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!

@Cream123 thank you. I feel bad about worrying about myself when my sister is having the worst time ever. My family didn't tell me about the lump (it was found at the weekend) until today as they knew I've been a mess on the drugs so didn't want to add to that. I am seriously over this cycle. The drugs have affected me so much this time. I have my second neupogen infusion tomorrow and that should mean biopsy on Tuesday 🤞. I think all the estrogen meds gave me mild thrush so I've had to treat that . My vision went a bit weird the other day, just for a second and only the once - it's listed as a common side effect from the viagra!

It's good they've given you the green light. My clinic is start between cd2-4. Give them a call in the morning to see what they say but it's probably ok. There's always something to worry about isn't there! Sometimes it's ok to not force yourself to positive and just let yourself feel sorry for yourself for a bit!

@Gardenlady543 sorry about the deflated feeling. Not long until hsg at least. Sorry, I have no idea about the cramping. Does it say anything in the paperwork you were given? Good idea to dip test your urine to be safe. Make sure you drink plenty of water.

@Gardenlady543 by end of journey ive obviously meant a baby!

@seven201 sorry about it all. Just all of it! Ur sister and the drugs and feeling shit. The era really affected me too I wonder if it’s coz u know ur not transferring it just feels like a bigger drag and the side effects seem less tolerable? But I found it really though ! Wonder how I find it when I start oestrogen this time I hope I don’t feel as sick!!! I’m sure they will get through things quickly with us sister so I hope she has answers soon.

@seven201 it sounds like a nightmare, the good thing about the ERA cycle is that you can stop everything as soon as the biopsy is done and go back to feeling normal.

@Cream123 you’re right with the hsg I should know if there’s any damage when they do that, otherwise it might not be picked up for months. I’ve been reading about others who were worried about the era with ashermans on the FB groups but people say their specialists have reassured them that it’s not invasive and it should be fine.

I’m on such a rollercoaster right now, first I was happy that there might be something treatable, now I’m thinking about every possible diagnosis and what it would mean. My DH has always been very chilled out about children, he’s happy with or without. I asked him tonight what he would feel if I can’t have children and if he’d want to leave me for someone who can. He said of course not and that he’s more than happy with me and our dogs, so that’s a plus that I don’t have that extra pressure.

Are you both on neupogen? How did the clinics decide to put you on it? My specialist has mentioned a long course of estradiol, the aspirin and Pentoxifylline. But hasn’t discussed other options. If all these tests come back as negative then it may have to be a case of throwing everything at me for the lining.

@Cream123 it could be that it feels worse because there's no embryo going in! It seems to effect me differently each time. I had one round where I had a permanent bad headache all cycle.

@Gardenlady543 sorry about the rollercoaster. I'm so glad you have such a supportive dh. I bet you've been building up to ask that question!

What's Pentoxifylline? I'm on 12mg estradiol (some oral, some vaginal) a day, 200mg estrogen patches every 72 hrs, aspirin (75 although I'm wondering if that should be 150), viagra and the 2 neupogen infusions, all to try and help my thin lining. I got the impression I was on max dose of everything and there wasn't anything else they could try. I did Google 'neupogen infusion ivf' this evening and the clinic I looked at talks about also injecting it 🤷🏻‍♀️.

@seven201 yes usually I don’t feel sick (maybe just odd day) this time was every single day! I’m on the neupogen injections but I’m undecided about this time due to covid it’s not an immune suppressant and I’m doubly vaccinated but still unsure I took it with my son ....if I do it will be post transfer as I didn’t do it on era cycle

So full heavy flow started overnight. So today is cd1 correct? Protocol due to be uploaded today but u can start oestrogen on day 2 or 3 correct? Getting myself in a right tizz coz my lining isn’t great quality and I’ve booked holiday for a week and period came early my dates r all off. It’s a manageable but I’m trying to optimise scan times esp as I need my ashermans consultant to sign my lining off too. Why is it such a struggle balancing it all! If my lining doesn’t behave at all I’m going to be away when they may need me to rescan ....let’s just ignore that and hope it behaves!

