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!

@seven201 thanks, I'm feeling pretty down so I agree it's quite an achievement getting this stuff organized. I feel like it helps to know I'm doing something proactive to try and improve the situation. I called my specialists secretary to try and find out if she can organise things from my email or if she needs to review me and she said she'd get in contact with her, I asked if I should book in an appointment just in case and there aren't any for 3 weeks!

Sorry to hear it's added additional pressure organizing the appointments with work. It's such a nightmare because we have so little warning for investigations and treatment and it's not like we can book whole cycles off work because who knows how long this process will go on for.

That sounds like a good measurement for you and if the neupogen can get it thicker then that's great news!

@seven201 great glad things r going nice and boringly in terms of ur lining. Hope neupogen helps again. It’s so hard juggling it with work infact I find that is the most stressful things esp as I’m 5 hours from London and have to go down for mr lower and mr Gorgy fairly often. Hopefully u will just have one more scan and then transfer soon!!!

@Gardenlady543 hugs x

Thank you ladies. Hoping to transfer later end of next week.

Exciting @seven201 when will u test? How u feeling.l?

Question once I’ve had my surgery on Monday I’m going to start my Oral probiotics again. And treat me and husband with metronidazole again (didn’t do hubby pre fet but also didn’t let him near me!). Then do a 15 day canesflor course. This will take me to end of july. Then do u think 1 tablet a week though august will be bough to keep on top of my microbiome ? Or more frequent? Thinking I’ll cycle in sept next as they won’t let me go st away with august bleed as they usually like it to settle post a mc - hate the delays!

@Cream123 sounds like a plan, you technically just need the 10 day course of canesflor, but I added on an extra day for the days I was on my period (just in case absorption was affected). I think once every 2 weeks should be fine, but I have been doing weekly when having the transvaginal US and IVF procedures, so if you've got tests going on etc then weekly sounds good. And keep up with an oral one daily.

I think by the time I've gone through a repeat ERA/EMMA and been seen by Prof Brosens I'm looking at September at the earliest, probably October for the next transfer. Time really does pass quickly with this stuff.

@Cream123 what's the metronidazole for? I think the idea of once a fortnight and once a week during internal scans sounds a good plan.

It does all take so long. I feel for you both know that it will be that long before it happens again.

I had my first neupogen infusion today. My lining was 6.2 yesterday and 6.4 today. Got my second infusion on Thursday. I asked the doctor when my transfer will be but she said "we'll see on Thursday" so now overthinking and wondering if that means if it's not thicker on Thursday then they'll be a delay or cancellation. I think I am probably worrying over nothing!

@seven201 try not to read too much into that comment, they have to stagger patients and also take weekends into account, so they are probably talking more about the scheduling side of things. My friend is with Mr Gudi and she gets such amazing 1 to 1 care, that man clearly works far too much. But unfortunately for the rest of us it has to be scheduled in around availability. How are you feeling otherwise are you coping on the medications?

I think @Cream123 took the metronidazole after the EMMA result. So instead of going through the biopsy and potentially being told she might need another course of treatment, because she's having surgery, she will just do the treatment as an extra precaution. I think that's sensible.

I've has a bit of a difficult day, still not heard back from the clinic about what's happening. One of my breasts had some localized pain, I had an infected cyst in the same area before, it seemed to have settled down to just generalized tenderness by today but I'd booked into see the GP and I thought probably best to go so she can examine me. She made quite a big deal of 3 lumps in the area and has referred me to the 2 week wait breast clinic, I know GPs do this for literally everyone because there is so little that you can tell from an examination alone. But it's just worrying with the high oestrogen level and that comment my specialist made about "oestrogen producing tissue". Dealing with anything extra along with infertility is so difficult. I'm hoping o can stop meds on Thursday then get my estradiol checked ASAP and hopefully it's gone back to normal so I have one less thing to worry about.

@Gardenlady543 oh gosh. But definitely the right thing to get it checked out. I do think the estrogen causes breast pain as I've been having twinges. I know what you mean about thinking it may be too much to cope with. You are stronger than you think.

My sister is having her mastectomy as I type this (hopefully she's in recovery now, we're waiting for the hospital to call) so it does make you worry but chances are it's nothing sinister.

@seven201 I was going to ask how she is. I hope she heals well from her op

Yes it’s for the Emma as originally it said I needed metro so I thought I may just repeat it pre next FET.

My dh is really struggling today. I was saying maybe I might be ready to stop after the next cycle (my last blast) my heart is shattered from 7mc over the years but I don’t think he’s ready to stop (obv I will have to make the call as it’s physically though for me and he’s lovely and it hurts to see him so upset). Ugh. Some research from the quenby lot for stigagliptin so may ask gorgy if he can give it to me. Might as well alongside my 1000 other drugs!

Continue to feel sick and counting down to Monday when op booked.

@Gardenlady543 sorry about the lumps. Totally agree anything that happens in my life slightly stressful on top of ivf just pushes me over the edge. Least u will have it ruled out ASAP - what did u do about ur oestrogen are u going to see what your baseline is?

@seven201 don’t worry see how Thursday is and keep going with the meds hopefully u can get it thicker she prob just means it might be a few days later to get ur lining closer to 7?

@Cream123 sorry your dh is having a tough time. I know I'm guilty of kind of forgetting about my DH's thoughts on it all and just assuming he'll be on board with whatever I decide. All you can do is keep on talking about it.

