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 it’s just so upsetting. Like climbing up Mount Everest to find out u didn’t get to the top after all that effort.

Personally think knowledge is power. I think Lower is great. He’s so so good surgically and he’s dealt with niches - he did mine too whilst sorting out my ashermans just in case. If he doesn’t think it needs sorting he won’t operate for no reason as I really wanted him to check me before my fet to check my ashermans was clear and he wouldn’t do it! Well he was very clear I didn’t need it. And he was obv right.

@Cream123 thank you. That is so helpful. I think I should arrange an appointment. My husband is very anti me having more surgery as I've had 4 general anaesthetics (3 of those ops didn't go to plan or had complications after) plus a c-section. I'd do it again if it was thought it might help. I might as well see what he thinks though. Thanks again.

Even if he says those things r not issue u can rule them out and try focus on other things
Lower does ivf too so u can get another perespective on your cycles and what he thinks could help even if he thinks he can’t help
If that makes sense!

Oh brilliant. Thank you x

@seven201 if u ring his secretary and tell him u have a niche and fibroid and wondering if mr Lower would want to do a saline scan she might be able to schedule u so on ur first appt u can get those done (need to be done on particular days of your period) so ur not going down again. She might not be able to tell you though if you need one but it’s worth a shot ! And then u can have a plan that day. He measured my niche and said it wasn’t very big and prob wasn’t hugely
Impacting on things but I had a lot of post menstrual spotting and he had to go in to do my ashermans so he said he would cauterise it so it made less toxic fluid. If it’s big and he thinks it’s causing an issue he may shave it down or I think he sometimes does a lap and repairs it that way if it’s really very big.
He’s also a fibroid specialist but I know nothing about them!
Good luck and hope ur feeling ok. X

@Cream123 thank you, you really are wonderful! I don't know if I do still have the fibroid. It's not been mentioned for about 6 months so maybe it has gone, or just moved (she said it was on a long stalk). I think my cyst has gone from my previous FET as it wasn't mentioned this time. Good idea to chat to the secretary. I think I'm going to be away in cornwall when my period arrives. Is the scan usually at the start of a cycle? I'd be interested to see what he thinks of my prominent midline septum. The doctor who did my tube cleaning and ovarian drilling didn't even mention it or the niche, just put it in the letter to my gp. My ivf doctor said "they don't really operated on those any more" which wasn't very reassuring.

How are you doing?

Oh enjoy ur holiday u deserve it! I’ve no idea about septum’s either sorry.
Think it’s day 3-10 or something like that
I’m ok just finding time going slowly and hoping all ur guys get ur bfp on ur next cycles x

So I had my natural cycle scan today, today is CD 20 but my ovulation is delayed in cycles right after a medicated FET so I only just got the LH surge this morning. There is a 22 mm follicle looking ready to ovulate soon. My lining was 7.4 mm and triple lining which seems quite good. My only worry is I detected the estrogen rise 11 days ago, normally there is only 6 days before the LH surge. Has the longer time with oestrogen led to the lining being this size and in my normal length cycles it's much thinner? My specialist then called me to discuss the scan but I missed it by about two minutes and by the time I called back the receptionist said she wasn't at her desk and she never called back so I have no idea what her thoughts are in relation to the scan.

I've then asked her secretary to prepare the prescription for me for my era/Emma mock cycle which is due to start in around two weeks time, she asked me what leftover supplies I have so I went back to her and told her and also said I need Viagra adding in this time. We had a detailed conversation in the recent consultation about what treatments I should have to improve blood flow because I've got an underlying diagnosis of Raynolds. She had mentioned pentoxifylline in the past but for some reason said not to try this but said we can try Viagra so I thought well OK at least I'm getting one of them.

Well now she appears to have changed her mind and had her secretary replied to me to say she said the lining was good so there's no need for it, my lining isn't good my lining only just met the minimal requirements with a history of bad lining in numerous cycles and a known circulation problem. After three unsuccessful transfers I just want to make sure I've got the add-ons to target things where we could get some improvement and I'm just sick of fighting for everything. We made an agreement about this so why am I now having to argue for it.

@Cream123 thank you for that too

@Gardenlady543 oh that is frustrating. It's not like adding viagra is a dangerous add on so why not just let you do it. Definitely insist on it, but it's annoying that you have to!

Thanks @seven201 yeah it's so tough pushing for these things . How are you feeling, have you got in touch with Mr Lower?

