s not a mistake! But would be strange if the antibiotic didn’t get rid of the pathogen.....my consultant wasn’t bothered about rechecking and coz of my ashermans I was worried about the era causing repeat scarring (this risk is nearly zero but I have had a lot of bizzare low risk stuff happen to me on this journey so I would prob end up the one who got it!). Be interesting to know how many peoples second Emma comes back clear and how many need retreating. I don’t think the evidence on microbiome stuff is amazing it’s still in its infancy so they are prob trying to do the best they can....certainly the Emma form says that things can alter ur microbiome day to day - showering bathing swimming sex etc. It’s quite a dynamic existence so my worry is that things may be totally diff at transfer time!

Anyways think I’m just getting anxious as I hear up to first scan etc. Potentially in 2 weeks I could be pupo if things go to plan :/

@Cream123

That seems sensible, I can update with my repeat EMMA, if that comes back fine then I’m sure you’re would have been fine too.

I think the difficulty with the research is establishing the various types of each bacteria in each participant and then separating them into groups.

This study doi.org/10.1016/j.ajog.2016.09.075 separated women with more than 90% lactobacillus vs those with less than 90% lactobacillus, the outcomes were statistically significant:
Implantation 60.7% vs 23.1%
Pregnancy 70.6% vs 33.3%
Ongoing pregnancy 58.8% vs 13.3%
Live birth 58.8% vs 6.7%

Those differences are huge and if mine is at 0, then no wonder I’ve had no luck. I’m so glad I got this test.

Gosh that’s crazy results. Though the numbers in each group r so small it’s still very clear of the difference. Might get some oral probiotics to keep me topped up once this symprove ends it’s good stuff and gets to where it needs to but it’s so exp and tastes utterly disgusting!

Gosh I have no clue about probiotics! I might take some while I'm waiting for my results. Do you recommend any in particular? Preferably a tablet/capsule.

Following this thread with interest. Thanks for all the info all and glad you are starting to gain some answers from the tests.

@seven201 don’t start before the biopsy it could mess with the result, there’s a list that I attached to one of the previous posts, if you have less than 90% lactobacillus they will advise antibiotics and then vaginal probiotics. I can’t start until my specialist speaks with me this Thursday and I’m worried about waiting so I’ve bought some oral and vaginal ones to take in the meantime. Just in case the one time we had sex in this natural cycle has resulted in an embryo floating around.

Hi @GreyGoose1980 I can see from your post that you’ve had 8 transfers, have you been tested for recurrent implantation failure? If so what tests have you had?

@Gardenlady543

I’ve just had an ERA the other day and a MLI test. My clinic don’t do EMMA and ALICE. It took a while for them to suggest implantation tests as we originally had clear MF issues and I started ivf in my late 30s so they thought it may also be egg quality (although we had a good number of high grade blastocysts) but it’s still the failing to implant with DE.

@GreyGoose1980 oh I remember you saying now, that's so annoying. I pushed for it and in my case it has come back looking awful, my specialist said I have 0% good bacteria. Someone else mentioned to me that they've had a vaginal swab, you can order these online for about £200 smartnutrition.co.uk/health-tests/female-health-tests/vaginosis-profile/

It's not going to tell you exactly what's happening in the uterus, but hopefully it might flag out if there is something badly wrong.

Have you had blood tests to see if you're prone to clot and to look for autoantibodies? That might be something to consider?

@GreyGoose1980 what's the MLI test?

Thanks @Gardenlady543 I’ll look into the swab.

I had a test done which was fine and was also prescribed Clexane as a precaution for my last failed OE transfers.

I think the MLI test is for the antibodies / killer cells but I realise I didn’t ask enough info on that so will go through it in my follow ups consultation.

My original consultant was a bit slow to recommend testing other than the saline sonogram and empirically prescribed steroids and clexane when my first few transfers didn’t work.

Sounds like it was unnecessarily frustrating for you to get your EMMA ,ALICE results, sorry to hear that. Do you have your ERA result back?

@GreyGoose1980 yeah the ERA said prereceptive, I think everything is going to be repeated after a natural cycle with the course of antibiotics and probiotics.

It sounds like you've had most of the tests I've had then, I've had:

• PGT-A
• autoantibodies and thrombophilia screen
• ERA/EMMA/ALICE
• HSG (saline scan should be equivalent)

@Gardenlady543
Yes, sorry my first second paragraph should have said ‘I’ve had a thrombophilia test done’.

What does a ‘perceptive’ result mean?

Good to hear you have a plan. I think I really need to hear some more answers now!

@GreyGoose1980 in the ERA they look at the genes that are activated, in my case it wasn't consistent with my endometrium being receptive, so I'll have an exact number of hours to be on progesterone which is longer than the standard 120 hours.

I really hope you get answers too!

Thanks @Gardenlady543