ERA / EMMA / ALICE testing thread 5(!)

[VenusStarr]

Just setting up a new thread as we're coming to the end of thread 4.

@Janefx40 @birdbybird @seven201 @Gardenlady543 @patientpatient @MyEasterEggs @thislittlebird @Yuliaaa @Violette22

❤️

@Gardenlady543 I'm afraid I haven't used PIO since I discovered Asda so I don't know. Maybe worth checking in with the surgery team if you are still sore just in case there is something they can do?

@2021ivfagain sorry about your consultation. I think it was a good decision that you didn't use all your embryos at once, even if it hasn't ended up working out this time.

Starting the cycle almost felt like a relief that we were finally at the end and would have our answer - good or bad. But there's no doubt that the 2WW was Uber pressurised knowing that so much hung on it.

Lovely to hear from you @Dochas12111

@seven201 really hope it all works out with the letrozole and that the early start doesn't effect anything x

@seven201

Hi. The issue is my fsh. I need to make sure it stays lower with medication doing oestrogen priming. I respond really well to stimulated FET but not with medicated. Therefore, there’s pressure to stay with stimulated. So one month could make a lot of difference in my situation. One month it got so high: I was highly stressed and did oestrogen priming but didn’t absorb all medication and took provera which was disastrous and my egg retrieval was cancelled. The next month had to work really hard so living with a concern that one day I won’t have any follicles. But strange thing is when I’ve done oestrogen priming I had quite a lot of follicles still.

Also need to sort out the microbiome issue my nutritionist has identified.
@Gardenlady543

Hope you’re doing better. I’m sorry you’re in pain. What are the next steps for you?

Have you heard of anyone being prescribed antibiotics for signs of candida from a swab? Thanks

Thanks @Dochas12111 I kept the hospital ones on initially then upgraded to my usual pants and was coping ok until I started back at work. I think maybe this is my body getting used to sitting in the chair. Hopefully I get used to it, I'm pant free in loose pjs today.

@2021ivfagain
I don't know about zumenon and Allicin, your specialist is worried in case they interact with the drugs you're taking so you'll have to ask someone to look that up.

The EMMA ALICE is looking at the microbiome, that isn't affected by a protocol. But the longer you wait to do a transfer means the microbiome has more opportunity to change. Eg mine was normal in November 2021, but it might not be normal now, nothing to do with the protocol though.

Candida is a fungus not bacteria, you will need antifungals to get rid of it. Oral fluconazole should NOT be used if you are trying to conceive. You are fine to use testament dose clotrimazole pessaries though.

ERA doesn't have a huge amount of data behind it, for what might change the result, what the lab say is that it is only relevant for the progesterone regime you take. If you change that then the lab would say do another test. Whether you need it at all is another question, in my case I'm ignoring the 2 I had and doing a transfer just slightly longer than the standard timing. Some people think the window of implantation is longer in natural cycles vs medicated FET by the way.

Sure upload the result of your swab and I can look at it, I'm obviously not an expert so you'll have to see what the people interpreting say. As far as I know it's the overall amount of lactobacillus that's important, I don't think anyone has defined which strains are the most important, the most evidence is l. Crispus in the evidence base. Some vaginal probiotics only have 1 strain in, so if someone used that kind of product then it would be expected that they would have mostly that strain. I like to mix and match products to let my body get a mixture of strains.

@seven201 hopefully the timing of letrozole isn't that important, it seemed like your clinic said it should be fine. It's so hard to know with timings, I have been doing LH tests to help predict my period timing, got something that looked kinda positive a few days ago, then stark white for days, then out of the blue today a definite positive.

@Gardenlady543 how are you feeling now? Was your ovulation on target to get the embryo transfer done before Xmas closure?

I just had my saline scan to check all the scar tissue has gone. It has! Woop woop. 3 follicles getting ready (bit early which I was expecting after weird period) so triggering later next week. I am so used to getting bad news that I am feeling excessively happy.

@seven201 that is great news. I'm so glad it went well and that you are finally ready to go!

Thanks! I really am chuffed. Currently hooked up to intralipids in CRP thinking about buying M&S walnut whips on my way back to the car park! Hope all is still good with you.

@seven201 oooo walnut whips is an insipired idea. I'm going to get some next time I'm out x

@seven201 that’s brilliant news! So chuffed for you 😀

Hi All. I really hope you don’t mind me gatecrashing this thread. I’ve only just joined I think really looking for support and understanding, maybe any insights as you all seem quite versed in lining issues. As lovely as my family and friends are they just can’t fully get the upset I’m feeling right now I feel so so alone with it. It’s been a horrible few days I’ve just felt like a crying mess.

