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!

It was the era results - I'm receptive, so that's good news. I think when I did my fresh cycle I'd done 4.5 days of progesterone.

Hope everyone is OK, I'm away for a few days so I'll come back properly later this week x

@Gardenlady543 yes I see what you mean. I rem having similar thoughts actually. How many blasts have u got left? Just got to hope the next one works after u have rechecked microbiome checked nk and done scope. If not u can do a fresh once u have gone through you remaining blasts which may take you a year? (And hopefully won’t come to that). It’s very hard when u have contract u had the same with my son and this time.

@VenusStarr that’s great. So for ur Fet do your progesterone for exact same time. Have u got Any blasts left to try again or do u need to do a fresh?

@seven201 it’s so hard to not feel cross at our men who just don’t feel the same pull as we do. They are biologically different to us. Try keep talking and your marriage happy if possible to keep u going through these difficult times. I know that’s what helped me during some very difficult times.

Thank you @Cream123 my dh was saying it was a bit of a waste of time, but I'm pleased we know and I'll do exactly the same, like you said. I like knowing there's things I can control. It gives me a bit more confidence going into a FET.
We've got 2x 3AA blasts on ice (untested). If neither worj out, we'll look at embryo banking I think as I have low amh and possibly look at testing. Hopefully we will get lucky with our two 🤞

Hope everyone is ok

Hi everyone,

Finding this thread very useful as I had the ERA/EMMA/ALICE test done recently. Main conclusion for me was a disrupted microbiome so on antibiotic suppositories for a week then probiotics for a 4-5 weeks. The test centre recommended doing the test again but I really don’t want to as 1. Extra two months wait (im 37 so keen to crack on with FET) 2. Had a very difficult/painful biopsy - I had to be put under the next day so they could get a sample…was obviously post receptive . Has anyone else done the antibiotic/probiotic course without redoing the test and what was the outcome?

@taurus16 I didn’t repeat mine. I needed antibiotics and the probiotics. My next fet which was the cycle after worked but I had other more significant issues which were also sorted at same time and contributed more tbh. Good luck! Hope it helps :)

Hi @Taurus16. What was your result from the Emma Alice test? I wonder why everyone is being told to do different things? I'm going into my era cycle next week and been taking probiotics regardless I wonder how this would affect any result?

Thanks @Cream123…I don’t think I’ll repeat mine. I’m going to discuss with dr and see what she says.

@Hema902. ALICE test showed no infection but EMMA test showed ‘abnormal endometrial microbiome’. The report gave a breakdown of the most abundant bacteria . I had 46% Lactobacillus (good bacteria) and 42% Gardnerella (bad bacteria) . After discussion with the Dr I was told that I would be given antibiotic for the bad bacteria then the probiotic canesflor for six days then once weekly for four weeks to build up the lactobacillus. They want the lactobacillus to be in the 80-90% range if I recall correctly.

The thing is I’m not surprised my microbiome is off. I had a failed hysteroscopy under GA beginning of the year (they couldn’t get in) , re-attempt of hysteroscopy (they managed to get in second time) then egg collection around May, then an hour attempting the ERA after finally getting a sample under sedation. I’m sure Lots of prodding/procedures would have affected it.

I think you’re ok taking probiotics…I think antibiotics would affect results more.

If anything hopefully the probiotics would mean you don’t need to take anything further.

I think the ideal is to repeat per igmeonix report if u find bacteria or have a really bizzare microbiome there to check it’s gone/corrected. But practically I know most people don’t - I certainly didn’t

@Cream123 I have 4 euploid embryos left, I have no idea how many it will take to work though :( I think I'll have the next transfer after these tests and then have a think.

@Taurus16 normally they recommend a daily vaginally probiotic for 10 days after the antibiotics, then reduce down to every couple of weeks moving forward. I had 0.00% good bacteria and had the treatment then went into a FET with a euploid embryo, it was unsuccessful so now I'm repeating because there should have been a 70% chance of success. Surgery is one of the causes of dysbiotic bacteria, as is Ivf and in my case I put it down to the mirena coil. It was such a startling result to get.