Bit of a weird one for me, my specialist has called me today and actually it turns out the ultrasound done yesterday shows a lining of 7.6 mm at the top, but it looks thin at the bottom, this is a common theme for me. In the ERA biopsy she could only get the biopsy at the top, there wasn't enough lining towards the bottom and then in my recent transfer it looked OK at the top but then thin towards the bottom. She feels I need a hysteroscopy, this was something that I discussed with Mr Trew and he said not to do it because there wasn't a reason to do it, but my specialist said she can't explain why my lining is thin at bottom. I mentioned my Raynauds and she said that if it is a circulation issue than a hysteroscopy would see show the lining looking white.I have asked her to send me the ultrasound image and I will approach Mr Trew with it and ask if he will be able to do the hysteroscopy. If he can then I'm hoping he can take the EMMA biopsy at the same tome, I am dreading it if he says no because if there is a very adhesion at the bottom, which may well have occurred give him my microflora was really bad, then I know I'll be in perfect hands to have it treated. If he says no, then I will have to have it done by somebody who doesn't know my case and who isn't an expert in treating these issues.

@Gardenlady543 I’m sure mr trew will do one based on that? The Hsg isn’t 100 percent sensitive. Certainly mr lower missed my ashermans on a saline scan he did 2 years ago. Everything is so long and frustrating.
I had a scan today and she saw a Haematoma which explains my bleeding. Feel much better with a reason. It’s small and hopefully on way out.

@Gardenlady543 Hmmn that is odd. I hope mr trew agrees to do the hysceroscopy for you.

@Cream123 oh good. Nice to have a reason behind the bleeds. Hopefully that will help you to relax a little.

I've had a reply from mr lower's secretary and I think she's going to get back to me with some dates.

I was told my clinic would ring this week to book in my dd follow up but they haven't. I've left two answer phone messages this afternoon too. Just want to know what they think and get back on the list.

@Cream123 that's good you've found out about the haematoma to explain the bleeding!

@seven201 that sounds like you're making progress, I hope he can see you soon.

So I've heard back from Mr Trews clinic they said I'd need a consultation but only had an appointment a week on Tuesday. I asked if he could decide from the information I sent about the hysteroscopy as he's seen me before and they contacted him and he must have agreed to go ahead as they've said they've added me to the operation list and he's currently waiting for a date for surgery. I really hope I can get this soon, I know he had issues getting surgery slots in the pandemic. Gosh it feels like I'm right back at the beginning again. I'm hoping that Mr Trew can do the EMMA biopsy at the same time as that will then prevent me needing to do a mock cycle hopefully.

I'm really not sure what the hysteroscopy will show, I wonder if there could be say a tiny adhesion at the bottom of the uterus preventing the lining from building up down there, but being ok at the top.

Oh I’m so glad it’s sorted already as in no fighting! Hope u get a date soon I’m sure he could do ur Emma fingers crossed.
Some Of my scarring was running along my lining rather than bridging and so made my lining patchy and that’s why it got missed on a saline scan. It’s harder to see that scarring for obvious reasons. Though my lining looked patchy and irregular as a result which yours doesn’t. And yours is triple which is also reassuring.
Either way at least you can rule this out 100 percent if all is well.

Excellent progress @Gardenlady543. It's the small wins that make such a big difference

So I have the date for the hysteroscopy on 3 August 2021, this should be around day 4 of my next cycle. I take it I shouldn't do the mock cycle in the next cycle if I'm having the hysteroscopy?

Mr Trew said he can't do the EMMA at the same time, so I guess depending on the results of the hysteroscopy I need to make a decision whether to go into a transfer cycle in September or do the mock cycle with ERA and EMMA then and then do the transfer in November.

I am feeling quite frustrated today, my manager has two groups of staff members and we have a welfare meeting (informal chat about life) every month. He knows how triggering it is for me to deal with pregnancy and birth. But for some reason he put me in the group with the heavily pregnant woman, in the last meeting she started talking about her maternity leave I got upset and left the meeting straight away. I told him what happened and he seemed to understand. But for some reason he didn't move me into the other group and expected me to come to another meeting with her today, she has since given birth and will be likely showing off the baby. He seemed perplexed that I couldn't come, the whole thing has really upset me by the end I was literally shouting at him "I am not coming to a meeting where there's a baby present".

@Gardenlady543 I’m so sorry. People just don’t get infertility at all. I found everyone to be quite rubbish and lacking of empathy even if they tried. As a result very quickly I stopped telling anyone anything and very stressfully juggled annual leave and work . I’m sorry he was so insensitive :(
I think not wanting to hear about someone Mat leave or seeing their baby is totally reasonable and I’m glad you educated him a little on how women struggling with infertility should be treated!

