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!

So here's my surgery update:

There were some thin adhesions at the top of the cervix which meant it was stenosed, nothing in the cavity though, which looked very good, including the colour. He asked if they have had issues passing the catheter for transfers and I said no. He said this is unlikely to have caused the lack of success, he said it may be why the ultrasounds look thin at the bottom though, almost like this is causing the appearance of thin lining without it actually being thin. He said it will be interesting to see how the scans look now they’ve been removed. No need for any other procedures. I do wonder if this has caused the issue with a lack of success naturally because it could have prevented sperm getting up.

@Gardenlady543 glad all went well. Interesting he did find something. I think on the asherman usa forum I got the impression that Mr March thinks that scarring anywhere can affect the receptivity of the rest of ur lining. So I was obsessed in making sure I was fully clear. So I’m sure what he has done has helped. Fingers crossed!!! (Don’t think I was fully clear actually when got preg but obv clear enough vs pre op).

@VillageFete I'm sorry I don't know anything about burselin. I think doing the longer progesterone as per era probably makes the most sense. You could go for a time slightly lower perhaps eg. 5.8 days instead of the full six or something. Sorry your Cyprus doctor is so crap. It makes such a difference.

@Gardenlady543 ooh. That sounds good! So there was something slightly blocking the entrance and he has cleared that? And your lining might actually be good despite scans showing thin there? Sorry, I don't understand all the lingo!

@seven201 yeah the end of the cervix that's in the uterus was narrowed with adhesions, which is weird because the clinic have been able to pass catheters through with no issue. I've had no sleep last night thinking about it, I kind of expected for them to say it was normal or there were adhesions in the uterus, I did not expect an issue in the cervix to come up.

@Cream123 that's interesting about what Mr March says. I asked Mr Trew if this is Ashermans and he said that Ashermans covers a lot of things and that adhesions anywhere fall under it. But it's unlikely that this has affected the lining thickness. It will be interesting to see if the lining looks thicker on the next ultrasound.

Feeling so groggy today after the anaesthetic

@Gardenlady543 I had cervical ashermans before my son. But it was fully shut so I didn’t get any periods after one of my mc. And no catheter could get through. It’s much better to have it there as it means uterus is untouched and healthy. Where baby will implant. I can’t help but think that this is one piece of ur jigsaw along with the other pieces u have found. Maybe not the entire answer but it will certainly not harm that it’s now sorted.

Ps yes I felt rubbish for a good 2 days after

Ohh that's interesting that you had it too @Cream123 it took me by surprise, just goes to show what can show up. I do wonder if this is why natural conception never worked, it wasn't completely stenosed but any narrowing isn't going to be good for sperm. Mr Trew described it as a big tick off the list as I've now had two thorough investigations showing the uterus looks normal and to use the information from the ERA etc moving forward. So now I need to keep an eye out for the LH surge and book in the NK biopsy 7-10 days after that.

Mine was after my 5th ercp though so was an expected complication. I think it’s good thing to have found. Really hopefull u are getting all Ur jigsaw pieces.
Stay strong it’s so rubbish x

Sorry didn’t ask - any ideas where urs came from??? The coil?

@Cream123 I did ask Mr Trew if it could have been the coil or the bacteria and he said it could be anything. So I have no idea, I mean it technically could have been all the IVF procedures.

He said in the past people would struggle to conceive and have the stenosis dilated and they would conceive. Definitely better that I know about this and it's fixed.

@Cream123 I'm worried, I seemed to be ok yesterday and had no bleeding. But I got really constipated I ended up straining which is says not to do. I then took laxatives. Today I'm getting abdo pain which I thought was due to the laxatives but I've got fresh red blood from the vagina, is this normal? I'm worried the straining has caused damage.

I had bleeding on and off after my procedure for the entire month! I never really stopped until My next period reset Eveything. I wouldn’t worry despite it being totally natural too. He’s cut away and scraped ur cervix and so all those cells need to escape x

Thanks @Cream123 I think I was worried as it settled and then came back on, but it sounds like that's normal. The constipation wasn't helping so I've stopped all the laxatives now. Hopefully I'll get back to my normal self in the next few days.

@Gardenlady543 mine did that too would stop and start until my next period reset. Just rest tv and make sure ur partner looks after u. Hugs

Hey- anyone had the Emma/ ERA / Alice test? Did anyone have antibiotics ? What were they? I can't afford these tests - I wonder if I should take some antibiotics and pro biopics prior to my transfer?

Hi @Hema902 a few of us here have had it. The antibiotics depend on what bacteria is found, I took co-amoxiclav but I think most people get advised metronidazole, others aren't told to take antibiotics at all, just vaginal probiotics. If antibiotics are used it's a 7 day course. Some clinics abroad routinely use doxycycline as part of Ivf cycles.

