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!

@Gardenlady543 thank you. I had the biopsy last week so I just wanted to take some on the shelf type normal ones whilst I wait for the results and try naturally. I can pop into a health food shop and ask for advice though. Just didn't want to pick something rubbish on Amazon.

@seven201 of course you did! My memory is shockingly bad at the moment :(

I got these attached ones

Canesflor is on the list of recommended vaginal ones. This is the easier vaginal one to source in the UK.

Femdophilus is an oral one, people with recurrent bacterial vaginosis seem to swear by it and it's been in a number of clinical trials.

@Gardenlady543 oh you super star! Thank you x

@seven201 if I were you I would probably stick to a low dose of the oral one, I don't think it will do any harm. You may well find out your bacteria levels are perfect when you get the results back.

I used to have permanent (would instantly come back after any treatment) but not awful thrush, but somehow having my daughter helped that massively. I'll get the capsules I think. Thank you

@seven201 ah maybe it will pick someone up then, I've been looking at the medical literature and I think people are quite lucky if they have an excellent environment with more than 90% lactobacillus.

I don't understand my situation, I have so much fermented food! I have my own water kefir and make my own fermented vegan cheese, I even have a book on fermented food and went on a course called go fermental!! But I've seen that the coil can introduce dysbiotic bacteria, so maybe that did it.

There is this article:
www.ncbi.nlm.nih.gov/pmc/articles/PMC6332758/?report=reader#!po=29.8387
While it didn't find any significant differences in outcomes (it was small numbers and they had issues deciding who should go in the good and bad bacteria groups), all 9 of the patients that has less than 90% lactobacillus, did get to more than 90% of lactobacillus with treatment, some did need 2 courses of the treatment to get there, but still this is obviously treatable which is good.

So I now have the report and what my specialist told me was right:
0.00% lactobacillius I can't find any cases in the medical literature of such a low amount of good bacteria, I've seen cases of 1% but never 0%.

It says exactly what antibiotics I should be on so I emailed her secretary and asked for a prescription for both me and my husband, my friends husband was treated when hers came back abnormal because otherwise the female could become recolonized with the bad stuff as well. The secretary said that I'll have to wait until Thursday. I've dropped a copy of the report in at my Gp practice and hoping they'll give me a prescription today, I don't want to wait a day longer to get this sorted!

@Gardenlady543 wow zero??? That’s bizzare. Like u said I think 90 percent is prob like 0.01 population. I think it goes to show how diet etc can’t control any of these things which in a way is good as puts less pressure on us to be “perfect”. I’m sure the local probiotics will will do the job. I’m also wondering where my bug came from I had surgery in May so maybe that upset my microbiome - I had 70 percent lactobillus but this pathogen. Which antibiotics do you need?
I thought same about DH but I only just finished my antibiotics Abs I’m not letting him near me so figure it’s ok

@Gardenlady543 my gp gave me my antibiotics without anything from care except era report and an explanation so fingers crossed

@Cream123 yeah my gp is usually very good, so hopefully they'll sort it out. It's quite annoying that this wasn't actioned when the specialist read the report. If I received a report saying this, I wouldn't have put off prescribing the treatment, but nevermind.

If you aren't having unprotected sex then it should be fine, but might be worth your partner having the same course as you and getting him some probiotics, prior to having unprotected sex, that's what I'm planning.

So my specialist is going to speak to me on Thursday, if I get this course from my gp then I'll finish the antibiotics and probiotics on day 6 of my next cycle, so I think I'm going to push to go straight into the mock cycle. With my results being so bad I might need 2 courses of treatment, so it seems silly to delay things.

@Cream123

Mine is co-amoxiclav for 7 days.

I honestly thing this imbalance is caused by things that have been done to us, rather than anything we do. I have a very high intake of probiotics compared with most of society and eat so healthily. I think this came in with my coil, IVF procedures, surgery etc, all seem to increase the risk.

@Gardenlady543 agree. I had a bloody baloon in my uterus for 3 weeks post ashermans op I’m sure that didn’t help!
When is ur consult with mr trew?

Yes I told DH no sex once my antibiotics were done but might get him to take them - I’m feeling so sick anyways I don’t fancy it! Poor chappy!

I’m finishing my 10 days of probiotics today and will continue with the oral ones (symprove ended yest after 3 months and I can’t stomach it it’s gross(!) so taking the ones u suggested as my reserch led me to them too).

I think if this FET fails I’ll get my Emma repeated as my consultant isn’t really bothered to repeat them as usually it’s clear from his experience. But now I’m worried about it again!

Scan no 1 tmrw....

@Gardenlady543 u can repeat Emma on a normal cycle I think u don’t need the oestrogen etc.

Ps what was ur era result!

@Cream123 I think in most cases one course of treatment resolves the situation, plus your flora is magnificent compared to mine lol. In my situation I need to repeat the biopsy in case I need the treatment twice.

My ERA is prereceptive 145+/-3, (89% of women reached receptivity with 1 more day of progesterone) so no need to repeat. However given my flora is ridiculous I think I will push to have it repeated at the same time as the repeat EMMA. There seems to be some evidence that receptivity can be affected by the microflora. Also in the USA a lot of people will repeat to get the converted receptive result.

Yes makes sense esp if ur doing the biopsy u may as well check at 145 that u r receptive
But beware I’ve seen many cases of that not being the case and it keeps changing every time u biopsy! Someone had it done 5 times!!

@Cream123 I've just looked up the symprove, I've not heard of it before, who recommended it? I think the oral one I found looks like a good one, I will prob continue with the vaginal one every so often as a maintenance type thing.