We’ve been TTC over 2.5 yrs. I am 35 with endo and lowish (supposedly still normal range but very bottom) AMH. Husband’s (also 35) sperm “sparkling” says consultant. Only other test I’ve had so far is Hycosy which was fine. Day 21 progesterone suggests I ovulate. Never ever had a BFP.

1st cycle in May 22 was gutting only 1 egg retrieved but it did make it to 5 day blast grade 4AB. BFN
2nd cycle in August slightly better but on max dose FSH now and androgen priming. 3 eggs, 3 quality 5 day blast. Fresh transfer of 4AB BFN.

In both fresh cycles my lining has been borderline at 6-6.5mm (trilaminar) on day 10 and I needed extra oestrogen between ER and ET to get to this (in August crept to 6.9mm by day of ET)

Day 12 scan this week in the medicated FET just shown lining a very thin 4.2mm.

Been really gutted 😢 . They are rescanning Monday and increasing doses but think now only aim is to thicken enough to do endometrial biopsy and no hope of FET. I don’t want to waste good embryos unless lining is 7mm+. Not when I may not get embryos in future cycles given track record so far at EC.

I am really worried that there’s something wrong that means I just can’t develop a thick lining. I’ve never even heard of anyone with lining under 5mm on day 12!??

I’ve been doing EVERYTHING. Like every single tip and trick, already take probiotics etc, and am like ridiculously halo above my head healthy right now in terms of diet, moderate exercise, fluid intake (I’m sure you guys know the pain of feeling you’re sacrificing a lot sometimes with no apparent result). I just feel my uterus is broken and I’m letting my husband down. Sorry for pity fest!

I’ve asked my clinic if I can have hysteroscopy and the endometrial/TRIO biopsy at the same time. They only mentioned biopsy to me but from everything I’ve seen hysteroscopy is going to be important to know why my lining doesn’t develop see any adhesions etc especially given I have endo. Did you have both done together? How long did you have to then wait for next ET?

sorry for long post but wanted to give some background!

@Enfys23

Hi. I’m sorry you’re going through this. I’m 41 but TTC second baby. We’ve had male factor issues but now my age is a factor. I have high fsh. However, if you are doing a frozen transfer, I recommend a mild stimulated FET cycle with 10000iu gonasi trigger. On ovulation day my lining was 13.8mm. I did oestrogen priming for 8 days beforehand then on day 3 of period I took 225iu meriofert every other day.

The mild stimulated FET cycle was very good. I had to take progesterone day after transfer.

Thank you so much @2021ivfagain that is really helpful and something I’ll ask my consultant about.
I am sending lots of good vibes your way.

@Enfys23 has l-arginine been suggested to you? My nutritionist told me to get straight on it between baseline scan and transfer if I happened to struggle with lining issues during my FET cycle. Appreciate you’ve probably tried every other nutritional trick but though I’d mention this one.

I had the hysteroscopy and EndomeTRIO at the same time. Good luck ☺️

thats great to know they could do both together thanks @MyEasterEggs

I’ve only just discovered l-arginine recently- what brand/dose do you use?

@Enfys23 she recommended Solgar L-Arginine 1000mg. Think you can get it next day from Amazon. Start taking ASAP and stop after ET!

Thank you ❤

@Enfys23 I think a hysteroscopy or at least a saline sonogram sounds like a good idea. I've had ivf cycles cancelled in the past when my lining just wouldn't thicken enough. I think I had a 4mm measurement once. I usually manage to get to nearly 7 or occasionally 7, with lots of meds.

I’m sorry you’ve also had these issues. I’m definitely going to push for further tests when I go for the scan tomorrow. I just hope I don’t have to wait another month. I’m not sure if they can do hysteroscopy so last minute. I guess after starting progesterone go do the ERA test etc then it’ll be only a week or so warning for them to set it up.

@Enfys23 my ivf clinic don't do hysteroscopies at all but I did have my era/Alice/Emma there. Hysteroscopy is usually under full sedation or a general I think (I had sedation) so needs an anaesthetist. Saline sonogram again my ivf clinic don't do, I had to go elsewhere. Some
Ivf clinics are more set up for this kind of thing though.

Hey @Enfys23 so sorry it’s not worked out so far, it hasn’t for me either, though my issue is unexplained, but probably a combination of low progesterone, high NK cells and low oestrogen (though this doesn’t have a negative effect on my lining). It’s my fourth transfer on Wednesday, no BFP so far either. So, I just wanted to add some natural things, like pomegranate juice and Brazil nuts (maybe psychological, maybe not). I’ve also been on vitamin E on both natural and medicated cycles. Good luck.

