ERA EMMA ALICE testing thread #6

[Gardenlady543]

@Janefx40 @birdbybird @seven201 @Gardenlady543 @patientpatient @MyEasterEggs @thislittlebird @Yuliaaa @Violette22 @2021ivfagain @OrangeBengal @Enfys23 @Loz2467 @DEIVF @Hopeful199 @ER12 @greendress789 @Douchas12111 @Lori2022 @AdviceForJane @Anonbaby @Molls87 @ChickenT2b @GoldenElephant @IVF22 @StillTrying10000 @warrior101 @whatcangowrong @Yaynayokay

Oh yes it really has happened we are onto thread #6.

All are welcome to join us, we started out as people interested in ERA EMMA ALICE but we seem to have had every test available between us.

So if you want to know about the microbiome, reproductive immunology or you just feel your case is complicated and what like minded people to talk to about it you've come to the right place

@CailinInUK thank you for replying! I see. So do people get Alice or Emma or both? Would a logical step be to do the immunes first and then if still no answer then do the ERA testing? What is the treatment for ERA? I think I read with immunes etc it is steroids amongst others.

@Zest11

EMMA ALICE is undertaken as one test, it's looking at the microbiome in the uterus, the EMMA looks at various types of bacteria including good bacteria, the ALICE is specifically stating if there are bacteria present that are associated with endometritis (inflammation of the uterus). I wrote about the microbiome here https://www.reddit.com/r/infertility/comments/rwsxwy/theuterineemicrobiomeemmaaliceemenstrualfluid/?utmmsource=share&utmmedium=iossapp&utm_name=iossmf

ERA is a test to look for the window of implantation based on the gene expression profile. The company that made the test will say whether they think at the standard transfer timing when a biopsy is taken, the endometrium is pre receptive, early receptive, receptive or post receptive. If it is not receptive then they will advise the transfer timing is adjusted. It's a pretty debated test. Some specialists think it's good, some think it's expensive and doesn't make a difference.

Immune tests are even more controversial, again a lot of specialists don't believe in it at all. People with implantation failure and miscarriages often go down this route though as we end up running out of evidence based avenues to explore.

@Zest11 personally, I would do PGT-a before/as well as doing the above tests, depending on your age.
you normally get Emma and Alice done at same time as it’s the one biopsy. Could also use this biopsy to do ERA too, though it would need to be timed and prepped to reflect your transfer protocol if ERA being done.

@Gardenlady543

Excellent news on progesterone and I am pleased the transfer went ok. I got pregnant with my son and he was either 6B+B+ or 6B-B- as it was a double transfer.

Are you taking ivig as well as prednisone? An article I found said certain probiotics can expose people to lactobacillus infections if their immune system is severely compromised. The thing is I will be on a lot and I take a lot of oral probiotics which have dramatically improved ibs, prevent thrush and other vaginal infections. I’m just feeling a bit worried as I will be on an awful lot of steroid medication.

I had lots of blood tests today to test liver function and glucose as ivig can affect it.

@Janefx40 Are you still taking ivig? Did it cause any issues? Also do you take oral probiotics?

@CailinInUK we are a same sex couple so no diagnosis but just not getting pregnant. I’ve had thrombophilia bloods and fertilysis microbiome. Thinking whether I need hysteroscopy, immune…who knows but implantation just never happens 😞

@2021ivfagain I was told to stop probiotics when on steroids as bacteria can multiply more than wanted but not sure if this is definitely necessary x

@2021ivfagain that's interesting, can you share the article, I'd like to have a read. Always interested in this stuff.

My protocol is hydroxychloroquine 200mg twice a day for the last few months, LITx4, prednisolone 25mg from cd7, clexane from cd7, intralipids on CD9 and lots of progesterone. I'm not on IvIg I don't think I'd be able to afford to add them in, the specialist didn't mention them yet. He wanted to do the LIT and this protocol.

@Gardenlady543
www.optibacprobiotics.com/faqs/suitability/probiotics-not-suitable-immunosuppressed

I will be having uterine hcg and uterine neupogen before transfer for low nk cells in endometrium and ivig drip as well as prednisone steroids for slightly high nk cells.

I’m not on intrallipids.

@2021ivfagain I just had a quick search, I think it is because there is a handful of cases in the literature where people who seem to be extremely immunocompromised eg a transplant patient on multiple immunosuppressants and a inflammatory bowel patient on biological treatment, ended up with systemic infections due to lactobacillus. But the couple of articles I read didn't indicate these people were taking prob too s. So I don't know, I would have thought these probiotics are so common in infertility patients and nobody has told me not to take them. I have been using strong vagina probiotics daily up until a couple of days ago, maybe it has helped my microbiome a lot as my pH is spot on! I would say to ask your specialist but I've not found anyone who knows anything about the microbiome aside from the fertilysis doctor.

