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!

@Cream123 thanksthe list would be good if you can send it through. I know I'm not fully out yet as my OTD is Thursday next week but it's not looking good, I will test again in a few days time and call the clinic in the early week to ask to book in the review appointment. I know my case is complex and there's not anything my specialist will be able to add though.

So far I've had

• Autoantibodies- normal
• Thrombophilia screen - on heparin and aspirin
• Embryos are PGT-A tested (4 remaining)
• ERA- prereceptive, but will repeat with new window if I do the EMMA again
• EMMA ALICE, I'll probably repeat the EMMA
• HSG - normal, Mr Trew said there is no point doing a hysteroscopy as they found absolutely nothing wrong during the HSG which is unusual.

It had looked like the issue was lining quality at transfer day but this seems to have improved after treating the microflora, I'll find out if they hid anything from my about it at the review. They like to be positive at transfer day and not mention problems even when you ask.

The estradiol has been high so reducing the estradiol dose down is something to try, but people have successful fresh transfers where estradiol is higher so not sure it will make a difference.

The only other thing I can think of is pentoxifylline and viagra as I have Raynauds and cold hands and feet, they might improve the circulation to the lining.

@Gardenlady543 I’m so sorry for what you’ve been going through. I have been chatting to you before on different threads under another username. It could be no harm to some time off the meds especially with your Oestrogen result. I did my 1st round of IVF in March 2019 and I am still here doing it. I understand the feeling of wanting to keep going and get that BFP ASAP but you’ve had a lot done in this past few months and it could be worth giving your body and mind a break for a few months so have a think on it once you are past OTD. When you are not straightforward it really becomes a marathon not a sprint. I also did another egg collection when down to my last embryo so it is an option. ARGC seem to throw the kitchen sink at their patients so it could be worth considering them? I’m so sorry to hear about your pet too.

@Cream123 I am so sorry about your scan and MC. Glad your DH is great. It makes such a difference when they can support you fully. I think your action plan sounds very sensible.

It’s hard to know what to say ladies. when you’re in that group where IVF isn’t working easily it just crushes you. But we are all still here and still fighting. I am hopeful that there will be positive outcomes. Often there is. It just takes time which is unbearable when your arms are empty.

@Gardenlady543

Lap - silent endo linked very closely with infertility. Have 2 friends riddled with it and had zero idea.

Hysteroscopy - I would still do this. ESP if you do the above just in same procedure.

Quenby - she runs a rif clinic. She is meant to be great really understands linings and is very reserch based. She will do a nk biopsy and advise you on a treatment plan based on those results. She’s also just good to chat to as super knowledgeable.

Shehata - I saw him. He mainly does mc but also implantation failure. Will test for nk (blood) and tnf levels. And give u a combo of pred / asprin/ high dose omega / intralipids / humira and hydroxy.

Gorgy - all singing all dancing. He will do everything. Will test ur nk (biopsy and blood) and tnf . Will suggest neupogen washes as some evidence it can help with implantation. May also suggest the injections during transfer (based on KIR results). Uses a lot of hydroxychloroquine asprin clexane pred and metformin if your insulin resistant which he will check. Ivig if needed. Intralipids. Sperm fragmentation levels as that can lead to eupolid embryos but not implantation or mc.
He does LIT and LAD this is the one thing I didn’t do but I did the rest with him (was a bit too whack for me!). He’s pretty open to u mixing and matching things. He’s got terrible bedside manner. But his approach to fertility is good - he looks at the embryo / the immunes/ the sperm / the cavity . He’s one of the only ones I’ve met you who does it all and believes it’s all of it coming together. I found shehata was too focussed on immunes and put me off Pgs. As did argc.

Argc - I had a cycle here. Was a disaster. Got preg (as usual) and still mc. They are not keen on pgs and I mc an abnormal embryo. But they do immunes like ivig intralipids and steroids. Personally I don’t like them but I had a bad exp.

@alwayswithhope thank you. It’s though. Where r u in tx again?

@Cream123 I am waiting on results of my ERA/EMMA/ALICE then hoping to do a FET in August.

I’ve done 6 rounds of IVF and 2 transfers both failed. I have 4 frozen untested from the 6 rounds (for 3 of them we got no embryos). I tried to do PGS one round but of 3 sent 1 was abnormal and 2 inconclusive so as we get so few we decided to stop testing so we’ve the 2 inconclusive and 2 untested completely to transfer.

