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!

@Gardenlady543 oh that is hard. I'm sure she will be happy to still be there for you and won't rub her pregnancy in your face. Be honest with her about what you need.

Thanks @seven201 I had to stop talking to my best friend when she got pregnant (to make matters worse out of the blue I got a card from her today, so something else to process!). This friend knew it was too hard for me to speak to that friend and I guess the two of us knew one of us would get pregnant first. She has said I can either cut contact or she won't mention the pregnancy, she would like to support me but understands either way, I'm not sure what I'll do right now as I imagine it will be hard to know things are progressing for her. The first thing she said was that there was still a long way to go, which I found insensitive, I'm sure it was unintentional but I know I'll need to bring this up as I will ruminate on it.

I am basically in constant communication with her so it will be a big change for me if I don't have her. I have called up a counselling place where there is a psychologist who knows about infertility trauma, they said they probably won't be able to get me in for 4 weeks but I think it will be good.

My friend getting pregnant (this was her second transfer after months of embryo banking), has made me want to just do a transfer with my bleed next week but the only reason I would be doing it is because she got pregnant and if it doesn't work I'll want to do these tests anyway.

@Gardenlady543. That must have been soo hard to digest, after everything you did to help the transfer be successful. I can see why now why immune testing is the next step for you . Also, totally get why you would want to jump into the next transfer, i feel like that all the time. I don’t think there is a right answer here. Would you know if there certain symptoms associated with a person who has high NK cells?

Booking in for counselling will help and its good you have thought ahead. As lovely as it is to hear your friend is pregnant, the dynamics of future conversations will change and you just need to do whats right for you and your mental well being.

@seven201 Wow, they misdiagnosed your uterus, I’d be fuming. Waiting is a real killer, the waiting and how do i keep myself busy so I’m not always thinking about how long its been, everyday is a challenge. So from my reading….my understanding is (and anyone please correct me if I’m wrong) that Hycosy and HSG are similar but Hyscosy uses ultrasound to visualise the uterus whilst HSG uses X-Rays, Hysteroscopy uses light so you can actually see the picture of inside your uterus and is similar to an Endoscope (just different organs being investigated)

I also got confused about femdophilus as received a pack from amazon, it says on the box to store in the fridge but from q&a section it seems like it comes at room temp and have to refrigerate once opened ( comes with a moisture absorbent thingy inside the tub)

@Taurus16 I know logically the best thing is to do the tests, I have this illusion that things will automatically work as they have for my friend, but I have a different issue to her and there hasn't been any change since my last transfer. I've been up all night crying, it's just this realization that I'm so alone and in this awful place.

Prof Brosens seemed to think my NK cells will be abnormal, he said it's different to recurrent miscarriages, that people in that situation often implant everything and that in my issue my body is over selecting embryos, basically nothing is good enough to implant. It's a protective mechanism to prevent miscarriages. I don't even know if I will have a result before my next transfer as there needs to be 2 biopsies and the results take so long, it's good to know I've got the process started though.

@Gardenlady543 I’m sorry to hear about ur friend. I’ve been in that position before (of ur friend) and it’s really though. So first time me and a friend both trying for no 1. In contact multiple times a day . I got pregnant and stayed preg and she didn’t (bearing in mind me getting pregnant means very little to me and those around me as I’ve lost so many until I hit later). But we stayed in touch v regrually as I still supported her gave her advice discussed options and i never discussed my pregnancy. I just pretended I wasn’t pregnant to her. We had both been at it for 4 years so I know how hard it must have been for her to know things were going well for me. She had had multiple cycles never had a bfp. Turns out she had silent endo )I’ve told u about her before). However we both then started ttc no 2 same time. I’m now preg and she’s come to end of line. She’s def taken a step back and we hardly speak. I totally get it and I’ve just let her carve her path so she can deal with her fertility how she wishes. She’s actually a little mean to me sometimes tbh but I get it’s a defence thing and just let her deal with it her own way.
My best friend who is like my sister is in touch every day with me and starting ivf and no 2. She’s the last one in our group to have no 2 and there are photos flying around of everyone’s no 2 atm. We have just continued as normal and again I’ve never mentioned the pregnancy except when asked be her.

I suppose u can just tell her what you need. U need friends who understand the process around u maybe she could be that person for u? As if u haven’t done ivf u just don’t get it. But u also have to protect urself so u can focus on your own goal so just do what’s right for u.