@Gardenlady543 Also on inhixa blood thinners once a day from ovulation confirmed. I’m taking 400mg cyclogest twice a day rectally and lubion 25mg twice a day. My progesterone was 113 when I did it last month for biopsy, but your level is really good.

@2021ivfagain your regime is very similar to mine, as I alternate between pio on one day and lubion twice the next. I also have some of my own progesterone from the follicle which is what the doctor thinks has pushed it up. And I know the hcg which is still around encourages the follicle to make more progesterone.

@Gardenlady543

Thank you. I will double check anyway. My consultant wants me to keep taking vaginal probiotics until transfer anyway. I might have to reduce the amount of oral probiotics I take as well. Currently, I take prebiotic every day, two Saccharomyces boulardii, one probiotic for ibs and a probiotic with lactobacillus crispatus. Do you take oral probiotics?

can I ask what your ph is? My lowest has been 4.2. I’m still on canesbalance as norethisterone affects it but seem to be better now.

I do not take pio. When I did IVF before, I took lentogest a few times a week and crinone twice a day. I’m only on 850mg progesterone a day but it seems to work. I might track my progesterone half way through as I’m not taking as much as you. However, I take 10000 iu gonasi.

@Enfys23 I haven't found anything that works to help my lining. I've tried estrogen (12mg tablets plus 200mg patches), viagra, l'arganine, vit e, acupuncture, ubiquinol 200x3 a day and probably some Other stuff I've forgotten. The only thing that might make a difference for me
Is neupogen infusions into the uterus but I've always been a bit sceptical if they just do a generous measurement a couple of days after that as it's expensive and they're justifying it that way or maybe my lining is just better when very close to transfer day. I've not tried everything though. My lining is good if it gets near to 7. I have had 4 pregnancies with it at its presumably thin state though, so it's not 'everything'. CRP don't think it's anything to do with my miscarriages.

@2021ivfagain annoying they won't accept one of your blood tests. So annoying!

@Lori2022 sorry your latest try failed. Have you had a hysteroscopy or saline sonogram?

@Addidas thank you for that. That's given me
Some reassurance. Are you pregnant or already had the baby? This series of threads has been running a looong time!

@Zest11 welcome. If money isn't an issue I'd do bough the era/Alice/Emma and immune testing personally. I did them about a year apart and they both showed problems. If you implant please then maybe no need for the era part.

@Gardenlady543 well done for getting through the day. I've had a couple of Transfers where they've faffed about with different sized catheters. As long as the embryo itself goes in smoothly I think It's fine. I hope the next couple
of weeks go quickly for you.

On the subject of probiotics. I take two a day orally and sporadically vaginally. We're in the ttc window but i think I'll do one the night after we've finished and another a few days later. I always find myself a little itchy after 'the window' so I'd rather use them than not. Always hard to know what's the right decision!

Not heard back about a Mr Lower appt yet, but I think it's the right course of action for me and my silly uterus!

@Gardenlady543 wow, thank you for sending me the link, you are really knowledgeable!
And I know what you mean about running out of evidenced based options!

@CailinInUK thank you!

@seven201 sorry it’s cream!

@Gardenlady543 wishing you so much luck! Sounds good about your lining too! So fingers crossed for you and I hope you get to give us all good news very soon!

you’ve helped so many people on the forum I hope it’s your turn!

im still super paranoid about my lining and endo and had another chat with my Dr this morning. He said although my lining is thinner he’s seen it with the hyterscopy and appears fine and biopsy came back as no Inflamtion or infection ( although I’m sure it wasn’t the Emma and Alice) it was probably just a standard one. He said to me many people can have very superficial endo that doesn’t affect anything. The main reason endo affects IVF is if it’s in the ovaries as it affects the egg quality etc. So I’m hoping he is right. I do just worry as my lining thickeness was only 6mm at 5 days past ovulation and if they transfer at 5 days past egg retrieval then surely it’s going to be thin again xx

I also only have 1 scan which will be day 10 and then egg retrieval on day 12 if it’s all gone to plan! Makes me worry that 2 days before potential transfer my lining could be naff and wouldn’t be much time to do anything about it? Xxx