Yes it might well be just to give my lining a bit more time. I'd forgotten that starting the progesterone stops it getting thicker, so maybe it does need a bit more time.

@Gardenlady543 which email or number did u use to contact quenby team? Wondering if I should just have a chat with her she’s prob the only one I’ve not talked to over the years….

Hi @Cream123

I'm sorry to hear about your partner, I think it's good that you guys will have a few months to chat about things before the transfer. I guess the only benefit of this process being slow.

I hope you're feeling ok about tomorrow

Prof Quenbys secretary's number has changed, she's now on 02476 967397

Thanks @Gardenlady543 . Fine about tmrw just need it confirming and the op doing. I’ve been in bed today and vomiting and i just need it to be sorted with now.

Quenby can’t see till sept and I had a look and apart from being kind and supportive I don’t think she will add much to what im already doing. Do keep us posted on bronsen clinic though.

@Cream123 I hope today as ok as it can be for you.

I'm booked in for my transfer next Thursday. My lining is now "over 7" so I'm pleased. Starting the progesterone bum injections tomorrow eve. Am visiting a far away friend for the weekend so I'm going to have to get her to do it

@seven201 thanks. It was highly unexpected. All was fine. I’m not getting hopeful as I’ve had eveything be fine only to loose it at 8/9/10 weeks. But my ercp is cancelled for now and they scanning me again next week.

Oh no for the progesterone how embarrassing the things we have to do. So glad ur lining is over 7 and ur so close to transfer :) how many hours were u at ?

@Cream123 oh my goodness!! What a surprise! How many weeks does that make you? You must be feeling all the emotions right now.

I'm not sure how many hours. I think I needed to start progesterone about 24 hours earlier than last time.

I’m 7 plus 3. Yes confused and perplexed and not getting carried away. It just doesn’t seem right there was no hb last week and my bleeding. They r scanning me next week. I had totally resigned myself it was over ans I’ve not taken my Folic acid and some of my Immune meds alll week. Not sure Wots going on. But my son was a bit odd too and his starting hcg was low and docs told me to expect a chemical. So I do know weird things can happen.

@Cream123 wow. Such a rollercoaster. Get back on the folic acid etc and try and take it easy.

@Cream123 oh wow that's great news! I bet you're shocked. I know you are being cautious about it all, but I so hope things keep looking good.

@seven201 that's good news for you with your lining too!

It's my OTD today and unsurprising it's an official negative. My specialist has given me a quick call. She said I need to have a natural cycle break before a ERA EMMA repeat as we need to recheck the estradiol level. Which I mean is what I expected her to say. She didn't seem that into repeating the ERA EMMA, but I mean it seems logical given how bad the microflora was on the first one.

I told her I'm on the waiting list for the implantation failure clinic and that they focus on NK cells and she said that she was going to recommend doing that next! I have to say that shocked me a bit, her thought process was that she knows the evidence is iffy but my situation doesn't make sense. She recommended level 2 implantation failure tests, I've had a look online and that's NK Cells and TH1/TH2, I assume the implantation failure clinic will do them both, but I don't really know.

I kind of expected her to say it's only one transfer since treating the microflora but she seems quite concerned that this one hasn't worked.

She also said she thinks I should have a break from treatment as it's been a lot for my body constantly having cycles and spoke about using the time to do a hysteroscopy, but with Mr Trew saying it wasn't needed, it doesn't seem worth doing at the moment.

She said that we can do COMET on the sperm in the future but thinks we should hold off until there's 1-2 embryos left as it's variable and can change and it's only really going to be relevant at the point where we're about to do another fresh cycle.

She said we need to have a proper consultation to put all the plans in place so I'm booked in on 8th July. She is aware I'm wanting to try the viagra and pentoxifylline in the next transfer cycle. I expect I'm entering a few more months of tests again now, to repeat the ERA EMMA and look at the immune stuff.

@Gardenlady543 sorry about your official test day. I'm so glad your son sultans let you do a mini consultation. She sounds really nice and willing to listen and research to your ideas too.

Have a big glass of wine tonight.

@Gardenlady543 glad u have a solid plan. Sorry it’s your OTD- yes wine and choc needed.

Sounds like a sensible plan and like your moving fwd. the th1/th2 bronsens prob won’t do. He only does the nk in the womb gorgy will do not and th1/th2 in blood. They both have very different views on bloods vs endometrial sample (though actually gorgy will do both).

Thanks guys

Yeah @seven201 I think her main reason for calling was getting my to agree to not going straight into a mock cycle. But she was genuinely concerned to know that I'm ok. She also said that all the doctors at the clinic know about me as a complicated case 

@Cream123 ah that's interesting to know. I think starting with the implantation failure clinic is the best option for me at the moment, it's pretty reasonable cost wise there. It's good to know there are other options out there.

Not sure about the wine, it's rare I drink anyway, maybe twice a year under normal circumstances. DH has arranged a fancy dinner for us next weekend that has wine paring that we could share but I'm just worried as everywhere says avoid alcohol and I haven't drank anything since we started ttc. Although it's not done me any good to date, maybe alcohol will kill off NK cells if they are raised!

Yes think bronsens will be really helpful and def a good way to go. I wonder what he will have to say about your zero lactobacillus….

I would go and enjoy your meal out . A few drinks won’t do anything but do whatever you feel comfortable with.