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!

Hcg gone up. Another one Thursday.
@Gardenlady543 any news about ur oestrogen!

@Cream123 Oh yay! What level is it today?

So I went in late this morning, I'm waiting for a call so will update when I get it.

I had a different technician today, she said she is more stingy with measurements and told me she thinks my lining is at 7.5mm! That's quite a difference since I was told it was 8.2mm yesterday. Anyway she said the fluid collection is outside my ovary and they are quiet. So no sign of a developing follicle which is good.

They took my bloods again so I'm waiting for an update. I wouldn't be surprised if they mixed up my sample somehow because 8000 is ridiculous. Anyway I'll have to wait to see what they say.

Yes update us coz 8000 is ridicolous?!

It’s 437 x am stil petrified of this Bloody bell I’ve had. Bleeding never ends well with me. Time will Tell x

Ps lining measurements r different from diff people
I’ve had good 1-2mm differences before so don’t worry but rude of her!!! Are u increasing ur dose or u staying as is,

@Cream123 wow that's a fantastic level! I think you said you wanted over 300.

So I've just had the call, it's now at 7000! Today's doctor was concerned enough to call my doctor to discuss it and I'm back in on Thursday morning for another blood test and scan. They are completely perplexed but happy that it seems to be coming down. Although it remains ridiculously high!

I asked if anyone had talked about cancelling and the nurse that called me said no, so I think that's good. They have no idea why it's so high!

@Cream123 lol they definitely won't be increasing the oestrogen dose, I thought they may even ask me to decrease it!

@Cream123 oh my goodness! You're still in. Such promising news.

@Gardenlady543 how odd!! I hope you get the green light to carry on.

I hope you guys are ok and you're feeling ok with your test tomorrow @Cream123

I am back in for a blood test and scan tomorrow. I am certain my oestrogen has dropped down to normal levels now. I don't feel anxious anymore, it has to be the reason behind why I felt so awful. I felt close to having some kind of panic attack all the time (I've never had a panic attack before), it felt like I wasn't breathing properly, like I was constantly holding my breath and like I was looking over the edge of a high building every second of the day. Anyway I'll know when the result comes back tomorrow, if it's still high despite me feeling back to normal now then I have no explanation!

@Cream123 and @Gardenlady543 good luck for today.

I hope that was the cause of the panic feeling.

Thanks @seven201

So my lining was 8.2mm on Monday, 7.5mm on Tuesday, today the first measurement she got was 7.2mm! She did a few measurements and managed to get 8mm in the end. It's bizarre because I asked if the high oestrogen level could be detrimental and she said no, that it should be helping. She said the quality looked good and she would do a transfer based on how it looks. But my cut off is supposed to be 9mm. I'll have to wait to see what they say this afternoon when they call.

Good luck with the blood test @Cream123

@Gardenlady543 sounds like it's not going to get thicker this cycle. Mine is usually in the 7s and they'll transfer then for me. I don't think I'd ever make it to 9. The quality of it is the most important thing so if it were me I'd be happy with 8. See what they say but don't feel too disappointed.

Well my specialist called me and said my oestrogen is still over 7000, she said none of the doctors have seen this before. She mentioned a concern about some form of oestrogen secreting tissue, which made me worry I've suddenly developed a tumour, although I can't see how that would arise in such a short period given my oestrogen level was fine in my last FET. I've called my oncologist friend who has told me not to worry about that, it's very unlikely.

Anyway my specialist said she wants to cancel the whole cycle, I said I don't want that. A high oestrogen is not going to harm me, it's going to go higher than that in pregnancy. Lots of people don't even have their oestrogen level monitored in a FET. Given I'm a slim person on 12mg of estradiol its probably just too high of a dose.

She said that we could take a progesterone level tomorrow and if it's not raised (indicating that there are some follicles there that we can't see present). Then I could potentially start the progesterone on Saturday for a transfer on Friday. She's happy that my lining is somewhere between 7-8mm and that it looks good.

I'm just so upset, everytime something like this happens she wants to cancel the cycle. I feel I've gone through so much to get here. If this cycle doesn't work then she said we can measure the oestrogen at baseline if it's high then I'll need further investigations. If not then the next FET will probably be with down regulation and a lower dose of estradiol.

@Gardenlady543 gosh I’m so sorry. To put it into context for my sons cycle I was on 14mg (orally and vagunally) and 2 patches every other day. So ridiculously high and my levels max were 1500 I never went over. So i would be surprised if just the oestrogen is doing it??? Do u have any endocrine contacts?

Sorry it’s one hurdle after another and it really is a long and stressful journey. The waiting is actually one of the worst things.

Hugs x

@Cream123 I messaged Mr Trew and he replied to say that oestrogen only goes this high when there is ovarian activity, so it's normal to go this high with stims and it can also go this high with an ovarian cyst. He said if my clinic say there's no cyst then it would be unusual.