@Cream123 Yes the igmeonix report recommend a repeat test but I don’t think I’m inclined to repeat it. The clinic dr emailed me this evening and said she understands if I don’t want to repeat the test (didn’t really seem to be for or against it but did recommend another course of probiotics when starting the FET

@Gardenlady543 which probiotic did you take and how long for ? Did you have a repeat to test to see if treatment had increased your lactobacillus? On my report they recommended canesflor for 6 days then weekly for four weeks. But I’m also looking, myself, into taking fem dophilus probiotic as well.

@Taurus16 oh that's interesting, everyone's report that I've seen says 10 days. This is the list the lab provide. Canesflor is the easiest vaginal probiotic to get in the Uk. I also take femdophilus (5 billion) daily and optibac for women.

I'm going to have a repeat test in my next cycle, my lining has had issues and that seemed to resolve after I had it treated but the next euploid transfer didn't work.

I'm also having an NK biopsy on Monday. It's likely my next transfer will be in November.

Hey! Oo that's interesting about the different protocols? I wonder why clinics don't treat this empirically anyway. I'm being treated empirically for immune (predinisilone, Clexane and Intralipids). If my bacteria comes off I won't repeat neither. It's too costly. @Gardenlady543 have you tried immune medication? I think my last chemical could be actually be chromosomal- my husband has low morphology. Anxious to see what PGS testing shows.

Hi everyone, my results are in. Emma and Alice are all fine, so no treatment needed at all. Feels a bit surreal. I'm glad I've checked but do feel a bit weird and sad that we didn't get a reason for our chemical / failure in my fresh ivf round.
We're going to ttc naturally while we plan the FET, I've been scared to risk pregnancy while in limbo but now we know we've ruled out infections and inflammation, there's nothing to stop us.

How is everyone @Cream123 @seven201 @Gardenlady543?

That's good news @VenusStarr with my abnormal result I'm always worried about it getting bad again. But completely get how it feels rubbish not to get an answer.

@Hema902 my specialist wouldn't add anything without evidence I need it, so I'm having an nk biopsy in Coventry on Monday. I'll be interested to see if there's an issue, it takes 4-6 weeks, sometimes 8 weeks for the result.

@Hema902

Hey! Oo that's interesting about the different protocols? I wonder why clinics don't treat this empirically anyway. I'm being treated empirically for immune (predinisilone, Clexane and Intralipids). If my bacteria comes off I won't repeat neither. It's too costly. *@Gardenlady543* have you tried immune medication? I think my last chemical could be actually be chromosomal- my husband has low morphology. Anxious to see what PGS testing shows.

@Hema902 I'm interested in your empiracle treatments. My clinic, care, has always refused steroids when I've asked. They've only let me have clexane. I'm going to ask again tomorrow when I have my follow up.

@VenusStarr ooh! That is good. Although I remember wanting them to find a small fixable problem for them to fix. How do you feel about it?

@Taurus16 sorry you've had such issues with biopsies etc. What a nightmare. I don't know what I'd do repeat wise if I were you, possibly try another FET then repeat if you want to then? My treatment was canesflor then oral probiotics, no repeat recommended.

@seven201 yes I'm with create and they did prescribe me it. I'm not sure if it's because I have a known thyroid disorder. But it did give me my first chemical pregnancy.
@VenusStarr - have you PGS tested your embryos?

@Gardenlady543. Thats the same list i have on my report but having looked back on it, Igenomix just stated ' a course of probiotics' and didn't state duration. The Dr from my clinic recommended the protocol and i've noticed the canesflor packaging says to take for 6 days then weekly. I think for the probiotic the extra days wont do any harm and I'll be taking femdophilus on top - have just bought some from amazon. Its good you're going for the NK testing. i was considering getting the tests done in coventry but after consultation with the Dr we decided to do ERA triome first, a transfer and if that didn't work the immune testing.

@Hema902. Yes, looking back on it...i wish i had known about this area and took probiotics alongside the other supplements we take for egg quality after having all those surgical procedures. My clinic also treat empirically and i was on clexane and aspirin for my last FET. (First IVF was a fresh transfer that resulted in a missed miscarriage) Their reasoning was there is no harm in taking them and its cheaper to just take the drugs then do the testing. Because i have had a natural birth in the past made it less likely i would have clotting issues.