I hope you’re ok and some of that made sense. X

Thanks for the message @Cream123 I think the situation is so complicated even more so as I feel guilty at how hypocritical I'm being. When I was so sure the last cycle would work I thought about how I'd tell her, how I would beg her not to cut me off as I really needed her and now the tables have turned and she is saying whatever I decide is fine, she'll understand. But I just don't know, it is like a break up that I'm orchestrating, I just don't know how I will be able to keep having contact with her, I'm so close to breaking as it is.

I just feel shit, this is good news for her, she deserves it, I want this for her. I have just never felt so alone, I have been up all night crying.

@Taurus16 thanks for the hsg/HyCoSy/hysteroscopy info! I think that's alright with the femdophilus. The 5 billion one needs to go in the fridge, the 1 billion one doesn't.

@Gardenlady543 oh you poor love. Personally if it were me I'd take a few days to just cry and then force myself to try carrying on being friends. It's sounds like she'll be led by you, so definitely won't be going on about her pregnancy. You do need friends to talk to. It's great you'll be doing the counselling.

Thanks @seven201 I feel so pathetic, so much has hit me at the exact same time. She messaged me this morning and I told her how I feel, I feel like a shit for it because she's supposed to be happy and celebrating, but I regret not telling my old best friend things and just sat on them and now it's 18 months down the line and I'm having a mental breakdown when she sends me a card.

This friend understands the situation, I think it could have easily been a role reversal if my last cycle worked and we both know that. She is a very sensitive person so whatever I decide will be fine, I just don't know what I want and told her that. I think you're right that sitting on it while things are so raw is a good idea.

How r u today @Gardenlady543

Hi @Cream123 thanks for checking in, I'm feeling quite rough still. I'm tearful most of the time and have woken up at 3am for 3 days in a row now. I've still been working, worried about a manager from work calling me which inevitably will happen at some point. I just feel quite weak.

I have set up an appointment with the psychologist in around 4 weeks (first available slot, they like to wait until an opening so they can then see a person regularly) and I'm seeing the Gp on Friday. I'm due to start my era Emma cycle on Monday if I get my period then, so hopefully knowing I'm moving further forward with things will help.

I hope you're ok

Hello All,

This thread has been very informative.To give you some background, I am over 40 and had my 2nd failed transfer, (currently going through a miscarriage at 6 weeks). I had a call with my DR earlier and she said I have a couple of options to prepare for my 3rd transfer:

• PGT-A testing
• ERA
• Reproductive Immunology

Which one of these do you think would be most effective? I am leaning towards the PGT A testing, I currently have 4 frozen embryos, I am thinking of having these tested (£1,810 to test 4), but the Dr actually suggested that I do another egg collection and have more tested.

Which option do you think is best? Should I have the 4 frozen embryos tested or follow the Dr's advice, do another egg collection and have more tested? It can take up to 6 weeks to have the results back and I really want to do a transfer In Oct.

Your insights would be greatly appreciated.

Hi @Moonstarr I'm sorry to hear about your loss.

So if considering PGT-A I'd say, at age 40 around 70% of your embryos will be aneuploid. They will either not implant, implant and miscarry or result in a condition such as Down's syndrome. So you'll need to have 3 embryos to have a good chance of 1 being euploid.

PGT-A testing won't improve the chances of pregnancy, but it can shorten the time to get there, as it will help select which embryos have the best chance. But there are risks: embryos may not survive the thaw (I lost my best embryo in this way), there is a risk the embryo can be damaged as it has to be biopsied and you may get an inconclusive result or be told an embryo is mosaic, which puts people in the dilemma of what to do with it.

Of course given that you're experiencing a loss, you may want to go ahead just to eliminate the chance of an aneuploid embryo implanting and having to go through this again.

I think your specialist is right that you should bank more embryos now if possible, it will give you the best chance.

An alternative to Pgt-A would be double transfers which most specialists are happy to do when someone is over 40.

I think most people here would say do the ERA EMMA ALICE, as it's picked up issues for us. Do look into the EMMA and ALICE if considering the ERA as the microflora is really important for implantation and ongoing pregnancy. The ERA may be less useful in your case, as you must have been receptive since you've implanted in your recent transfer.

The immune stuff has less evidence base to it. I've just had a biopsy for Nk cells as I've done all the other tests. The theory is that people like me who never implant could be overselecting embryos, all embryos will have slight issues due to the amount of times they doofus, and my body might decide that no embryo is ever good enough to implant. While those with recurrent miscarriages may be doing the opposite, implanting everything and later the body realises the embryo is abnormal and the person miscarries. If you are considering this test, then you might want to look into the service at Coventry. Prof Quenby will see people if they have had more than 2 miscarriages and I saw Prof Brosens who runs the implantation failure clinic. It seems to be the cheapest and most research based service offering this.