The other thing to potentially add in for you both since it may help is beetroot juice. Beet It do an organic one in glass bottles with ginger which makes it more tolerable if you’re not a fan of the earthy taste! Plus the ginger is anti-oxidative and anti-inflammatory too.

Thanks so much everyone.
@seven201 I’m lucky that mine are set up for things like hysteroscopy and have anaesthetics on site. I’m sure it must be so hard to have to organise things between different care settings etc.

@OrangeBengal wishing you so much luck for Wednesday. It’s really hard never seeing those two lines and never knowing if it’ll happen for one isn’t it, I’m really hoping this is your time.

@MyEasterEggs haha my husband has been laughing at me trying to stomach the beetroot/ginger combo. When I was upset after the scan I threw it out saying what’s the point why am I putting myself through that! But I might restart it now I’m calmer. If anything might help, I’m willing to keep giving it a go. But yes not sure beetroot really doing much for me 😂the things we will do eh?! Vitamin E, Ubiquinol and pomegranate juice, and nuts definitely some of the nicer side of things vs beetroot 😖

@seven201 I think I’m on track for the timing, I have LIT again this week. I also started taking ferrous sulphate to try and get my ferritin up, I'm a bit worried as I had high transferrin sats in the past so will do a test next week. That’s great news about the saline scan!!!

Welcome @Enfys23 sorry to hear about what’s happened to date, I’ve never had a BFP either.

This article (dx.doi.org/10.1016/j.rbmo.2013.08.011) is on recurrent implantation failure and has a section on thin lining:
“Recurrent implantation failure may sometimes be associated with a thin endometrium (<7 mm) noted at the time of ultrasound examination on the day of HCG administration or embryo transfer. The observation suggests that the endometrium is not optimally responding to oestrogenic stimulation. There are several possible underlying causes. It may be congenital, associated with Turner’s syndrome or a T-shape uterus. It may also be acquired, as a consequence of previous radiotherapy to the pelvis or iatrogenic damage to the endometrium following intrauterine surgery or infection. From time to time, the underlying cause may not be obvious. In this particular clinical situation, hysteroscopic examination of the uterine cavity is recommended to rule out intrauterine adhesions or Asherman’s syndrome. Any intrauterine adhesion should be carefully removed with minimal thermal injury, under ultrasound guidance, by an experienced reproductive surgeon. The main challenge of intrauterine adhesiolysis is the prevention of recurrence of the adhesions.

This article talks about medical management options with thin lining: doi.org/10.1016/j.mefs.2016.09.001
The medical management is unlikely to help with adhesions or scarring, they'd need to be removed surgically.

I think a hysteroscopy with a specialist who is used to treating Ashermans syndrome would be the most sensible next step in your case. While you could do an ERA EMMA ALICE at the same time the hysteroscopy would have to specifically be on the right date and the right time after starting progesterone and the sample would have to be treated in a certain way, it’s quite a lot to coordinate.

Supplements and dietary changes haven’t made a difference for me, the only thing that helped was a high amount of estradiol.

@Gardenlady543 glad you are on track. I used to take something called Ferrograd C which was really great at getting my ferritin up. I think the combo with vit c helps us to absorb the ferritin. Easily available online.

@Enfys23 sorry about your lining. I've never done medicated cycles so it may be different but the only thing I would add to what others have said is that linings can thicken a lot before trigger/transfer. The relevant measurement is usually how thick it was at trigger or 7 days prior to transfer if there's no trigger/day you start progesterone.

It can increase a lot in a few days and I had a cycle (natural admittedly where my lining seemed dire until the day of trigger when it suddenly improved. Then I got Covid and we had to cancel anyway...but that's another story! Hope your scan goes well tomorrow x

Thanks for everyone’s support. And thanks so much @Gardenlady543 for that info. I hope all goes well for you.

Scan today did not go well. Lining worse than last week.

So will have to stop all meds and abandon this cycle. Said they would need to alter the regime as standard meds not been good. Maybe more transdermal. I’ve asked them about poss of low dose stims. Looking now at biopsy and hysteroscopy (they agreed to this) next month now. But then with wait for results (if we can get thick enough for biopsy) next embryo transfer likely not til January. Gutting.

Sorry to hear this news @Enfys23 I think you should prioritize a hysteroscopy, unless you can get your lining to around 8mm they are unlikely to do a biopsy. You seem to have an explanation for why things aren't working with the thin lining, so I wouldn't be going for the ERA EMMA ALICE in the first instance. You can always do this in the future if you can get your lining up. There is another option to look at your microbiome, a menstrual fluid microbiome test with fertilysis (fertilysis.com/tests/female-infections/fertilysis-female-microbiome), they only need a few drops of menstrual fluid.