@seven201 thank you for replying! It's hard to know what the right thing to do is. Our son is 2.5 so we did implant. We also had an FET a few months ago but lost at 5.5wks. There was a yolk sac and pregnancy sac but then the other 2 transfers since my son completely failed and e.v.e.r.y month we try naturally and nothing happens. It is beyond frustrating. I was reading a post from you from another thread. I am sorry to hear about the mc you had a few months ago. It's gutting isn't it? What are your plans now? X

@CailinInUK hoping you can get everything sorted. This is my first time at IVF so I’m worrying about everything! Have you used the other company yet? My partners getting my script on Friday then I’ll email them. Xx

@Loz2467 Hi, not tried the drug company for stims yet. I’m still waiting for period post late miscarriage and for my consultant to agree my protocol/give prescription. Did I read right that you have only one scan arranged during a stimulation ivf cycle at Day 10? I personally would prefer to start monitoring earlier but perhaps I’ve misunderstood your message.

@Lori2022 I feel your frustration, I also didn’t start this journey for infertility (I’ve never tried naturally). I’m in it to avoid passing on a genetic condition from DH’s side and here I am seven years later still in it with 12 stim cycles, 4 FETs, one early miscarriage and one devastating late miscarriage this Nov. Thankfully one daughter age 3 after 8 stim cycles (worth every injection and penny). We’ve been unlucky with the 50:50 genetic testing with most of our banked euploid embryos affected. Plus I’m 43 and about to start more stim cycles, I must be crazy. Fully aware of the low success rates at this age but I made a euploid and got to 20 weeks this year age 43 so hoping I can again.

What age is the person who provided the egg, was was it you or your partner? Depending on age I’d consider PGT-A alongside other investigations, if financially possible.

@Addidas hahaha! I thought I didn't remember an adidas but didn't want to be rude! Thanks for message. Hope all is well with bubs!

@Zest11 sorry about your loss and struggles.
In your shoes after reading your update I think you should get immune tests. From what I understand (which isn't a lot) It's quite common for the first baby/pregnancy to trigger an immune response. In my case my body seems to attack embryos. 3 of my losses were before 6 weeks, 1 at 7/8 weeks. If you're near Surrey or london I'd recommend the CRP clinic. I have a new (returned) problem of fluid in my uterus probably linked to my c-section niche, so need to get that looked into. Otherwise we'd been doing letrazole superovulation rounds. I do have one embryo left in the freezer so may use that next year. I'm 40, so am feeling the clock ticking!

@Gardenlady543 congrats on your transfer. I just logged on to see how it went. I think grades are fairly irrelevant. This one wasn't fully expanded which I worried about but it worked out anyway.

Glad it's on board.

Welcome new people and hope everyone else is doing ok xxx

@CailinInUK Im so sorry about your late miscarriage it’s devastating isn’t it. I had one at 19 weeks last Feb and have had secondary infertility since. 😞 I want to tick IVF off the list to say we tried everything even though I know nothing will be taken lightly.

Yeah I’m with Care and had my call with the nurses yesterday and mentioned the scan to her and she said they used to do one on day 8 too but just say 10 now. I might ring up and ask for another to see how things are progressing because it’s my first chance at IVF and plus I do think I have thin lining issues. Even if they charge what’s an extra £150 in the grand scheme of everything we are spending. I feel too nervous to just have one scan 2 days before potential egg retrieval. What if I need added estrogen etc to thicken my lining surely it will be too late? I don’t really know much about IVF.

@Loz2467 that is so late I was having my collection close to then, they scanned me from CD6 as I have a high AFC.

@2021ivfagain I have used vaginal probiotics daily for most of this FET cycle, I take an oral one daily as well, I alternate between optibac for women, bio v femme, flora femme and the physioflor oral one.

@seven201 let us know when you know when Lower can see you.

Thanks @Janefx40

I decided to stay in my bed and watch tv on my iPad last night. After my last transfer I got confused and forgot to take my heparin, so I brought everything in next to my bed, I was still late taking them! I then woke up early at 5am managed to fall back asleep and when I woke up again I'd missed the timing of all my morning meds, so I've been running around trying to get it all into me. This must be a post transfer thing!

@Gardenlady543 glad it all went pretty smoothly for you yesterday. We have a grade AA on board and the clinic were happy that it was hatching for FET. I personally wouldn’t worry about grade though as our CC is genetically sound whereas the BBs aren't. My embryologist said grading can be quite subjective. And anyway, you’ve done all you can, and you’ve done EVERYTHING, so I have every hope for you. Wishing you all the best 💛