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!

Ok so I’ve had the appointment, he basically said it’s luck and things vary from cycle to cycle, and if I have 3-4 more transfers one will probably be successful. I’m sure things do vary but by the time I have my next transfer it would have been 2 years without any positive pregnancy test with high quality embryos. He said microflora is the flavour of the month right now but there isn't evidence that treating it improves outcomes.

He then said let’s talk practicalities and explained about booking in for the NK biopsy, which I was surprised by as I thought the whole appointment was him telling me tests aren’t needed.

@Gardenlady543 that sounds confusing! Is it 3 transfers you've had now? How do you feel about the NK biopsy? Is that nhs? I guess you might as well do it but does that mean yet another month delay?

@seven201 the whole thing was quite upsetting to be honest. He said I wasn't on his clinic list and he didn't seem to have read the background I sent, as he didn't know anything about my case. Clearly this was caused by an admin error but I had paid for the consultation so I kind of expected more. The first question was "how many times have you been pregnant" (the answer is never). I had to keep reminding him of things when he was giving advice, eg I had to cut in to say I'd had Pgt-a, had a hsg, have light periods. I was hoping for an opinion but an opinion can't be given without understanding the background. I kind of thought this would be looked at with the same approach as recurrent miscarriages, after all recurrent implantation failure and recurrent miscarriages are often caused by the same things. But the advice was basically keep trying. Great, so the fact that I'm close to a mental breakdown is fine, I'll just ignore that this has taken over my whole life and I have no faith I'm ever going to have a child, that I've cut almost all my friends out my life, that I can't go anywhere because it upsets me to see children, that every work conversation with my manager isn't actually about work but about how I'll juggle work with treatment... because almost 2 years of constant disappointment apparently isn't enough to count as anything, you just have to keep trying longer and ignore that the embryos look great, cycles are regular and everything is timed but it's the same negative test each month.

Basically this will allow me to get NK cells done, but I don't think it will add anything else.

I can have the first biopsy this cycle, it's 7-10 days after ovulation. He said I can't have the next one in the mock cycle for ERA and EMMA as it would mess up the nk cells if my clinic biopsy first, so I would have to have it the following cycle (October), the problem is I was planning to transfer in November and the results don't come back for 4-6 weeks, so I won't know if I need steroids or intralipids until then and it's unlikely I could have a transfer in December as my clinic close over x-mas. He said we could do the first biopsy and they could give me the results after that and we could go from there. It's confusing because he said the nk cell levels vary between cycles, if you get a high on one cycle then he said it's likely it would drop and be low fairly soon after. If it's very high consistently then I think that's when they recommend treatment.

Do you guys know what does Dr Gorgy requires to prescribe an immune protocol as an add on, do you guys think he would do it if the first biopsy came up very high?

@Gardenlady543 I'm sorry that it's just added more confusion and upset. It's really crap, especially as you paid presumably quite a lot of money for that. I guess you just do the first biopsy and go from there.

I think only people, and mainly the woman, who have been through infertility understand just how shit it is. I definitely have been changed forever by it. There's no escaping it, it's just always on your mind that you are not pregnant and everyone else seems to be. It ruins your personal and professional life. And obviously I am very fortunate to already have a dd; it's harder for women trying for their first. The doctor you saw today sounds like a complete prick.

@Gardenlady543 sorry the appt was so rubbish. I’m surprised . I also don’t think saying trying every month is enough - though maybe he was saying it will work out eventually for u. But obviously having no empathy for what you are going through. I took me 4 years and 4 ivf cycles and 6mc with 4 ercp along the way and an op to clear ashermans to have my DS and I’m forever changed from it, it was an absolute nightmare. Work friends body mind all changed forever. And I still feel like I have some issues from it that are lingering on that I could do with dealing with tbh. And no one who hasn’t been through it can understand it. Huge.
Gorgy does nk biopsy but also a lot of bloods to check ur nk cells levels tnf etc. I never did the nk biopsy with him as I just did the bloods. There are problems with both (bloods and biopsy) ways and let be honest no one actually knows what to do. Gorgy has zero empathy by the way. Just to pre warn u. I think somewhere deep down he cares which I saw now and then.

I think have ur hysteroscope and I just have a feeling from what u have said about your specialist that something will be found and hopefully fixed.

@seven201 hope ur holding up ok.