Also care do FET on a sat don’t they? I know the scan and do collections...

@Gardenlady543 my neupogen is from mr gorgy in London. I see him for immune add ons

@Cream123 typical that it might clash with your holiday. Hopefully not but if it does you should be able to arrange visiting a different care clinic. I think different categories clinics do things on different days as mine rarely do things on a Saturday morning (I wish they would) and open 9-5 only I think. It's such a juggle around work! My care clinic start estrogen on day 2, 3 or 4 (I was 4 for this cycle).

@Cream123 can you not just take for longer and then scan after holiday

That’s what I ended up doing for a fet

Lining was scanned when back and as 1.1 we continued the fet

If it was too low or thick we would have stopped abs started following month

That was the one cycle . Our 5th that worked

Not sure if the extra progynova or just finally ivf worked

The drugs of 6mg if I R.E.M. correctly are the Lee the lining ag the thickness

Then start pesseries after scan after holiday

Hope that makes sense

Hi all. Can I jump on? I’m expecting day 1 next week and I’ll be starting FET protocol for doing an ERA/ALICE/EMMA.

I have only done two transfers and only one was a blast (other was a morula) bit it took me 6 rounds of ivf to make 4 blasts (untested) so I would hate to put one back and find out if didn’t take as I needed something so simple like a course of antibiotics! I’ve also had immune testing done so I’ll be on low level of steroids and I’m getting Thrombophelia tests done too to see if I need to go on Clexane. Just trying to tick as many boxes as possible and hope one of the embryos is genetically normal!

Thanks girls. Yes I think I’ll actually manage to it all after some working out ! I’ll keep on the oestrogen a few days more and start the progesterone while on holiday. Just hope lining behaves Abs I don’t need a scan while away best start looking for some private clinics!

Welcome @ForeverAintEnough12

My Period is quite heavy whoopy!

@Cream123

Thanks girls. Yes I think I’ll actually manage to it all after some working out ! I’ll keep on the oestrogen a few days more and start the progesterone while on holiday. Just hope lining behaves Abs I don’t need a scan while away best start looking for some private clinics!

Welcome @ForeverAintEnough12

My Period is quite heavy whoopy!

Fingers crossed

Mine was ok

@ForeverAintEnough12

Hi all. Can I jump on? I’m expecting day 1 next week and I’ll be starting FET protocol for doing an ERA/ALICE/EMMA.

I have only done two transfers and only one was a blast (other was a morula) bit it took me 6 rounds of ivf to make 4 blasts (untested) so I would hate to put one back and find out if didn’t take as I needed something so simple like a course of antibiotics! I’ve also had immune testing done so I’ll be on low level of steroids and I’m getting Thrombophelia tests done too to see if I need to go on Clexane. Just trying to tick as many boxes as possible and hope one of the embryos is genetically normal!

Welcome. Sounds very sensible to do all the testing now.

@Cream123

Thanks girls. Yes I think I’ll actually manage to it all after some working out ! I’ll keep on the oestrogen a few days more and start the progesterone while on holiday. Just hope lining behaves Abs I don’t need a scan while away best start looking for some private clinics!

Welcome @ForeverAintEnough12

My Period is quite heavy whoopy!

Glad it looks like it's going to work out timing wise!

I had my second neupogen infusion today. Doctor scanned me and asked me to go empty my bladder (I had been to the loo 10 mins before) but it turned out to be my cyst getting in the way! She struggled to measure my lining but one measurement was 8.1!! I've never got to that thick before! 7.3 is 'good' for me. Annoyingly though they won't give me progesterone after the biopsy on Tuesday. They want me to have a normal cycle between to leave enough time for test results and treatment. I'm trying to be fine with this.

Hi @ForeverAintEnough12 you definitely qualify to be in this group I had my ERA/EMMA/ALICE after 2 unsuccessful transfers. I had the procedure 2 weeks ago, my specialist had issues getting a sample and now I’m being investigated for Ashermans, she did get the sample on the third attempt so I’m waiting for the results and a HSG now. I’ll be on aspirin and heparin in future cycles because they found a PAI mutation on my blood tests, I don’t think there is much evidence for it, but I’ll happily try anything.

