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!

Ah @seven201 so sorry I forgot about ur sister. I really hope she’s ok did she get her diagnosis ?

I don’t feel excited - I just can’t imagine ever managing to get pregnancy again! And then don’t even talk to me about maintaining a pregnancy!

@Cream123 thanks. She's sort of ok. Looks like mastectomy and chemo.

I know what you mean. I don't think I'll ever get pregnant either! Will be a shock if does ever happen.

@seven201 I’m so sorry. Hope she’s as ok can be and u r too x

@seven201 oh dear, bless your sister, what a nightmare for her to have this going on.

My period was basically 2 days of spotting after the ERA, I think my specialist had removed most of the tissue that was there in her 3 attempts.

Also I didn't even realize femodophilius had different amounts of bacteria, I'm just using it as a top up, so hopefully either one should be ok.

@seven201 my period was light too. Gosh they should tell people about that. Coz of not ashermans history I totally freaked out!! Seems like all 3 of us has lighter periods

Hope ur appt was constructive @Gardenlady543

I'm glad it's not just me with the light period!

The fem dophilus comes in 1 billion and 5 billion versions. Amazon is confusing as the photo shows a label with 5 billion but it's actually the 1 billion version! I think I'll just stick with the one I've got for now as I can't even find the 5 billion one. Apparently it's a different colour box .

Have you had the appt @Gardenlady543 ?

@seven201 so I've just had a read of the questions and reviews and seen the 1 billion vs 5 billion thing. It looks as if the 5 billion need to be refrigerated though, I would be worried about how Amazon have stored them and I'm sure they won't arrive in a cold pack. They once sent me frozen lasagnes without any cold packaging and the packets had all bloated out as they had gone off while in transit!

I have had the appointment, so my specialist is happy for me to go straight into a cycle in a weeks time which is good. She said the EMMA company advise a repeat and that they wouldn't charge for that but it would still likely cost around £1000 as I'll have to pay Care for the scans and biopsy etc. she's happy to do the ERA during the repeat. She said I could also go straight into a transfer cycle if I didn't want to repeat and that as I have 5 embryos, giving it a go is an option.

I was so convinced I'd be doing a repeat that I haven't even considered not repeating. It would be nice to do a transfer, it's been so long since my last one! And the fact I could end up pregnant next month rather than waiting until August/September is very appealing.

Worryingly she told me more about the first biopsy, she said that usually the endometrium looks grey when on estradiol and when a person starts progesterone it goes white. She said it looked strange- a mixture of white and grey or "not white" as she said. I'm hoping this is all due to the microflora and there isn't something else going on.

@Gardenlady543 do u mean when she did the biopsy? Or on scan. How bizzare. Def ask mr trew about that

I know what you mean about wanting to just get on with it. My last transfer was feb last year! Covid closed eveything down. Then I did a fresh in October hoping to cycle st after but I went to mr lower thinking my niche was stopping me conceiving and ashermans was found so that’s delayed eveything to now...so does she mean u could start ur fet in a few weeks?

What r u going to do? Mr trew May suggest u need a procedure or do u think that’s unlikely?

@Gardenlady543 oh well done for the appointment. Agh, I don't know what you should do either. It's good you can ask mr trew about these things too I guess. It's annoying when you come out of an appt with new queries and concerns.

Thank you for the 1 billion / 5 billion thing! I too wouldn't trust their transit and storage. Oh dear about the lasagnes!!

I've been vaccinated! Was Pfizer.

@Cream123 her comment about the lack of whiteness in the endometrium was something she noticed on the day of the ERA, I think that whole procedure was weird as there was no tissue there.

I could start with my period which starts on 22nd May.

I didn't even realise she would suggest this, I guess my specialist wants to move things along too, I have had pretty much every test I could have had since my last biopsy. I'm am now inclined to do the transfer, ok we may lose an embryo but otherwise nothing else has been lost, if I really wanted to do the repeat after I could.

@seven201 yay on the vaccine, I was a bit unwell for the first few days after it but it settles and the second dose was fine. And I feel better having had it.

In other news a smear invitation came in the post, so now I need to schedule that in too. I'm thinking of trying to arrange it in the first few days on my FET. I know they say it shouldn't make that much difference if done in early pregnancy, but don't really want to do it in the second half of the cycle I'm in at the moment.

@Gardenlady543 I know my care consultant doesn’t retest so maybe it’s what care tend to suggest. I know mr lower does repeat it if it suggests so. I obviously haven’t repeated mine....
Maybe have a chat with mr trew re the hysteroscopy and then decide? U have 5 great blasts so yes it’s true u could just try this one and if it didn’t work (fingers crossed that won’t happen) revisit repeating Emma and also doing a hysteroscopy (plus minus lap for silent endo)?

@Cream123 the earliest Mr Trew can get me in with my schedule is 3 days after I need to start the cycle unfortunately.

I did ask my specialist about the receptiva test for endo if the biopsy is repeated, she said to deal with one thing at a time lol.

I think I'm swaying to just get on with a transfer.

I called Access Fertility by the way and asked about the 6 month break in the contract and the man I spoke to said that's about the multi cycle refund packages and not feel under any stress to rush.

@Gardenlady543 have u managed to decide what to do? U could see if mr trew has a cancellation - I’m a regular at doing that lowers! . Often works!

@seven201 hope ur sister is ok...

@Cream123 I'm trying to see if Mr Trew can see me this Wednesday the clinic initially said he was fully booked and then there had been a cancellation and now I'm waiting to see if they reply to say I can have that slot.

I emailed my clinic and said I want to go for the transfer, I think I would rather just go ahead. If it doesn't work then I can reassess after that.