I can't find anything on the internet for anyone having had this problem. My LH is normal so it doesn't seem to be anything outside the ovary doing it.

I think my only potential explanations are

• the microflora has changed the way my body handles oestrogen so this dose is far too much, but my specialist says she's worried about the lining if we reduce it.
• the fluid collection around my ovary is actually a cyst that wasn't previously producing oestrogen but is now. Not sure what can be done about this, hopefully it shouldn't affect this cycle.
• there's multiple follicles making oestrogen that haven't been picked up on the scan. The progesterone should help identify if this is the problem.
• there tissue elsewhere in my body producing oestrogen, although it's seems strange that this wasn't there 3 months ago.

I'm just sick of it, I could cry. All I can do now is hope the progesterone is not raised and we can go ahead and that this cycle works. If this cycle doesn't work then I have to repeat the oestrogen level, if it's back to normal then that's good. If it's not then I'm facing a huge amount of tests.

I surprised u haven’t cried tbh! It’s so stressful and confusing.

Only u can decide what’s right to do...but just consider if it would be wasting a blast? I don’t know if a cyst can affect outcome or not?? Yes my oestrogen about that only during stims.....

I’m so sorry :(

@Gardenlady543 hi , sorry I’m on this thread but name changed. For my FET protocol I will be on down regulation sniffer and then oestrogen and progesterone. I had a cyst on my baseline ERA scan and got me to take the sniffer for an extra week and it went away and my oestrogen levels went down. I know you don’t want to cancel but maybe this kind of protocol will keep your level low and prevent activity but not affect lining if you do have to go again. I previously had a scan where I had fluid around a follicle and was told it was from having ovulated. Did they rule this out?

@Gardenlady543 I kinda agree with @Cream123 that it could be a waste of a blast if there is a hidden cyst somewhere. Is your uterus and ovaries always easy to see on scans? I know you have plenty of blasts but with what you have you could have siblings without needing to do another egg collection so they’re worth holding on to.

@Cream123 @alwayswithhope

My ovaries are both visible and look fine.
The thing that doesn't make any sense is that I use the CB fertility monitor and my oestrogen behaved normally last cycle. So I don't understand why it's so high now.

My specialist spoke about downregulaion next time which would seem to avoid the issue of follicles developing.

I just don't understand it, I don't know where all this oestrogen is coming from. As far as I'm aware cysts are common and shouldn't affect a pregnancy. There seems to be some evidence that high oestrogen can affect FET outcomes but other studies found no issues. I guess if fresh cycles can work with oestrogen around the level I'm at, then it can't have too much of an impact.

I just don't know how I'll face things if this cycle isn't successful and the oestrogen remains high after I've stopped all the meds.

@Gardenlady543 don’t think too many steps in advance - impossible I know. And of course u will know how to face things - it might be hard complicated and delay things but u will get through it. Look what you have navigated through so far. Us ivf lot are made of strong stuff. Ur just feeling overwhelmed today as ur faced with no plan all these descion ms and choices and u don’t know which way to go...it’s stressful. Especially as no one can give you a straight answer. In a few days u will have formulated a plan and u will be feeling better.

Step one progesterone tmrw is that right?

It’s really shit. Have a cry and I hope ur dh is home for cuddles?

Ps just incase I ever loose u in threads in future not sure if era is valid if u change protocol. Something to talk to ur consultant about x

@Cream123 yep step 1 is progesterone and they'll ring me with the result on Saturday.

Oh I hadn't thought about the ERA I mean technically the result may not be valid with the microflora as it is now. I don't really know what impact the downregulation would have, it looks like that's a fairly good solution for functional cysts if this is what I have.

Gosh so much more to think of, a few days ago I was hoping for a reassuring scan so I could be calm and here I am a few days later with a million more things to worry about.

How was your blood test today? Is it still looking good?

Keep us posted. Hopefully u will work out wtf is going on. Sometimes it’s a really long climb to the top with lots of hurdles things in the way sadness tears exasperated phone calls and more tears. Don’t know why it’s so complicated for some of us!

Yes thank u for asking . We ok for now x

@Gardenlady543 oh you poor thing. I have no clue about any of it so I am completely useless but you have my sympathy. Fingers crossed for tomorrow. The mental rollercoaster of non straightforward ivf is just such a head fuck!

@Cream123 that is excellent news!

Thanks @seven201

Oh and that's amazing news @Cream123 !

I think I need a really long sleep, I've heard from someone in the USA who has had a similar oestrogen level to me, she said her specialist told her it is normal when using oestrogen vaginally and nothing to worry about. Although that doesn't explain why Mr Trew thinks it's very strange.

I think if my progesterone is fine then I just need to stop focusing on this and hope for the best with the transfer. Had the nurse not been concerned about the known fluid area, then I would have been none the wiser anyway!