@seven201 pentoxifylline is an option for thin lining, this article talks about the various options. www.sciencedirect.com/science/article/pii/S1110569017302947 My specialist mentioned it because I have raynauds. We were holding off but if everything comes back as normal I will ask her to give me everything that can help with lining.
Are they infusing the neupogen in your uterus or is it an injection. I used to prescribe it when I worked in oncology. Who is doing your infusion, is it your clinic? They wanted me to have a natural cycle inbetween too, I was just told to continue the progesterone for a few days to allow the protocol to be set up in time as the results take about 3 weeks.

@Cream123 That’s interesting about the neupogen infusion how much does Mr Gorgy / the neupogen cost? Do you have to get it done in his clinic? Good news you’ve got heavy flow for the lining moving forward!

@Gardenlady543 thank you for the link on pentoxifylline, I'll take a look later.

Yes, my clinic do the infusion into my uterus. It seems to have helped a little. Every little bit helps! I've heard it was also used on covid patients (there was a shortage in February), but not sure if it still is.

I did have acupuncture on Monday so that may have helped my lining too

@seven201 love your “Im trying to be fine with this”. To be fair if something backs back postive in Emma and or Alice u can’t go st into a cycle (regardless of the fact that some think it should be on a withdrawal bleed).
It took exactly 4 weeks for my results (!) bank holidays made it a bit longer and I’m actually going to be finishing off my Emma treatment during my FET . Ideally I would wish to have finished tx and then go but I can’t bear waiting anymore! So I’m going (but had this month off so it’s with a natural period). Great news with the lining - it helped when I was trying for my son too.

@Gardenlady543 gorgy is pretty exp. and he’s not got the best bedside manner(!) and I’m not sure what I think of him but he’s very flexible and I kinda pick and choose what add ons I want with his guidance. Care are great but we’re not forward enough with outnof the box tx so I just went elsewhere - it’s confusing juggling them all but oh well!

So he bascually injects it into ur uterus and that’s it -it’s about 80 quid for the vial and 200 for the procedure I think. I inject a small amount of it (24units I think) every day. - there is some evidence for recurrent mc which is why I used it for my son. Undecided about this time.

I’ve started!! My last fresh was in October been waiting what feels like forever for it!

@Cream123 congratulations!!

Yay @Cream123 Is this a fresh cycle? For some reason I thought you were having a FET.

No it’s a fet
I mean my fresh to make my
Embryos was in October and I’ve been wanting to get going for ages!

I've realised I have no clue what actually happens in the ERA. Empty bladder or full? Should I take paracetamol before (I assume there's no anaesthetic involved)? Is it sore? I should have asked the doctor but it just didn't occur to me until just now!

@Cream123 ah that makes sense, everything takes so long, my FET transfer was January/February and who knows when I’ll be able to do another.

@seven201 it’s a comfortably full bladder that you’ll need, take a couple of paracetamol before you head in there. It isn’t sore, it’s just uncomfortable as there’s a full bladder and a speculum in, in my case as there were 3 attempts it meant it took longer than it should. The actual biopsy isn’t painful, my specialist said she used suction and they only remove a piece of the lining that would come out in menstruation, so you might get a light cramp but it really isn’t that bad.

Take a pregnancy test that morning because the clinic told me when I got there that I had to take one before they could do any procedure in the uterus and that I should have done one, despite them not telling me too! Anyway it meant I had to do it there and then and that added about 10 minutes extra to the whole situation which is a long time when you have a very full bladder.

@seven201 yep as garden says. Para an hour before and it’s over quick and really didn’t hurt me during or after it. I went in after drinking about 350 MPS an hour before and it was just right. I’m a bit obessed with how full my bladder is as due to my niche the catheter can get stuck into it and I’ve worked out from my Last transfer things go in smoothly with that amount!