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

@Janefx40 I remember you being completely convinced this time that you felt nothing.

@Loz2467 I was completely sure I hadn't implanted as I had felt nothing but implantation happened and I had hcg present, until it went down.

Well after all the LH confusion I got my period today, super early for me at CD25, I think I must have not ovulated after the invasive saline scan as I started testing, got the estradiol rise and tested for LH every day since CD9 and it never came.

@Gardenlady543 Snap! I got my period very early too, 21 day cycle. I’m normally 30-33 so unusual but perhaps to be expected after my late loss. Is there a chance you missed the LH surge? Do you BBT? My BBT indicated I ovulated but then had a very short luteal phase. hopefully you can now at least plan next steps?

I’m CD5 now and had a baseline scan today. My AFC is a conservative 12 (not bad for my ancient age) so going ahead with long protocol, starting down reg on CD21 with stims early March. Glad things are moving.

@Faithhopelove83 @Enfys23 @RPishopeful @Loz2467 thank you for your kind words re my loss.

@Enfys23 @Loz2467 best of luck for successful implantation!

@Lori2022 I think you asked about Invivo versus Fertilysis. I’ve not used either of those so can’t advise, sorry. Invivo lists the bio markers it tests for so perhaps check they cover what you’re looking for if this is intended as a repeat test..

@CailinInUK yes you make a good point. Thank you 😊
lots of luck for your cycle

Oh wow @CailinInUK at least we are both in the same boat! I usually have 31-33 day cycles as well so really unexpected. So I don't think I missed the surge, I am wearing a fitness tracker but I don't know how accurate the temperatures have been so I can't tell much from that. I think the saline scan was so invasive that it messed up the cycle. The person doing it was pumping in saline to try and wash out the abnormality and then the catheter was pulled out and was covered in blood and I bled after. I think my body thought, I am not releasing an egg into this. I have the HSG booked in for late next week, really hoping it's normal. What medication will you be on from CD21?

@Gardenlady543 your poor uterus has had so much interrogation. I hope the HSG comes back normal.
I’ll be taking nafarelin (Synarel) from Day 21.( I opt for this nasal spray rather than buserelin injections.) Now paranoid that my cycle will be short again and my day 21 will be end of cycle rather than 7 days before cycle end..)

@Lori2022 I did Invivo through Anna Firth at Melanie Brown Nutrition. Was prior to EndomeTRIO so I could optimise for a few months ahead of that. But no idea how it compares to Fertilysis.

@RPishopeful happy to help. I take aspirin in morning with breakfast and supplements around 8am then clexane around 8pm. Prontogest is only more effective for some people. I didn’t respond well to lubion so switched. On cyclogest am/pm too. I had blood tests to check progesterone every 2-3 days ahead of transfer, over TWW and had a couple of tests after BFP.

Hey, I wondered if I could join as this seems to be the thread for people whose IVF is less than straightforward! By way of backstory, I've had three FETs, the first two ending in miscarriage around 6 weeks (with high and doubling HCG). The 3rd has just failed to implant, which was honestly a big shock. I was expecting another loss, but not a negative test!

I've had recurrent miscarriage bloods, with nothing shown but low vitamin d (now rectified). We've got 11 embryos left from our cycle so we're going to get some of them tested. I've also booked in for a saline scan, as I've never had one (or a hysteroscopy) and they seem a good place to start re womb abnormalities, fibroids etc. Considering doing Emma/Alice, but unsure...

Welcome @MinPinSins please do join us :) you have a lot of embryos, how old are you? I had 9 when I started Ivf and I was persuaded against testing and after 2 unsuccessful transfers I had them thawed and tested, I think when there is a lot it's a good idea. A saline or HSG is a great idea, I feel everyone doing IVF should have this type of imaging as the standard ultrasound can miss structural abnormalities.

There are few options for the microbiome, I wrote a post about it here https://www.reddit.com/r/infertility/comments/rwsxwy/theuterineemicrobiomeemmaaliceemenstrualfluid/?utmmsource=share&utmmedium=iossapp&utm_name=iossmf for the uterine microbiome the options are a menstrual fluid test or biopsy for EMMA ALICE. Some people start with a vaginal swab which can give some indication of what the uterine microbiome might be like.

@CailinInUK I hope your cycle is back to normal this time, can you ask your clinic if it would make a difference if you are close to the end of the cycle when you take the meds?

@MinPinSins very welcome, I’m very sorry for your losses. I’m relatively new to this thread but definitely not new to the game in general. As @Gardenlady543 said, testing as many of your embryos as possible is a good idea. Did you have your progesterone level monitored for your FETs? If not, worth doing too. Possibly an ERA if doing EMMA and ALICE anyway. Some on this thread don’t rate ERA so jury’s out. Hard to know in this game sometimes. Also consider different type of FET..

@Gardenlady543 great minds :)! I emailed nurse last night to ask that question!!

Thanks @Gardenlady543 . What were the results of your PGT after you defrosted your embryos?' Im 30 now, and was 29 (almost 30) when they were made. So relatively young, although I do have PCOS, which may have impacted egg quality I think.

Glad the saline is a good idea. I'm kind of gutted I haven't done one before, especially as it's so cheap compared to most IVF things.

Thanks for the microbiome link, I'll have a look - I had no idea there were options outside of ALICE/EMMA.

Thanks @CailinInUK . I had my progesterone monitored for the first, and it was very good. Not the second or third.

My reason for not thinking about an ERA is that my first two implanted on time (I tested from 5dp5dt) and had good doubling HCG, which makes me think it wasn't a receptivity issue. Is it something you would still recommend?

My FETs have always been medicated because I don't ovulate. Are there other types I could try with natural out?