I’ve done thrombophelia bloods, NKC bloods ( I need steroids) and this is my repeat ERA as I was pre receptive. Just want to rule out as much as possible in case one of the embryos is normal as they were so hard to come by.

@Cream123 that’s interesting re ARGC. I was considering them as a last white hope if our embryos don’t work.

@alwayswithhope yes ur embryos are so so
Precious. Really glad ur lining eveything up best u can so they have the best environment to snuggle up.
This thread due some postive news soon (which gets past 6.5 weeks!)

@alwayswithhope I wonder if they r better with the older ladies if u r? But they were totally Crap with me! Had my worst cycle there ans had the same outcome as a mc

Thanks for all the info @Cream123 lots for me to think about :) how are you feeling?

Thanks @alwayswithhope :) what was your username before?

@Cream123 I hope you're feeling ok today, I'm feeling quite broken, 9dp5dt and it's another BFN on a FRER. I would have thought it would have shown up by now if it was going to be positive. I'll call my clinic tomorrow to book in the review, but I think my case is too complicated, so it's worth me contacting a specialist.

I'm not sure who to contact, everything I can see points to NK stuff having no evidence base to it, does Quenby do other things too or mostly focus on that? Then there is Gorgy who clearly does everything, but am I just going to end up spending thousands of points on every test/treatment imaginable and get nowhere? Quenby will be easier for me to get to as I'm in the midlands. Who do you think is the best person to assess and advise on someone with recurrent implantation failure?

@Gardenlady543 sorry it's a bfn. Seeing a specialist is probably a good idea. I'm sorry I can't offer any useful advice.

@Cream123 how are you getting on?

I think I have thrush. I did a canesten pessary a couple of days ago but it's not worked. Do you think I could take the tablet one or should I wait until my scan appt tomorrow to ask first. I know you can't take it after transfer but just not sure how close to it you can. I'm not sure when my FET will be, but not earliest would be Friday but more likely the next week.

@seven201 I think you'll need to ask your clinic for advice on this one, you'll have to give them a call first thing tomo and see what they say.

@Gardenlady543 thanks, I will do.

What are you going to do today? Is there something you can do to try and keep your mind occupied a bit?

Hi @seven201 I had a few nice things yesterday. I picked up some colourful cherry shrimp (new pets) and went to a local market which cheered me up a bit. But I mean I'm just as down as I can get right now. I know my clinic can't handle my case anymore, well I am sure they can do the cycles and transfers, but I doubt it will suddenly start working. Luckily I work from home but I have a few work meetings this week, I don't want to talk to my colleagues, I don't want anyone to see me.

@Gardenlady543 I’m sorry :( it’s rubbish.
I don’t know which one you should go to.

Quenby and gorgy both focus on rif but gorgy does a lot more tests some with evidence and some with little evidence but it’s not very easy to do rct for fertility patients so there will never be any evidence.

Quenby is really into the lining. She will look at ur lining and do a biopsy and give u advice and give you sensible advice. U could see her first and then use gorgy for the one after if the next one fails (hope not).

I went to gorgy right at the end out of desperation. I didn’t care for the thousands and the whack stuff I was taking and injecting. It worked. Coincidence I don’t know? It was my first pgs cycle and with all the immunes u could throw at me - ivig hudroxy metformin intralipids neopogen wash and daily injections and Pred. I don’t know wot helped gorgy made me realise that it’s about eveything coming together and if one area is off then it won’t work and his job was to do what he could to push it getting closer to a sustainable pregnancy. So both of us put pgs embryos in and haven’t gotten our baby - so it’s either our lining , immunes, or something identifiable with our embryo. I didn’t cover my immunes as much this time so my next transfer I’m doing them all. As much as I think it’s crazy.

It’s hard to decide. Take some time. I did my transfer with care still but did gorgy stuff on the side. I will pre warn u that gorgy manner isn’t the warmest!

I still wonder if u should get a hysteroscopy just coz of the funny comments u have had about ur lining? Obv mr trew knows better than me!!! But it’s not a 100 percent sensitive and specific it’s prob 95 or something?

@seven201 not sure - sorry you have trush. Ur transfer is soon I really hope u bring us some good news!!

I’m not great. I’m struggling with pregnancy sickness and knowing it’s over makes it like torture got some meds from gp but it’s not really helping. I’m feeling fed up from all the jabbing, appts and my life being about this. But I’m coming to the end of all of this with a happy ending or without. Thank god for that.

