ERA/ALICE/EMMA testing thread 2

[seven201]

Link to the old thread
https://www.mumsnet.com/Talk/infertility/4187520-era-testing-after-multiple-implantation-failures-anyone-had-it-done?msgid=110302437&utmsource=mentions&utmmmedium=email&utmcampaign=2020-10-19&utmmterm=You+have+been+mentioned+in+a+post&rei=438192#110302437

Welcome to the new thread. Anyone welcome.

Hi @Saraah30 it doesn’t, you would need microscopy, culture and sensitivity (MC&S) of a sample to achieve this and I’ve not heard of this being performed on uterine tissue.

The EMMA/ALICE is “based on DNA extraction followed by amplification and
sequencing of the bacterial 16S ribosomal RNA gene.”

It is essentially telling you the proportion of bacteria present based on what is there genetically. That can help select the most appropriate antibiotic.

If there is a concern that dysbiotic bacteria may be resistant to certain antibiotics then I would suggest ensuring the test is repeated after treatment.

@seven201 The first NK biopsy took just over 3 weeks, so I think it will be the week after this week at least. I hope you're ok, I hate PMS symptoms! When I had the mirena coil I didn’t have any periods, but I know some people do despite it. I was taking progesterone but only a couple of utrogestans a day after my ERA EMMA biopsy repeat and that clearly wasn’t enough because I started spotting and I just thought oh screw it I don’t think I’m going to hold it off. You should still have enough time shouldn’t you if the period started now? having October as a month off and having a cycle in November? Really annoying about the contact, can you ask for your specialist’s secretary? I just email them directly.

Thank you @Gardenlady543 I'm on 4 estrogen tablets a day too so just a bit confused by what is normal as I had thought it was all meant to stop a period. It probably doesn't actually matter at all. Yes, hopefully I can start my next FET early November 🤞, so It probably makes no difference.

It's good you have a rough time for the results. Hopefully they'll come on the sooner end of the scale.

Oh that's interesting @seven201 with the estradiol, progesterone and coil I would have thought a period would have been held off. I wonder if it's post op bleeding still. At least your appointment is soon so you can ask what's going on when you have the coil taken out.

I've had less cramps and slightly less bleeding this evening so who knows what's going on.

@seven201 my af was all over the place post lower op. Sometimes depending on when u have the op the oestrogen isn’t enough to stop Ovulation so u kinda have a period and then another one a few days after stopping progesterone. It’s very confusing!!!!

Thanks @Cream123 . That makes sense.

My coil is out 🎉. And I don't need to go back for a scan in two weeks like originally planned as he did it today. All looking good in there. Found out he did the shave the edge of the niche option, cut the adhesion (got to see a pic of that!) and drained or removed the cyst. So allowed to get trying again!

Ahhh @seven201 that's amazing news! Sounds like he was really happy with the outcome of the surgery! Are you going to try this month with a plan for a FET in the cycle after?

Yes, that's the plan! Just hope my ivf clinic get back to me and say there's a space. I'm so glad I don't have to go back again in two weeks.

@seven201 that must have been a nice surprise then, finding out it's done and you don't need to go back :)

I'm sure there will be capacity, the last time I spoke to my clinic they said it was quiet. I feel like Care juggle things around a lot to fit people in.

Brilliant news @seven201 🥳 hopefully you get get started on your FET with one of your little ones embabies

Thank you!

Just been for my acupuncture, she seems quite nice. She focused on my lining today as I've got my first scan tomorrow for my FET 🤞 she's put little seeds in my ears too.

How is everyone getting on? X

Oh yay @VenusStarr I'm really glad this was a good experience, you never know you might end up liking her more than the usual one you go to. Also glad you got to try out the ear seeds! I found them quite good, I even bought my own seeds from Amazon so I could keep putting them on!

Oh, I didn't know you could buy them @Gardenlady543! I'll have a look.

She also suggested that I try going gluten free, do you eat gluten? I can see my husband having a gigantic eye roll when I tell him 😂 but I've just been doing some research and it doesn't seem that bad (she says!) will definitely help me cut down on biscuits and cake!

@VenusStarr

I think we might have had a chat on here about diet not that long ago.

There's a systematic review on diet and Ivf outcomes here that basically says no particular diet has evidence of improving outcomes

I'm a big believer in diet and health (I'm a life long vegan) but I mean I'm infertile despite a super healthy diet and I'm not sure that dietary changes would make any difference. If gluten was such an issue then surely people eating loads of gluten wouldn't ever get pregnant.

@VenusStarr I'm sure you've already read It Starts With An Egg. I think she only recommends gluten free diet for women with celiac disease, endometriosis or auto immune disease but says it can't hurt.