I'm sorry for you loss @Moonstarr will you be getting this baby tested?

I had a chemical after my first fresh transfer in June and did the Endometrio tests which all came back normal. We are planning our FET but can't do it until October as need to get a nurse consultation in - saw our ivf doctor today too.

I have had immune testing and do have an overactive immune system, so on lots of immune meds - we got the results and treatment within 2 weeks but waited around 4 weeks for the appointment.

With the Endometrio tests that was a mock cycle and the results took just over a week - so I think you could get this in alongside planning a FET, although if anything shows up on the infection or inflammation side, you'd need treatment.

Our doctor did discuss pgt-a testing but we only have 2 frozen embryos and I have low amh, so we want to just go ahead with these and will look at embryo banking if they fail. But my recurrent loss specialist doesn't feel our issue is chromosomal (we had one baby tested and all was normal).

Did you have any other meds like clexane or aspirin as part of your protocol?

Hope everyone is OK, I had to step back from all things fertility and baby loss, it's becoming too much, so limiting my time coming on here.

@Gardenlady543 I am so sorry you're going through such a difficult time right now ❤️ don't put too much pressure on yourself to be OK, this stuff is so hard. I'm glad you're seeing a psychologist, hope the wait isn't too long. I had a mental health assessment today and am being referred.
I hope the repeat tests give positive results.

@Cream123 hope you're well
@seven201 how are you getting on?
@Hema902 my era, emma and alice tests took 8 working days to come back, really surprised me.

Best wishes to everyone x

Just to add @Moonstarr I have had 4 previous losses which was why I did the immune testing. I'd done the nk cells biopsy that @Gardenlady543 us doing but that showed nothing and I had my 4th loss after that, which was a carbon copy of 2 of my other losses, so we knew something else was happening, especially as the baby was tested normal.

It's the first time I have heard about testing the baby. I had a big clot last night so doubt there is any baby left to tests. I was only 6 weeks.

Thanks for your reply. I am leaning towards having the 4 tested and if they fail do another egg collection and bank more

I was on inhaxa a blood thinning injection, works like aspirin. I was also on cyclogest and Progynova.

The Endometrio tests is this the same thing as ERA?

I'm sorry @Moonstarr 😢 they don't usually test on the first miscarriage, but if you were able to collect anything they might do it, I think it depends on your epu. From my experience it is quite distinctive tissue - 3 of my losses the baby stopped around 6 weeks but I didn't miscarry physically until later.
Even with my chemical recently, I passed pregnancy tissue and I was between 4-5 weeks.

Good luck with the testing, I hate the way everything takes so much time x

The Endometrio tests are the era, plus emma and alice tests - so they look at the microbiome / uterus environment and for infection and any signs of inflammation as well. As all 3 are biopsies, it makes sense to do them all together, it's not cheap though, but an ERA on its own is quite expensive x

@VenusStarr

Just to add *@Moonstarr I have had 4 previous losses which was why I did the immune testing. I'd done the nk cells biopsy that @Gardenlady543* us doing but that showed nothing and I had my 4th loss after that, which was a carbon copy of 2 of my other losses, so we knew something else was happening, especially as the baby was tested normal.

Oh no, I thought I passed most of it last night. Going into the clinic for a scan on 7th Sept. If it happens at home, how do you store the remains? Do you keep it in the fridge and take it to the clinic the next day?

@VenusStarr

The Endometrio tests are the era, plus emma and alice tests - so they look at the microbiome / uterus environment and for infection and any signs of inflammation as well. As all 3 are biopsies, it makes sense to do them all together, it's not cheap though, but an ERA on its own is quite expensive x

I think my clinic only does the ERA, will check with them tommorow if they do the other two.

Thanks for the kind words @VenusStarr I hope you can see someone quickly as well

Wow at how quickly your Era Emma Alice results came back. I hope my repeat comes back this quickly too!

@Moonstarr it's the same lab that does the Emma and alice and they use the same sample. My clinic hasn't done the Emma and Alice before but I insisted on it and it was a good thing I did, I had 0.00% lactobacillus (good bacteria).

Yes @Moonstarr - this is a bit graphic, sorry but I had a sieve and bowl in the bathroom and used that. We stored it in a tupperware tub and kept it in the fridge overnight and took it in the next day. We had to sign paperwork to consent to tests and then what to do with them, we opted for sensitive disposal (sorry all the terms are really horrible). Xx