So I think it’s quenby who runs the RM clinic who is really lovely and supportive I’ve heard. He might still be insightful when he does your biopsy? Sorry more delays. Just a nightmare

Thanks @Cream123 and @seven201 I think the thing that upset me the most is a standard statement that it will likely work in 3-4 transfers. Maybe it will, I really hope it will. But absolutely no evidence of implantation in 22 cycles, I mean it doesn't look good does it, not when the embryos look great with grading, the embryoscope score and Pgt-a results. He mentioned someone that had 12 IVF attempts and then got pregnant naturally on the next cycle. But I get symptoms of BV when we try naturally and I'm so worried about making my microflora worse. I also don't think I will be mentally stable after 12 IVF transfers, I mean who would! After the nk stuff and hysteroscopy, that's it, I need to just have repeated transfers and hope for the best.

@Gardenlady543 how are you feeling now you've had a few days to process? I don't know how anyone mentally copes with 12 transfers either!

Btw Mr Lower says swimming is fine.

That's good news about swimming @seven201 it sounds like Mr Lower knows a lot about the microflora, no one else seems to know anything about it!

I spent the weekend researching surrogacy which probably answers your question. Although that seems like a stressful minefield as well. I've got the hysteroscopy tomorrow. Feeling so blood exhausted at the moment!

@Gardenlady543 good luck!!! Do report back I hope u get some answers. I also started researching and looking into surrogacy twds the end with trying for my son. It made me feel a bit more Like I woukd end up with my baby some way or another and that gave me comfort (obv it is frought with complications and issues but it still made me feel like there was always that Option). I had some meetings booked with bb who we’re really helpful.

Hope tmrw goes well

@Gardenlady543 good luck for tomorrow. I really hope it is useful.

Wow, surrogacy. Hopefully it won't come to that but sometimes it's good to just start exploring more options.

@seven201 @Cream123 I think it helps to know there's some other way if the transfers don't work. I feel so much worse after the appointment.

Thanks for the good luck, I'm trying not to overthink this one as I got myself so worked up for the HSG.

Hi, I have a question I was hoping some more knowledgeable than I may know the answer to?

I cycled abroad. 2 PGS healthy embryos on ice out there. Was supposed to transfer 15 months ago but… Covid Anyway, i’ve been actively trying to get out there for the last 11 months since North Cyprus opened their borders. I’ve had multiple attempts but my body lets me down on the short protocol (starting Estrogen on day 2 of bleed)

I either don’t shed enough lining so can’t start, or my lining goes too thick, too fast, or I get fluid. I’ve had more cancelled cycles than I care to remember these last 11 months. I decided to take a month out and do an ERA. That was the one month that things went ok. Results showed I needed 144 hours of progesterone, so 6 full days instead of 5.

Anyway, after 4 more attempts after the ERA I’ve decided I can’t keep doing this to my body. Paid for a video consultation with Michael Booker who says I need to downregulate with Buserelin for 2 or 3 weeks first and then introduce Estrogen. He says this should combat my issues.

Problem is, I didn’t bloody do this for the ERA So are my results invalid? I’ll obviously use the same progesterone protocol, my Estrogen dose will be the same but i’ll have downregged first.

I can’t afford to redo the ERA. Plus, it’s time consuming and North Cyprus are very unpredictable and can ban us at the drop of a hat. Time is of the essence. I’ve gotta get out there whilst they are letting us in with minimal restrictions.

Do I still transfer after 6 days Progesterone? Or just the standard 5 days?

Also; reading some of these posts in here breaks my heart. It’s such a cruel, draining process. It literally takes over your life is torturous. It helps to know i’m not alone, but so sorry for those or you in this hellish limbo.

Hi @VillageFete I am not an expert as I've not done my era yet, but I would think that if you are doing the same estrogen / progesterone levels, your era should be valid. Where did you get your era done, just wondering if they would know? I hope you can get out to Cyprus soon. I really struggle with the endless waiting.

Good news about your scan @Cream123 I hope you're OK, I can imagine you still feel very anxious.

Good luck today @Gardenlady543 I hope you get on OK. Get lots of rest after.

That's good news about the swimming @seven201 :)

I'm just having a coffee before my next scan.... Been up since 4am as had to drive to my clinic. Hoping all is still looking good and I can start progesterone tomorrow. The clinic said they wanted me to mimic my FET, so to do all the immune protocol, but I'm not 100% sure why I have to as it won't impact on my lining etc but I'm just going with it. Had a rough weekend mood wise, estrogen is horrible! But I'm glad I know what to expect when I eventually do my FET. Will report back after my scan.

