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 I was so shocked when they emailed the Emma and Alice results.
I hope the treatment you've had has worked.
We could all use some good news on this thread xx

@VenusStarr

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

I will see if anything else passes in the next few days but what I saw last night did look like it could have been it. We'll see.

Big love to you both @Gardenlady543 and @VenusStarr . It's such a horrible time but I'm glad you'll both be getting some counselling. Sorry that you have to wait though.

@Moonstarr sorry for your loss. If I were in your shoes I think I'd do the pgt-a testing and the era/Alice/Emma then depending on those results decide on the embryo banking. I don't really know much about immune testing but I do take clexane and aspirin to help that side of things. If you can afford it then maybe just do it. I've recently signed the consent forms for my 4 little precious embryos to be tested. I've had failed 5 transfers now (but a dd 5 years ago and a naturally conceived miscarriage 3 1/2 years ago) so reached the point where I think testing our embryos is sensible as I'm 39 now. I am worried about how many will make it. It's going to be a worrying few weeks!

@seven201

Big love to you both *@Gardenlady543 and @VenusStarr* . It's such a horrible time but I'm glad you'll both be getting some counselling. Sorry that you have to wait though.

@Moonstarr sorry for your loss. If I were in your shoes I think I'd do the pgt-a testing and the era/Alice/Emma then depending on those results decide on the embryo banking. I don't really know much about immune testing but I do take clexane and aspirin to help that side of things. If you can afford it then maybe just do it. I've recently signed the consent forms for my 4 little precious embryos to be tested. I've had failed 5 transfers now (but a dd 5 years ago and a naturally conceived miscarriage 3 1/2 years ago) so reached the point where I think testing our embryos is sensible as I'm 39 now. I am worried about how many will make it. It's going to be a worrying few weeks!

Thanks for your advice, I think I will test the 4 frozen embryos then go from there. I am praying that they survive the thaw.

I have a thin uterus lining as well. But have managed with stims to get it to just over 8mm before egg transfer. I have done a Hyscopy and a biopsy and they all came back clear. No sign of ashermans. My progesterone levels have always been excellent, my clinic tests every 2 days up to transfer. Just confused about my thin uterus lining and do wonder if this plays a role in the implantation failures.

@Moonstarr I have had a lot of issues with my lining. On my original ultrasound scan at 9dpo my lining was just 5.4mm and I have light periods. It seemed to get up to 8-9mm in the cycles, but on transfer day it looked thin and patchy and when they went to take the biopsy for their era Emma Alice, the lining wasn't there, only blood was coming out even though it looked to be there on the scan.

Once I had the microflora issues treated with antibiotics and probiotics it improved, although my last transfer was still unsuccessful. I just went for this nk biopsy at 9dpo and my lining was 8.1mm, so a huge improvement. He got the biopsy first time and said it looked nice and healthy.

There are lots of options for thin lining if everything comes back fine on the tests. I'd discussed pentoxifylline and vitamin E and viagra. We've discuss G-CSF on this thread in the past, that's used too.

[quote Gardenlady543]@Moonstarr I have had a lot of issues with my lining. On my original ultrasound scan at 9dpo my lining was just 5.4mm and I have light periods. It seemed to get up to 8-9mm in the cycles, but on transfer day it looked thin and patchy and when they went to take the biopsy for their era Emma Alice, the lining wasn't there, only blood was coming out even though it looked to be there on the scan.

Once I had the microflora issues treated with antibiotics and probiotics it improved, although my last transfer was still unsuccessful. I just went for this nk biopsy at 9dpo and my lining was 8.1mm, so a huge improvement. He got the biopsy first time and said it looked nice and healthy.

There are lots of options for thin lining if everything comes back fine on the tests. I'd discussed pentoxifylline and vitamin E and viagra. We've discuss G-CSF on this thread in the past, that's used too.[/quote]
I have tried bit Vit E, it didn't make a difference. Pentoxifylline and G-CSF can these be bought over the counter?

My Dr doesn't seem concerned about the thin lining as it thickens up with medication for egg transfer but I am concerned that I may have some sort of bacterial infection as well.

If my clinic does not do the emma and alice tests, where can I get these done instead?

@Moonstarr
You'll need to find a specialist for G-CSF, I think we've spoken on here about Mr Gorgy doing it. Pentoxifylline will need to be prescribed. But it seems like you're in a similar position to me, the lining seems to thicken fine with estradiol, I have tried a lot of things: l-arginine, aspirin, vitamin E, all the diet stuff- it made not difference.

If you're in the UK any clinic offering the ERA should be able to do the EMMA and ALICE. It's usually around £1000 for the ERA and an extra £500 for the EMMA and ALICE. I would advise you to insist on them if doing the ERA.

[quote Gardenlady543]@Moonstarr
You'll need to find a specialist for G-CSF, I think we've spoken on here about Mr Gorgy doing it. Pentoxifylline will need to be prescribed. But it seems like you're in a similar position to me, the lining seems to thicken fine with estradiol, I have tried a lot of things: l-arginine, aspirin, vitamin E, all the diet stuff- it made not difference.