After the 7 days of antibiotics people are advised to take 10 days of vaginal probiotics, I've attached the recommended list from the lab. My friend has just been advised to take one vaginal probiotic a day up until the day of transfer, so you could try that if you're having a FET. I also take femodophilus daily, as there's evidence that improves microflora.

Hi thank you so much for the info @Gardenlady543. Did the results of the test delay your next FET? I'm worried I'll have to wait longer if treatment was needed. I had a chemical pregnancy with my last FET- not sure if the ERA is suitable for me? Cost wise- it's so expensive :(

@Hema902 you will take the medications of a medicated FET, on the day they would do have done the transfer, they take a biopsy, then the results of the ERA take 10
working days and the EMMA/ALICE 15 working days from when the lab get the sample (sometimes it can come back sooner). Then the treatment is 17 days. So at the minimum it will delay your next FET by 2 cycles (1 to do the test and 1 to await the result and treat). The cost of ERA at my clinic is £1000 and it's an extra £500 for the EMMA and ALICE.

Thanks for the info @Gardenlady543. I will try the probiotics before my next FET. Have you ever had a positive? Anyone had a hsg? I had a bag through the nhs which came up with tubes open but small filling defect. They said they will send me for a hysteroscopy. All the scans I have had privately have never pointed our anything is wrong here. I probably will do the hysteroscopy. Did you have it done? Did they find polyps/ scarring or fibroids?

@Hema902 I had a HSG which came back as normal but I had a hysteroscopy as my lining is consistently thin at the bottom of the uterus. I was found to have narrowing of the cervix where it joins the uterus caused by adhesions which were removed during the procedure.

A ultrasound can miss so much, I think a saline scan or HSG should be undertaken in anyone having fertility treatment. Given that the HSG has shown a filling defect then I would definitely do the hysteroscopy before having a transfer if I were you. I know what it's like just to want to get on with transfers, but I would much rather wait a bit to find out if there is something wrong than find out down the line I'd wasted embryos as there was an issue that needed fixing.

Hello @Hema902 I had the era/Alice/Emma.
Mine showed no infections but I did have low levels of good bacteria (so now do vaginal and oral probiotics) and also that I should start progesterone a day earlier.

I've had 5 failed transfers now but do have a naturally conceived 5 year old. I'm now going for a saline scan and if that shows any problems (probably will as I have a ridge in my uterus and a c-section scar too) possibly hysteroscopy to correct/tidy up. Personally I wish I'd done the era/Alice/Emma sooner. I'm also considering getting my 4 frozen embryos tested.

Hey @seven201. Ah that's interesting. Have you ever had chemical pregnancy? Or just not implanting. I'm getting my embryo tested and doing a Hysterscopy meanwhile to sort out the defect. I can't afford the ERA/ Emma / Alice right now but I will take the probiotics for the entire month. I hope it can help somehow. Are you on immune meds? I found that helped with the implantation but I do have an autoimmune thyroid disorder.

I had an early miscarriage 3 1/2 years ago but nothing since then. I'm on clexane but they haven't found anything. I take levothyroxine for my thyroid.

Taking the probiotics is a good idea.

Hi everyone, hope you're all OK. I had my biopsy yesterday, it wasn't a great experience, I found it quite triggering and just generally feeling overwhelmed. They said they got what they needed though, so just got to wait for the results. I'm pleased it's only a few weeks, hoping I'll hear by the end of August. Still feeling quite crampy today, but not bleeding anymore.

How's your hysteroscopy recovery @Gardenlady543?

Hope you're doing OK @seven201, where are you up to now?

@Cream123 I hope you continue to be well. Do you have any scans booked in?

@Hema902 I don't know about additional costs, but if you're having a hysteroscopy you can get the endomitritis test at the same time I think. I've got overactive nk cells so I'm on an immune protocol too. I've had multiple losses and had a chemical after my first ivf round, so doing the Endometrio tests before we plan a transfer.

@VenusStarr I'm sorry you didn't have a good experience. Massive well done for getting it done, you should be proud of yourself. I hope you get some useful results and don't have to wait too long.

I should have my saline scan 25th august (if period arrives at the correct time) and then potentially the hysteroscopy early September.

Had a bit of a falling out with dh tonight. He asked if we were having sex tonight and I was a bit blunt as I said "to be honest, I'd much prefer it if you just gave me your sperm". He knows I'm fed up with ttc sex (been 3 1/2 years of it) and I have asked before if occasionally we could do it using a cup and syringe, but he doesn't want to. He later read me and article about how important it is for couples to try and enjoy ttc sex, like I didn't know that already. Agh. I do feel for him but I am also fed up of having sex when I really don't want to! It's not helped me never knowing when I ovulate. I'm cd 24 today so probably don't need to continue, but I do occasionally have long cycles and opks don't work for me, nor does temping or checking cervical mucus .