Least husteroscopy isn’t far away. And then u can decide on Emma repeat. It will prob also depend on what mr trew finds if anything at all . With lower I couldn’t era Emma for a while after.

Hope ur ok x

Thanks @Cream123 the frustrating part is that I've kept him informed throughout and he seems to have understood what upsets me, but yet put me into a situation which was predictable at the last meeting where I got upset and then did nothing to stop me going through it again by expecting me to be at the meeting today. I ended up getting really frustrated and saying "I am not trying to be difficult, I am trying to protect myself. This isn't a formal work meeting, it's an informal chat, she will obviously want to talk about her newborn baby." I know he isn't doing it on purpose, I just find that it's a mountain to climb having to push for things when I couldn't have been clearer about what I find upsetting.

How come you had to wait before doing the EMMA? do you think I might have to wait? I expect if there is anything to find then it will be at the lower part of the uterus. I take it it doesn't matter that I will be very early in my next cycle, they can do the hysteroscopy if someone is on their period can't they?

I haven't heard from the implantation failure clinic yet, I don't know if I should call them to chase it, it's likely the appointment will be after the hysteroscopy and I'm guessing he will tell me the results on the day.

I'm sorry your manager was so insensitive @Gardenlady543 ❤️ I'm glad you have your hysteroscopy booked in.
Definitely call the implantation clinic - is that with professor Brosens? When I had my biopsy, I called when I got a positive opk and they booked me in the following week. They only do the clinics on Monday and Thursday afternoons. It might've changed with covid and booking in but its definitely worth chasing.

Hope you're doing well @Cream123

I've got my appointment on Friday to discuss doing the tests next cycle, I'm 8dpo today, so hoping he says we can do it, I've got the meds. i know he's been on holiday already, so fingers crossed. I feel like time has stopped.

@Gardenlady543 I had a baloon in my uterus after my op and so had to wait a month. But not sure what me trew uses. But hopefully there won’t be anything significant to find anyways. I was also on high dose oestrogen Abs my care consultant wouldn’t let me do Era in a withdrawal bleed. I don’t know if ur planning on repeating ur era?

@Cream123 if I was doing the repeat EMMA with Mr Trew then I would be happy not doing the ERA again. But as I have to do it in a mock cycle with meds I will do the ERA at the same time, I'll hold off on making a decision about the EMMA and ERA until after the hysteroscopy though.

I don't know what to think about this hysteroscopy, I thought I'd shut the door on the adhesions/Ashermans investigations but my specialist just kept mentioning doing a hysteroscopy, at least once I've had it she will stop mentioning it. Also do you think there will be a laparoscopy at the same time? I know when they find issues that need treating they often do it under laparoscopic guidance.

Thanks @VenusStarr I have adjusted my life to avoid triggers and it's just so upsetting when we lack control over some situations . Thanks for the info for the implantation failure clinic, yeah it's with Prof Brosens. I was told I should hear about an appointment date within a month and I've just got to the 1 month timepoint and not heard yet, I'll give them a call tomorrow. Not long until your appointment, are you discussing the ERA EMMA ALICE, or anything else as well?

No they won’t do a lap at same time. That’s a much bigger op and if they find ashermans that’s inside your uterus not outside so a lap won’t help….if u want to do a lap at same time seeing as you under general you could talk to me trew about it - I dont know how much he knows or does about endo though if that’s what your thinking?
The ga for a lap is longer and deeper though than for what may be a quick 2 second hysteroscope if nothing is wrong

@Cream123 probably best if I just stick to the hysteroscopy then for now. I was just wondering if a lap was part of what I'm having. If I was having it I'd want the fluid collection I have draining at the same time.

@Gardenlady543 sorry about your manager. That is very ignorant of them to just think you'll have got over it by the next meeting! I'm glad your hysceroscopy is soon. I hope you don't have to wait too long until the next step, whatever you choose that to be.

I've got a phone appt with mr trew on Tuesday as I'm away. His secretary couldn't decide when would be best to do my scan so she said starting with a phone appt made sense. I also have my first counselling appt on Tuesday!

My clinic are short staffed so I don't even have a dr follow up appt until 20th august, which is around the time I'd want my next FET cycle to start. So I think that means another month delay. I've emailed to ask if I can be put on the list for then anyway but no reply. I always have to chase them and it's annoying me! Everything is annoying me at the moment.

I told my hr department I thought their new ivf policy was mean and I felt unsupported and unvalued. I then backtracked by going on about how I don't want to be a trouble maker . Felt good to get it off my chest.

@VenusStarr good luck for Friday. I hope you get the go ahead.