@MinPinSins they’re valid reasons for not considering ERA so probably not worth doing it. Sorry for confusing you!
I’ve always had medicated FETs too. If your progesterone was good on medicated, perhaps stick with that for now. See what the PGT-A shows and take it from there?
Was your lining ok for the FETs?

Sorry for the triple post! @Gardenlady543 I've had a look at the links you sent, and the Fertylisis test seems fantastic - cheaper than an EMMA/ALICE and you can do it from home. Thank you for this. I've got a couple of questions I wondered if you knew the answer to at all. It says you would have to wait until April for a consultation with their doctor, but am I correct in that if I was able to get my clinic to interpret the results, I could just order right away? Do you know what is covered in basic versus full?

Lastly, I am still waiting for my failed FET bleed. Assuming that starts tomorrow, I'll have about 5 days of menstrual blood to use. Do you know how quick the kit would usually take to arrive? Thank you for all your help!!

Thanks @CailinInUK , I am really grateful for all the help. My lining was 10.1 for the first, 8.7 for the second at 8.4 for the third. So good for the first, and ok but not 'ideal' for the second two. I do wonder if anything is behind the ongoing decrease though .

@MinPinSins so I had 7 left when I tested, 1 didn't survive the thaw (one of the top ones), another top one was the only aneuploid, 5 out of the 6 tested were euploid. I was 35 at the time of the retrieval. So this helped with the understanding of my case, as even though I'd only had two unsuccessful untested transfers, in the context of never having a positive and such a high rate of high quality euploid embryos, everyone was on the same page that this was recurrent implantation failure.

Could you do modified natural with letrozole and a trigger? That's what I just did. I don't have PCOS and I ovulate and have regular cycles (my recent cycle that I'm complaining about doesn't count lol!), but everyone has thought I have PCOS phenotype D because I have a a high AFC and a high/high FSH/AMH, but all my hormone levels and insulin resistance is normal. On that point are you on metformin? Maybe discuss it if not.

This book chapter is worth a read by the way, www.intechopen.com/chapters/77309

I'm one of the people that doesn't rate the ERA, I had one where I was prereceptive and told to delay the transfer by 24 hours, did another ERA at this time even though they said I didn't need to as people with my results are almost always receptive at the new time and it said I was only early receptive and to add another 12 hours. I then moved away from medicated cycles after another failure at this time and did a modified natural and did implant for the first time, it's quite likely that I implanted at 3dp5dt, so probably inline with the ERA result, but the embryo was pretty slow (it had decided to go back inside when frozen and hadn't started rehatching again). And the thing is this is 8dpo which is a very normal time for people to implant, so I don't think delaying a transfer would have made any difference. There is some argument that people with a lot of chemicals may be doing a transfer in the post receptive phase, but you are clearly implanting and getting pretty far along so the transfer timing doesn't seem to be your issue.

As people go further along with investigations they move into reproductive immunology and checking for silent endometriosis.

Thanks @Gardenlady543 such a shame that you had so many euploid embryos and yet so much difficulty with them - I'm sorry for your failed transfers and chemical.

I hadn't heard of modified natural, I'll definitely look in to it, and speak to the Dr about that possibility.

Is a hysteroscopy the only way to check for endometriosis? I haven't done any immunology bloods, although I was on prednisolone and clexane for the most recent transfer as a just in case following the miscarriages. I am also on Metformin

@MinPinSins gold standard investigation for endometriosis is a lap, this involves key hole scars in your abdomen and a camera going in to have a look. There is a test called receptiva which is a biopsy, it's done a lot in the USA but can be done in the Uk by ordering a kit from the lab and getting your specialist to take a biopsy, people can get false positives and negatives though. I think if people don't have symptoms suggesting they have endo, it's worth looking into when there is no other explanation but otherwise you might want to hold off. Always a useful one to have in the back of the mind though.

@Gardenlady543 Thanks, it's so tricky to know what's best at each stage. I don't even know if I have endo symptoms! I struggle a lot with the pain of my periods, but wouldn't say they are particularly heavy. I'll probably hold off on that this time. I think we'll probably go for the PGTA, SIS, and if I can get my wife to agree, the Fertilysis microbiome test you shared.

@MinPinSins if you share your email I can forward the info from Fertilysis about the difference between basic and full. I’ve got the full personally x

Thanks@Lori2022 I've just messaged you

@Lori2022
I use Invivo. They are good. I get a report from Anna Firth after Invivo have analysed swab and you do get a detailed analysis. The drawback is having to wait 3 weeks for results.

@Gardenlady543 How are things going? I’ve not always been following the thread as I’m getting anxious about next cycle.

I took metronidazole as I had gardnerella again but it seems to be getting worse again. I only stopped antibiotics last week! My ph feels high due to excess vaginal discharge but I am on cd14 today. Also had to start norethisterone today in preparation for cycle next month. I don’t know what to do. Feeling like I’ll never get to transfer stage. Sorry for moan.

I’m thinking of doing another swab with Invivo but it takes 3 weeks for result and I’ll be starting my transfer cycle then. I’m wondering if metronidazole made it worse but don’t know what to do now.

@2021ivfagain sorry to hear you’re having worries down below. I don’t think mine has ever been the same since opening the microbiome can of worms in October.

as you’re short of time I wondered about getting a vagina swab done in the post as results take about 5 days. Doesn’t give all the info as Invivo but looks at gardnerella etc. Metronidazole gave me thrush.

@Lori2022

Already done that and that is why I took metronidazole. Yesterday it felt worse than before I took it. In fact I was getting better before metronidazole as I was taking lots of probiotics but I asked my consultant and he said it was ok to take it.