@Gardenlady543 the problem with systematic reviews is that they tend to only consider a certain standard of research but many things don't get funding to do those kinds of trials. Although I tend to agree that it's clearly not essential for most people, I do think diet can have a small impact on fertility for certain groups of women. It Starts with an Egg looks at different standards of evidence where large clinical trials don't exist

I didn't give up gluten for my collection cycles but I reduced my carbs so much that I was effectively gluten free or very low gluten. I will go back on the diet 6 weeks before transfer :(

@Janefx40 Unfortunately the evidence base in relation to diet across the board is poor. Research costs money and nobody wants to pump it into something that won’t lead to a ROI. But it’s impossible to make evidence based decisions when the evidence doesn’t exist and if evidence is of such poor quality that it wouldn’t meet the inclusion criteria of a metaanalysis or systematic review, then it really isn’t good enough to make a decision to change behaviour on. My concern is that if someone is to change their diet dramatically based on poor quality research then they are likely going to be putting themselves under significant stress for no reason.

I am a big believer in diet and health and I’d always advise people to eat a healthy balanced diet. But I’ve not seen any evidence that would make me want to drastically change my diet.

@Gardenlady543 well I definitely agree with you about the stress. I very rarely mention diet etc on threads and even if it comes up I tend to be cautious. I remember when I first read about it, I panicked because I hadn't been doing it and was about to start a cycle (which worked!). But when I had to do fresh cycles at age 44 I was ready to do it.

Xxx

Hi all, had my lining scan today (cd8) and my lining was 6.2mm. I'm back on Monday and hoping I'll be ready. Is that OK for day 8?

Thanks for sharing @Gardenlady543 and @Janefx40, it's hard not to put pressure ourselves and question everything isn't it?

How are you @seven201? X

@VenusStarr that's fine for CD8, they don't normally scan me that early, the earliest I have ever been scanned was CD9 and I was 6.4 and this was my best cycle where I got up to 9mm. In my most recent ERA I was 6.6 on CD11.

Thank you @Gardenlady543 I had a nurse training, so she struggled a bit. Plus I have a tilted uterus and fibroids, so it's a bit bulky too. They said they'd been reading my protocol before I went in and that they'd not seen anyone on so many meds and that I was complex 😐

Not a great use of words for the nurse to use @VenusStarr my specialist tells me all the staff know about me as I'm a complicated case, so you're not alone.

@VenusStarr hmmm always good to be special I guess...doesn't sound like the ideal choice of words. But great to have done the first scan. I'm afraid I know nothing about linings at all!

I think my period is about to start bang on cue. Feel wierdly proud of my body for managing a normal luteal phase after being messed around so much.

Well I'm not sure what to think of this news, my microflora continues to be awful:

EMMA May 2021
Lactobacillus 0.00%
Gardnerella 45%
Prevotella 16%
Bifidobacterium 10%
Atopobium 10%
Megasphaera 7%
Others 11%

EMMA August 2021 after 7 days coamoxiclav and 10 days vaginal probiotics, plus regular vaginal probiotics and daily oral probiotics
Lactobacillus 0.00%
Gardnerella 80%
Bifidobacterium 15%
Others 4%

ERA May 2021
Pre receptive recommends 145 hours, no need to repeat.

ERA August 2021- done at 145 hours
Early receptive - needs 156 hours, no need to repeat.
They think I'm a slow responder and say at least I'm now early receptive rather than prereceptive.

The lab are now recommending metronidazole, basically the garderalla is obviously pretty bad stuff and it's resistant to coamoxiclav, so while that antibiotic killed off most other dysbiotic bacteria, all that did was give the garderella a chance to florish more.

My specialist is going to speak with the lab and find out if they can do sensitivity testing on the biopsy they have. Basically we need to know whether metronidazole will work or not. But I'm not holding out much hope of them being able to do that.

I'm honestly beyond fed up, in one sense I'm glad that I have a reason for the unsuccessful euploid transfer. But all this does is delay things further. I'm glad I did the repeat biopsy. I guess maybe the issues I had with my lining were due to the other bacteria there, as the quality seemed to improve.

It looks like I'll be going into a third ERA EMMA in November.

@VenusStarr that sounds a good measurement to me. Gosh that was a bit insensitive. I always get "there any drugs you're not on?" or similar when I have ivf booking appts!

@Janefx40 well done your body for being on time.

@Gardenlady543 oh my goodness!!! What a shock that must be. I'm so sorry that it hasn't been sorted. I hope the lab are able to offer your doctor some ideas for treatment through further testing of the sample. Soooo frustrating the time this is going to add on to everything.