@seven201. Transfers and biopsies are complete hit or miss with me. First fresh transfer I had no problems but then had a difficult FET transfer and subsequent biopsies were pretty horrible . Apparently my c section scar has caused some weird false passage in my cervix making transfer very difficult.

@Taurus16 at the bottom of the page it says one probiotic daily for 10 days on mine, does yours say that? I think do the 10 days anyway, there's no harm in taking them a bit longer. My friend just got told to take one a day until transfer day in her FET just to make sure. So I'm going to do that next time. So it seems you can't have too many probiotics, especially with all the prodding and poking we go through with IVF.

I think holding off on the NK stuff until you've looked into other stuff is a good idea. There isn't any evidence for it, I'm
only doing it because I've never been pregnant ever and nothing makes sense, so I'm kind of out of options.

@Taurus16 this is what mine says

oh yes i see it! and its on my report, completely missed it at the bottom of the page. Well, now i have to take an extra course of probiotics as currently being treated with antibiotics for a UTI. So my transfer will be pushed back by another month, to probably to around November time.

What other stuff can be looked into? its a bit of a minefield . Ive had laparoscopy, hysteroscopy, hycosy, PGS testing and now ERA. Yes theres no evidence for immunotherapy but know people where it has worked for them after a number of failed transfers. fingers crossed you get some answers after this investigation.

Thank you @Gardenlady543 @seven201 I think I'm OK, was a bit shocked that they found nothing, but I'm taking it as a win. We know I do have immune issues and I have a treatment plan for that. So I think our chemical after the ivf round was likely bad luck or maybe an embryo issue. The era did say I was receptive after 5 days and as I did 4.5 days in my fresh round, it might have had an impact.
@Hema902 I am with Create too. We didn't pgs test as it was our first round and due to my low amh, we weren't expecting many blasts. My recurrent mc specialist didn't think our issue was our embryos. I think if after our next 2 FETs we might look into it a bit more. One of my pregnancies was tested and he was chromosomally normal (and 2 of my other miscarriages were carbon copies, growth stopped at the sane point, so likely my immunes).

I can't understand your reluctance to have another biopsy @Taurus16 after all the trouble you've had with procedures before. I hope the treatment plan works for you 🤞

Hope you get on OK on Monday @Gardenlady543

I've booked a review with my ivf doctor and got a provisional nurse consult for a FET. Aiming for an October transfer, all being well. We're going to ttc naturally but not holding out much hope to be honest. X

I’ve had my review appt with my ivf clinic this morning. It was a different doctor, who I liked.
I’m going to have my 4 embryos tested.
Also going to have a blood test to test for thyroid antibodies.
She suggested NK cells testing which I was planning to do (but may have since changed my mind after seeing Mr Lower and don't think I'll do this yet). Does anyone know of you can have NK cells if you already have a DC? She didn't mention my child at all so after the call I did wonder if she knew I'd already had a child.

I'm just out my saline sonogram with Mr Lower. Thank you @Cream123 for suggesting - I'm so glad I went!

So… I don’t have a septum (ridge in uterus) I have a big adhesion acting like the coil! The top left corner of my uterus is sort of stuck together. Big 6cm cyst found (not sure if it’s one that was seen 4 months ago or a new one) so going Friday 3rd to see if it’s still there (will mean cystectomy added to the surgery). He’s going to look at the c-section niche when under general to see if he needs to upgrade my surgery to deal with that in a mini way (shave the edges off) or to re-suture it (not ideal as my bladder attached itself to the bottom so could be risky, I assume from when I had my daughter). Surgery on 6th. I think the surgery may end up costing a fortune, but I feel confident that it will help, especially the adhesion bit.

I am not looking forward to requesting the first proper week of term off! This will go down like a lead balloon!

@seven201 wow!!!! I’m so glad I told u to go! I almost nearly totally missed my ashermans too and once lower removed it my next cycle worked got everything crossed for u! When does he think it came ? From ur section? To let u know post op he sticks a balooon inside u with oestrogen for 3 weeks it’s highly unpleasant but just to keep focussed on why we do this crap to ourselves!
He always said my niche was small so he just shaved mine done again it did the trick :)

Yes u can have nk after having a son.

@seven201 do u have private healthcare at all?