ERA EMMA ALICE testing thread 9

[Gardenlady543]

@2021ivfagain @Enfys23 @clhiu @CailinInUK @Spin101 @Loz2467 @Mybabydream @Janefx40 @ChickenT2b @kerrym87 @Sar1010 @AM08 @thislittlebird @IVF22 @APSR
@Faithhopelove83 @KLM25 @VenusStarr
@BewilderedBee @Dochas12111 @seven201 @StillWishingHoping

We've maxed out the other one so here's thread 9 😊

Oh I should add that I expect my Emma results to be relatively poor in Dec due to the recent antibiotics. I’m unsure what I’d do then in terms of timing for FET. Would I just carry on with the probiotics without re-testing but still stick to Plan A for FET in Feb or do a re-test? Maybe I could just do a Fertilysis re-test in Jan? Any thoughts?

@CailinInUK I’ve never checked my PH actually! I followed Canesflor plus Optibac last time and my retest showed 75% good bacteria up from 0% but I had longer to do it so i think I need something stronger.

my consultant said he doesn’t think fertilitysis would be accurate with Emma/Alice as good bacteria tend to colonise in vaginal canal and sample is contaminated by that. So I’m going to repeat the biopsy. As it’s my only PGS even if it’s a crap one!

@Gardenlady543 thanks I’ll look into ordering them to my bro or from eBay!

@Gardenlady543 when you said previously you would take both Balance Activ and Vagibiom, did you mean insert both at same time?? I’ve not tried that.

@CailinInUK re ERA mine showed progesterone was v low on just two cyclogest but as that found my receptive window my consultant advised to do this for transfer then start progesterone in oil injections a few hours after transfer and this worked. Progesterone was 12 day of transfer and 99 3 days later.

@Dochas12111 how many months did it take to get from 0 to 75%, out of interest?

I had the very same concern regarding accuracy of the Fertilysis test with respect to contamination by the vaginal biome and asked them the question, here’s the answer:

There is not enough time for the sample to contaminate or be contaminated by the vaginal microbiome, at least not at a level which is detectable in the results. In fact, most results turn up completely different microbiome compositions between a patient’s uterus and vagina. A usual result is that the vaginal microbiome is clear of infection and the uterine one is positive for dysbiosis. It is also very common for the two microbiomes to have completely different problems. It is common for the one to have for example anaerobic dysbiosis while the other to present aerobic dysbiosis. Overall, now after thousands of tests, we know that while theoretically possible, no actual contamination takes place during the brief time the menstrual fluid crosses through the cervix and maybe the vagina (as when squatting to collect, the blood flows very quickly from the uterus almost directly into the collection container).
Practically speaking, in order to exclude any false positive results or potential contamination, we combine the data we are receiving from the vaginal cavity and the endometrium. On the one hand, the evaluation of the results is quantitative which is allowing the determination of the level of infection on a measurable scale (as a percentage) so that we can decide whether what we are detecting is above the threshold of clinical significance or just part of the normal flora. On the other hand, if a pathogen is detected in high concentrations on menstrual blood and in similar concentrations on the vaginal swab , we accept the results. In case we detect a pathogen only in one of the samples, this could lead us to conclude that the results are false positive, and we exclude them as a contamination.

Not trying to dissuade you from Emma/Alice re-test!!

@CailinInUK no don't do that, both have acid don't take them at the same time, either take vagibiom or balance activ with a probiotic that doesn't have acid. But I would avoid any acid around ovulation or transfer. I think acid is best at the start of a cycle after the bleed has stopped. I know someone that took vagibiom all throughout her FET including transfer that was fine though and had a successful pregnancy.

So you are waiting for fetilysis and then you will do ERA EMMA ALICE? I would wait for the results of both of them before planning another retest.

@Gardenlady543 ah right, that’s what I’ve been doing- either Balance Actic or Vagibiom so I’ll stick with that. My pH has dropped so on the right track I think.

yes that’s right , I did the Fertilysis microbiome test earlier in Oct and I’ll do Emma/Alice/ERA biopsy early Dec. Seems a bit overkill. I’m doing the triome partly to re-test biome and check for endometritis etc but was also keen to do a mock FET cycle with ERA as departing from my medicated FETs down previously so want some reassurance about my response to lose dose stim modified natural FET. And to be honest, it gives me something constructive to do while I wait for COVID effects to abate and Christmas to be done! I will wait for both test results before deciding whether to retest. Unfortunately my Fertilysis results will be partly invalidated now as I’ve since had antibiotics so not totally crazy doing Emma/Alice in Dec except that it’s probably not enough time for my biome to recolonise…

@CailinInUK i retested after 3 months and that was the result so I don’t know how long it took to build up. I am retesting sooner this time - after about 6 weeks so it’ll be interesting to see what comes out.

That is good to know re fertilitysis. My consultant wasn’t keen on it at all! I’m going to just go with the retest for consistency but if you’ve got a fertility sis result too, repeating with that would show like for like!

@CailinInUK it will still be useful to know, if you have dysbiotic bacteria that wasn't covered by the antibiotic treatment you've just had, then you have time to treat with a different course before the EMMA ALICE.

Thanks everyone. Really useful stuff here I’ll definitely consider.