I've got an appointment with Mr Trew on 25th, it would be good for me to run the results past him so I emailed the report over, my specialist has never done an EMMA ALICE before. I expect he'll be happy with the plan to treat this and try another FET with the PGT-A embryo and then revisit the hysteroscopy if things don't work out. But I'll have to see, I don't have any of the chronic endometritis bacteria but would like to check that the various dysbiotic bacteria I have couldn't have caused Ashermans.

You know I've been thinking so much about this situation, given that it's rare to be prescribed antibiotics these days (I haven't had any since before I even had the coil put in), this bad bacteria flourished without anything stopping it in its tracks. And people might say, well people managed to get pregnant fine before antibiotics existed, but I expect there were a lot less invasive procedures involving the uterus back then! I didn't have any antibiotics when the coil went in or out, maybe people should have antibiotics cover when a medical device goes into the uterus given it stays up there for 5 years.

@Cream123 omg 5 times! I mean if I have it done and it says I'm post receptive then at least I can take the average of both results and go somewhere in the middle!

I did my research and found symprove was the only one really which has evidence that it’s bacteria make it to the gut and survive. A lot of the other ones just get broken down and die....I also think Mel b the fertility dietician recommends it for ivf patients not sure if her website has some info on it but I saw it on a thread on Facebook . I was already on it but I felt reassured she suggested it as she’s very up with up to date research (as much as u can be with diet and that sort of stuff anyways).

But like I said I couldn’t hack it anymore (started in jan) and now onto capsules (same ones as u).

Yes I’m a bit worried transferring at a random time mine is 139. But everything in this fertility game is random bizzare and pot luck so I had better just go with it and hope it’s right!

@Cream123 ah that's interesting, I might look into it in the future, I can see it's a drink and if you say it doesn't taste nice then I believe you!

The alternative one seems to have some good evidence behind it, hopefully after the antibiotics and probiotics, it will become a case of maintenance rather than battling with all the dysbiotic bacteria that's already there.

@Gardenlady543 I'm glad you've got your results properly now. I am so shocked about your 0! That's crazy, especially with your very healthy diet. I hope the doctor can shed some light on that on Thursday.

I had kidney surgery when my dd was one and had lots of infections and antibiotics due to the stent. Sometimes I think that's what caused my issues. Then other times I blame by c-section. It's so frustrating just not knowing what the actual problem is.

It's just not something you'd consider when getting the coil. It just seems a responsible thing to do. You can't win.

@seven201 I was shocked too, although I do have 10% Bifidobacterium and I've seen that it can be considered a fairly good form of bacteria, so I guess it's not completely horrendous.

I don't think my specialist will shed any light on Thursday unfortunately as this test is very new for her, she even said "you know more than me about it" when we spoke on Friday, I said "I have literally read every research paper!" I do have the appointment with Mr Trew in a couple of weeks, he might be more familiar with this microbe stuff.

Oh it sounds like you've had a lot of things that could have messed with the flora, I hope your result gives you some answers. I'm flipping between- this is the answer, now I'm cured! And- ok well what if I treat this and there's some other reason I can't get pregnant.

In good news I've managed to get the antibiotics from my gp and had my first 2 doses and was able to start probiotics yesterday. I don't know if I'm imagining things but I feel better down there, not that I realised I was feeling bad in the first place, but given the bacteria levels I may well have had undiagnosed bacterial vaginosis.

@Gardenlady543 in ur reading did oral probiotics manage to improve vaginal lactobillus levels. I’ve now finished my 10 day course of vaginal canesflor I would continue but I’m prob about to start my vaginal oestrogen tonight and don’t want them to affect the absorption of the vaginal oestrogen (though it shouldn’t am I over thinking it). Maybe I could do a few days more canesflor in the am and vaginal oestrogen at night? What does the thread think!
I’m still taking oral and doing 2 of those tablets we have so wondering if that will do to keep levels topped up?

@Cream123

So this paper looks specifically at that oral one I found,

doi.org/10.1139/W08-102

It's fairly small, they separate 64 women with bacterial vaginosis into 2 groups, both get 1 dose of antibiotic and then either placebo or the oral probiotic.

You can see from the attached image that most of the people in the probiotic group ended up with normal flora, and most ended up with their bacterial vaginosis resolving. They didn't analyze the microflora like an EMMA does.

I would say that you should be reassured about your flora as:

• you have had the course of treatment recommended- antibiotics for a week and vaginal probiotics for 10 days, there is no need to continue with the vaginal probiotics regularly.
• your flora wasn't that bad to begin with

If I were you I'd take one of the oral ones once a day moving forward. I think I might put in a vaginal one in once every 2 weeks x 4 and then drop down to once a month. Because clearly I was prone to get awful microflora and I want to keep on top of it moving forward.

So confusion! I went for my day 10 scan today and my lining was already 10mm?!

Last era it was 6 and so I needed to add in the vaginal till it got to 10 on day 14. I’ve done eveything else the same so not sure how it’s gotten thick so quick! Anyways now my dilemma is do I add in vaginal oestrogen just to mimic the era cycle as I’m worried local oestrogen in area may change WIO but then will that overshoot my lining to past 12mm when the finings are not valid?

I’m wondering if I just add one dose on Thursday night and pray it doesn’t go over . I think my last scan will be Friday with my ashermans consultant and if he says I’m ok to transfer I’ll get a date .

My holiday is totally screwing with things as I got told today they don’t do sat transfers??? So got to discuss with dh about coming back early which he already said Wasnt his idea of fun and would rather not go than for such a short time!!! But it’s not cancellable

Agh!

@Gardenlady543 missed ur comment
Thanks for the graph and link. That’s reassuring fingers crossed. Might get it repeated if this cycle fails...which most likely will! My lining looked very odd today wonder wot lower will say