Sorry you're feeling unwell today @Cream123 what day is your scan this week?

My friend said her sister enquired with Quenby and she has a long waiting list. I think I'll give her secretary a call and find out how long. She seems the most reasonable for this stuff cost wise and I mean any specialist advice I can get on where to go next would be good.

@Gardenlady543 I’ve been suffering with sickness from me the moment I got my bfp but it’s more Tolerable when u think there’s a baby at the end. But since I knew it was over it just feels hideous. My poor dh feels awful watching me vomit and feel sick all day for no reason - I’ve only managed a diet of chips and crisps for last 10 days! Scan Thursday and have already booked it for ercp with lower on the Monday. So then I can start eating a bit more notmally and feeling more human.

Think quenby is a good idea-she seems lovely supportive and knowledgable and sometimes u just need someone to give u some hope to keep u going. Really hope ur ok xxx

@Cream123 I hope you're ok too, I found ginger root oil ( https://www.amazon.co.uk/dp/B006JK1KUY/ref=cmswwrcppapiglttfabcF3PXFNW6N9KPJHB24H2G??encoding=UTF8&psc=1 ) in a diffuser helpful for nausea. And just to carry around and sniff when out and about. Crisps and chips sound good, dry salty foods are best, so crackers etc are good.

I’ve tried all of that even cyclizine isn’t cutting it. Anyways wil be over in a week…hope u get in to see quenby soon

@seven201 hope ur feeling hopefull for ur transfer. We have had one mc and one bfn. So hopefully urs is the bfp which stays!

@Gardenlady543 I'm glad you have your new shrimp to provide a bit of distraction. Useful to not have to be face to face with colleagues and patients this week too.

@Cream123 it really is most cruel to still have the nausea and no pregnancy. You saying "But I’m coming to the end of all of this with a happy ending or without. Thank god for that." Feels so powerful. To be even contemplating the end without a baby just seems strong to me. I'm still in the phase of not wanting to contemplate it.

@seven201 we’ve decided to prob do my next blast and maybe one more fresh (I’m
On access package) and if we get any normals from that we will transfer one only . So that’s 5 pgs normals which will have failed since having my son and then I think I have to admit defeat (2 we know failed due to the ashermans and then will be 3 prob mc which is what my body seems to like to do) . Certainly when trying for my son I would have kept going and going but I just can’t do it this time. Im hoping that by next feb or so I’ll have managed to do all that and can start moving on. I just can’t see it working - how I managed to get my son I’ve NO idea. Hopefully u won’t need to reach that stage .

Seeing as this tread was about Emma Alice era wondering if after my surgical management of this mc I need another era. They say it’s not valid after uterine surgery but I don’t really want to repeat it.

@Cream123 well done on your plan making.

That's a good point about repeating the era/Emma/Alice. That seems a bit ott to me but I have zero medical expertise! Would be very annoying (emotionally and financially) to have to re-do it.

@Cream123 I hope you're ok today, you could repeat the EMMA to make sure the microflora is ok, also surgery can worse the microflora, so it may be worth considering. But many people don't repeat or even have it at all and seem to do fine.

I have emailed my clinic today to say I want to go straight into a repeat ERA and EMMA. I would rather pay a bit more if I'm having the EMMA and know if I'm receptive on this new dosing. I also mentioned the sperm tests.

I have called Quenby's secretary, she will only see people who have had 2 miscarriages but works closely with Prof Brosens who runs the implantation clinic, so I've booked onto that. I am on the 1 month waiting list, they will email me in a month and tell me a date in the following 1-2 weeks for a virtual consultation. Then I need to monitor ovulation and they will bring me in for a biopsy. I've been told it costs £540 which covers the virtual consultation, 2 biopsies, the results and follow up consultations, I understand this is much cheaper than immune stuff elsewhere.

So I'm hoping that my specialist agrees to me going straight into the repeat EMMA and ERA, and Prof Brosens can see me in the cycle after.

@Gardenlady543 well done on getting so much organised today. That's no small thing! The biopsies sound very sensible to me.

I had a monitoring cycle today. Lining 6.2 but I don't get much higher than that without help so having my first neupogen infusion tomorrow. It means missing half a lesson so I sent an email requesting time off and was asked to move it to after school instead, but I initially read it as if you can't, you can't go! After double checking with the clinic and school again I finally have permission to go. It's all this crap that makes it so stressful (and the failures obviously).