@Enfys23 I didn’t realise immune issues could also cause issues with ovarian response. I think I’ll have another medichecks advanced thyroid test before any transfer going forward.

I think we will have to review DH’s sperm before another egg collection.

@CailinInUK Thanks. Yes, I think I definitely need to look at the immunes because my gut reaction is with my thyroid issues, something else might be picked up.

Prior to our last egg collection I was taking:
•Proxeed for women
•Coq10
•Vitamin D
•Vitamin C
•Methylfolate
•DHA (I think) the one that’s high in omega 3 not DHEA.

For my thyroid and following blood results from advanced medichecks thyroid test:
•Magnesium and Vitamin K2 (when I take Vit D so it’s absorbed as well as can be)
•B-12 as I was very nearly deficient
•Iron as I don’t eat any red meat at all and was on lower end of normal

I think that’s it!

I’ve not looked into karotyping or PGT-A (mainly because we don’t make many embryos).

I’m contemplating going Gluten Free and getting turmeric supplements for any possible inflammation. This TTC journey is literally sucking all enjoyment out of everything though and I really like pasta!

A lap to check for endo just isn’t affordable on top of everything else, I think we’ll run out of money before we get there!

Urgh. Hate to be a downer but it all feels a bit insurmountable at the moment. I guess I just have to tick things off the list one by one at the moment. We still have a frozen that I’ll have to use before next egg collection (multipackages and their rules) so I think at least level one immunes and Alice/Emma before that, which will cost a pretty penny as it is. At this rate I’ll be transferring in the Summer whilst we save!

Sorry ladies I will reply properly soon but I’m panicking!

I asked Care if I could be last transfer of the day again at 3pm ish as I got implantation last time and it would help ease my anxiety. I’ve been working all day and only just checked my portal and they’ve booked me in at 9:40am. I’m so annoyed :( that long with an early blast I just feel like there is no hope.

Also 2 days before transfer my prog was 103 n mol ( need over 100 n mol for adeno ideally ) this time it’s only 75 n mol. Shall I add another lubion?

Im just so worried!

@Loz2467 I would add an extra one but tell the clinic you are doing it so they are on board.

@Gardenlady543 Thanks so much! I’ll tell the nurses at the clinic tomorrow then I can get an extra script too. Can progesteone fluctuate? Like is there a chance it could be higher an hour later etc? I just feel so worried now and wish I’d started it a touch earlier too.

@Gardenlady543 also is lubion more absorbed than the cyclogest? And is it odd that I did the same as last time but there is a significant difference? And sorry one last question does cyclogest always have to be vaginal or can you can good absorption the opposite way too?

@Loz2467 I always take my blood progesterone level at the point where it will be at its lowest. So I used to take a PIO and cyclogest in the morning and then cyclogest at night. So I'd have a blood draw on the morning and wait to take my medication until the blood was taken. That way I will get a reading at the lowest point.

I use cyclogest rectally, others do too, I saw some information that progesterone is absorbed better rectally than vaginally. Lubion vs cyclogest, they are most likely very similar, since the usual dosage is one twice a day for both of them.

@Gardenlady543 That’s a good point actually. I’d already done my cyclogest this morning at 7am and my blood test was 10am? I do my lubion at 2pm in the afternoon. Odd how it was only on the morning of day 3 progesteone last time and it was 103. And then on the morning of day 4 prior was 75. I thought it would have been similar if not a bit higher :( I know progesterone resistance is an issue in endo and adeno patients so I’m always super paranoid about it. I know PIO is meant to be better than lubion isn’t it. So if this fails I might ask to switch to that next time but I know they see the standard of it being over 45 for transfer and won’t even consider the Adeno.

@Loz2467 Dr Gorgy is happy with progesterone over 80 and it's only the reproductive immunologists that like it high. So your level is fine. You are just trying to nudge it up a tiny bit.

@Gardenlady543 Thats helpful thank you as I know he really knows his stuff! It’s just because of the progesterone resistance with adeno I don’t wanna feel out already! I did an extra lubion at around 6pm. I can’t believe how much it’s differed to last time. What could affect it?

Just feel odds are against me. Earlier transfer time, earlier blast and less progesterone.

Do you know how long roughly it takes to increase prog?

@Loz2467 there's studies that show people who increase their progesterone on their FET day have the same pregnancy outcomes as those who had good levels in the first place. So it's fine to increase now.

@Gardenlady543 Thank you so much!

@Gardenlady543 i only thought this morning but I do remember a lot of the Sunday evening pessary coming out - sorry for TMI. Just can’t get my head around it being all the exact same timings but lower even a day later! Does it fluctuate a lot per hour etc anyway.

If my transfer is 12pm - that’s the latest they could do shall I do a lubion before I leave? Like 11am? I did my cyclogest at 7am this morning.

@Loz2467 what time do you normally do the lubion, I would take the injection stuff and do it at the regular time.

@Gardenlady543 I’d usually do my pessary at 7am. Lubion around 2pm and then cyclogest evening at 8pm if I can’t make 7pm. But now I’m switching to 2 lubion I need to figure a new time.

@Loz2467 if you're on 2 lubion and 2 cyclogest I would just do 1 lubion and 1 cyclogest in the morning and then the same again around 12 hours later.

@Gardenlady543 That makes sense! Thank you! X