Also when I asked my specialist what caused such awful microflora she said she asked the lab manager and they replied douching?! I was like "I don't do that!!"

Douching! I'm sorry but that accusation has made me laugh. So they asked the lab who tested the sample or the lab at your clinic? So rubbish that no one seems to know!

I think a transfer sounds a good plan.

@Gardenlady543 lower said it’s my niche which caused my microbiome as bugs just collect sit there and multiply! He said it probably explains why my lining is better looking but doesn’t think it changes the thickness (I asked for u).

So good news is lining is better looking but it’s still patchy. He said to go ahead. Not feeling very hopeful! Had my wash too. Now waiting for a transfer date

@seven201 I know! Who even does that?! She called up Igenomix and spoke to the lab manager about the results.

@Cream123 thanks for asking I wonder what's going on with my patchy and thin lining then, I hope it was because of thre microbe. I guess I'll have to see how this cycle goes.

My friend ran 0% lactobacillus past Mr Gudi today, he said he had seen in twice and both patients had a normal flora after one course of treatment. So that sounds like good news.

I've told my clinic I want to do the transfer next and I've managed to move my appointment with Mr Trew to this Wednesday so I can run it by him too.

In other news I has a "bird" stuck in my chimney today, I tried to coax it down and then heard an almighty thud, turns out it was a large squirrel!! Anyway after a bit of an adventure I managed to get it out the house, although it did climb a book shelf and get soot everywhere in the process.

@Gardenlady543 my god!!!! I would have freaked out !!! Well done for saving it.

Ok great re the 0 percent and great trew can chat to u before. When do u think u will start oestrogen then?

Transfer next sat

@Cream123 you've got the transfer booked for a week tomo? How exciting!

I'm expecting my period on the same day, my clinic start the estradiol on day 1 so I'll be starting then, it will be good to feel nauseated and potentially get a result out of it!

Omg I was on the phone to my husband when it suddenly dropped from the flue into the stove, how it managed to fit is beyond me, it's such a small space and I was like "what is that?! it's huge omg it's a rat, ahhh, no wait it's ok it's a squirrel!" We have a lot of local squirrels that we feed so it wasn't too scary although we don't want them in the house. I had called my chimney sweep for advice and when I called him back and told him the outcome he offered me a job!!

@Gardenlady543 yes next sat! My lining isn’t filling me with much hope and as usual mr lower little words were not reassuring.
I’ve had my GCSF wash too
Now progesterone starts on Sunday at 7pm.

Ok great u got in with trew earlier see wot he has to say...

@Gardenlady543 ur appt today? Hope it goes well.
Just patiently waiting for my transfer now!

Hi @Cream123

Thanks for asking, it was all very positive, he said the HSG had absolutely no issues whatsoever, which he said is rare as usually the radiologists like to find something, so there is no need for a hysteroscopy.

He said he has never seen 0% lactobacillus before and he’s shocked as I’m a vegan and eat a healthy diet. And said after my antibiotic + probiotic course to keep taking oral probiotics daily and take a vaginal one every 2 weeks, one after the period and one 2 weeks later. I mentioned the coil as a potential cause and he said that could have been the case. He said there is no need to repeat the EMMA and I'm fine to go straight into my FET.

He said there is no need to explore endometriosis as a cause of the lack of success as endometriosis doesn't cause lining issues.

I asked if the microflora issue could have caused my lining issues and he said he doesn’t know, as people with thin lining don’t tend to have biopsies.

He is optimistic and said that with the new ERA timing and the euploid embryo the chance of success should be around 68-72% in my next FET.

I said I was a bit upset as I’d hoped that the one time we DTD at peak fertility this month has resulted in a BFN. He said even in a very fertile person the chance of success in 1 cycle is low, so not to worry.

He said there’s no other tests I can do now, I asked what if I have no success, he said after 4 euploid transfers people start adding in things like steroids and clexane, but there’s no evidence for this stuff. I’m going to be on clexane this cycle anyway.

I think the thing that’s worrying me now is whether I will still have lining issues. It is good that both him and my specialist don’t feel the test needs to be repeated though and say that I can go straight into the FET.

How are you feeling about the transfer, not long to go now! Enjoy your last few days of the cycle, I know I'll be obsessively symptom spotting and testing after the transfer!

How are you @seven201, how long has it been since your biopsy now? you must be anticipating the results!

Great sounds like a great follow up! And perfect u don’t need the hysteroscopy!

I had suggested silent endo as it can cause implantation failure but often you see it with poor egg quality which you clearly don’t have...

Yes re steroids - I ended up doing them for my son as I had exhausted all the other options . I still wish I knew wot worked the pgs or the immunes! As he was my first pgs embryo but also on full immunes. It was only 27 when I started ttc so it’s like I was old that all my mc were anormal. Making me slightly worried as this cycle I’m not doing all the immunes party due to covid and also I have a proper reason to have had 2 fail to implant ashermans being the main and then the niche and era timing. My lining is still not great and I’m sure I need another op so if this one fails hoping I can do another hysterocopy in June?

When will u start oestrogen then? Sorry for the bfn this month and fingers crossed ur fet is the one :)

@Gardenlady543 sorry about the bfn. Sometimes you can't help but get your hopes up! The appointment sounds very successful overall. I bet it will take a while for it all to sink in.

@Cream123 not long for you now! Sorry about your lining, that sucks. Hopefully this FET will work for you so it won't be an issue!

I had a missed a call from my clinic this afternoon and typically when I called back there were no nurses available and one was going to call me back today or tomorrow. It's been a bit over 2 weeks since my biopsy so I assume they have the era part of the results. Wish I knew!

Ohhh @seven201 let us know tmrw fingers crossed :)