If you're in the UK any clinic offering the ERA should be able to do the EMMA and ALICE. It's usually around £1000 for the ERA and an extra £500 for the EMMA and ALICE. I would advise you to insist on them if doing the ERA.[/quote]
Thanks, will insist that they test for the EMMA and ALICE at the same time. I think I have made my mind about the tests moving forward. PGT, ERA, EMMA AND ALICE. I will throw everything at the 3rd round and see where it gets me.

That sounds like a good plan @Moonstarr do keep chatting to us on here, there's a few of us having ongoing tests and it's nice to have company while we're in the "IVF waiting room".

@Gardenlady543

That sounds like a good plan *@Moonstarr* do keep chatting to us on here, there's a few of us having ongoing tests and it's nice to have company while we're in the "IVF waiting room".

Will definitely come back and update.

Checked with clinic and they could also do the EMMA and ALICE test at the same time as the ERA. I am still a little undecided though if it is worth doing the ERA since in my case some sort of implantation took place in both pregnancies.

@Moonstarr yeah I agree, the thing is a lot of the cost is because your clinic will need to scan and monitor you and do the procedure to take the biopsy. That will be part of the cost that will go to your clinic and it wouldn't surprise me if that alone ends up costing £1000.

I was in the same position as I've got the ERA result already (pre receptive) with no need to repeat, I needed to just repeat the EMMA (this is the microflora part that was very abnormal), but my clinic had no cost estimate for the monitoring and procedures and I thought screw it let's just do the ERA again, in my case the microflora may have changed my implantation window anyway and it would be good if it comes back to say I'm receptive.

@Moonstarr I have thin lining issues but I think if you get to 8mm then you're actually ok. If mine gets about 7mm then my clinic transfers for me as I rarely get to 8mm. To help with my lining I have aspirin, viagra and two neupogen infusion into my uterus in the lead up to transfer. I don't think the aspirin and viagra make any difference for me but I'll keep taking them as the doctor tells me to! I think the neupogen does help but it's not cheap. I tried vitamin e and the other one l-arginine? (Can't remember) and made no difference so I've just left them in the drawer, along with all the other vitamins I've bought over the years! Is it triple line? I'm having my adhesion removed next month and I'm hoping that improves my lining thickness.

I think if you're doing the Emma/Alice then you might as well do the era. If you end up doing none of those three definitely get some vaginal and oral women's probiotics, as that can't do any harm.

Wow @Gardenlady543 8mm at 9dpo is great. I hope that's given you a little boost!

@seven201 I was surprised when he told me it was that thick. The only indication I have of my natural lining is it being 5.4mm on 9dpo back in September 2020 and in the natural cycle after my FET it was 7.4mm on the day of the LH surge. This was after the microflora had been treated. And then this recent measurement is the best thickness in a natural cycle so far. I'm not sure if it was the way he measured it.

I was told that where the adhesions were would not have affected the lining thickness but may have given the impression it was thinner as a kind of illusion. Then there's the fact I've had gel in after the hysteroscopy (no idea if this does anything to lining thickness) and also that I was told not to cross my legs. I'm now going to be super over the top about not crossing my legs in case that was the thing that did it!

I'll be interested to see how I do in the mock cycle, I'm going to be on a lower dose of estradiol this time to try and prevent my level going through the roof like it did in the last FET.

I hope you can get your surgery done ASAP. It sounds like it's really going to help.

Question for @Cream123 can a luteral phase be short after a hysteroscopy? I ovulated around day 18, I'm now 11dpo and it looks like I'm coming on my bleed, I didn't expect this until Monday. No chance of pregnancy at all, as we had to abstain after the hysteroscopy and for the nk biopsy.

My additional update is my fertility specialist called me after I sent emails updating her on the hysteroscopy and Nk biopsy. She said as long as there is enough tissue they will try to do the nk biopsy with the ERA/EMMA. And I broached the idea of another collection if the next transfer doesn't work to bank embryos, with the transfer of one of my euploids. She said that's fine from her perspective but I'd have to speak with Access.

@Gardenlady543 my periods were always a bit whack the one after a procedure tbh. So it coukd just be that….I wonder if what mr trew did helped. The usa lot are always saying scarring in one small area can impact the whole lining development ….

@seven201 hope ur feeling better now the news has sunk in.

@Moonstarr welcome. I had a thin lining prior to my son too. And had 6mc I wonder if it played a role in the mc. I usually got to 6mm even on stims.
What helped with my sons cycle (I got to 7mm) was
Gcsf wash - mr Gorgy will just do these for u on set times in cycle
Viagra
Asprin
1000u of vit e
A lot of l arginine
I’ve read about tamoxifen being used which was my next try but I didn’t need to

Link to new thread as this one is nearly full

www.mumsnet.com/Talk/infertility/4333916-era-alice-emma-testing-thread-2