Thanks @VenusStarr wow that's an early morning, I hope the scan goes well 

Hi @VillageFete gosh what a nightmare! The downregulation sounds like a good idea, I don't think it will have an impact on the ERA results as it's the progesterone timing that matters the most. Feel free to join us on here

All good to go, lining is 8mm - although one part is 6.8mm but I checked and he said it was fine. It was triple layer. Back on Monday for the biopsy, not sure what time yet, so they'll confirm later what time to start progesterone tomorrow.

@VenusStarr that's good news! my specialist said they only take the thickest part measurement, it does make me think though as I've got up to 9mm before but been told it's very thin at the bottom. Prof Brohens doesn't think it matters he said you only need a small bit of thickness.

That's reassuring @Gardenlady543 thank you. I'm similar, before ivf, a natural cycle when I conceived last year, my lining was 9.1mm on cd9. Strange how when you take meds and hormones it can be worse.

I meant to say, I'm sorry that your appointment with Professor Brosens was disappointing. I think he's a nice man but when you've had a lot of heartbreak, it's really difficult to hear just keep going and it will probably work. What time us your hysteroscopy today?

@VenusStarr @Gardenlady543 Thank you for the welcome! I had it done at Cherish in Sutton Coldfield. I have a feeling to cover their backs they will say replicate exactly.

Problem is, whilst on Estrogen for FET i’ll also be taking a small injection of Buserelin, which I didn’t take for FET. I’ll have been on a higher dose of Buserelin for 2 or 3 weeks prior to Progesterone intake too… Thing is, I have no bloody choice to downreg, so what do I do? Transfer after 5 full days, or transfer after 6 full days (as per my ERA)

Ingenomix won’t guide me on this, they don’t appear to understand downregging. This is interesting though, I asked them about lining measurements and how important it is to replicate a similar lining between ERA and FET, if anyone is interested in the answer. My lining was 12.2mm at biopsy.

The above should say I didn’t take the small injection of Buserelin for ERA! Not FET.
Bloody hell, I meant higher dose of buserelin for 2 or 3 weeks prior to Estrogen intake, not Progesterone.

Sleepless night last night! Not thinking straight.

I looked at Cherish @VillageFete, are you local to there? I'm in the West Midlands.

Your lining got to a good thickness. I still think I would go with your ERA result of the extra progesterone as you have the evidence that you'll be most receptive tthen.

I’m in Liverpool @VenusStarr But couldn’t find anywhere more local. I’ve been to Cherish for an Aquascan in the past. Very friendly ladies. Lots of the IVF abroader’s use them for scans and bloods.

Yes, I think I will. I just wish both protocols were the same, but what can I do? We can’t foresee these issues can we. I had no idea my body would continuously let me down when it came to transfer.

My Dr is Cyprus is a JOKE. Barely speaks English, incredibly unhelpful and disinterested. Unfortunately the other two fantastic Dr’s left during Covid and i’ve been lumped with this fella now

Oh, I'm sorry about your doctor, that's really difficult. Hopefully with the era result and following the 6 day recommendation helps you feel more confident. Are you going to transfer both embryos?

When we first had our fertility tests the nhs wait for a sperm analysis was ridiculous, so my dh went to Cherish, they were great, same day results for about £90, so would definitely go back for other tests.

@VenusStarr Dear God, no This is for a sibling. One more will do! Plus i’d like a back up embryo if first doesn’t work out.

I feel like i’ve been doing IVF/fertility treatment forever. It’s been 7 years now on and off. I feel pregnant naturally (no idea how) after my second failed UK transfer and then went for egg collection abroad once my miracle was 6 months old… Covid hit and then it’s just been a hellish wait and my stupid body lets me down time and time again. I’m not getting any younger either.

Ladies, has anyone used Buserelin to downregulate? I believe you start on day 21, I assume you would bleed whilst on it?

I’m a bit concerned because the Dr in the UK i’ve spoken to wants me to start it asap (around day 7 of cycle once I get prescription) But I have PCOS and didn’t get a bleed this month. I tried to induce one with progesterone but it didn’t work out, only had a spot of pink/brown but we still classed it as day 1 of my withdrawal bleed.

He said he’d scan me after 2 weeks to see if downregulation had worked, but surely my lining would still be thick then? I had a scan and it was between 5 and 6mm last week, so will be thicker now? I assumed I would definitely need a decent bleed in order to move forward with meds for FET or does Buserelin shrink your lining?

I’ve gotta go to Croydon to see him for a scan. Planes, trains and automobiles springs to mind