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 😊

@Loz2467 you're not out until to you find out by testing. In terms of other things to try, if it comes to it, you could try transferring more than one next time?
Yes I'm with Care. Modified natural/low dose stim not their first choice of FET protocol.

If you were to do more retrievals, I'm a general advocate of PGT-A. Even at 36, I was making lots of aneuploids. Partly down to the stim regime but also just down to me.

@Enfys23 I'm sorry that's tough news to get :( have you been on the Reddit, www.reddit.com/r/dnafragmentation/s/do2wdqyLrY I hope some of the others can advise about alternatives as Dr Ramsey is the one everyone talks about, there are some good supplements they recommend as well. We did the sperm chip because while dna fragmentation in DH was normal the abnormal ones were really abnormal.

@Enfys23 that sucks, sorry you got that news but it happens often because they just don’t test for it. So we saw JR a couple of times in 2021 but more recently we saw Mr Tet Yap who is also a great andrologist and used to work with Ramsay, he’s much younger so he’ll probably be the next famous andrologist. We saw him at Guys on the nhs after our private clinic recommended seeing him when we found out dh had antisperm antibodies, but he also has a private clinic and we did some tests through that, it’s called London Andrology.

Get him to take Impryl, because that’s what they’ll recommend to start improving oxidative stress which is a cause of the fragmentation. Hopefully he will have an appointment this side of Christmas, it’s worth a try.

@Enfys23 I’m really sorry to hear about the bad news and appreciate you’d be shocked and shaken by this if it’s throwing your chances if starting next cycle especially.
Not to be dismissive of JR as I also hear he’s the best, but I believe a lot of the advice about reducing DNA frag and improving sperm quality in general is the same and you probably don’t need to see him before making those changes. It’s all about lifestyle and supplements.
I recommend a Channel 4 documentary you can watch on demand called ‘Save our sperm’, JR actually features in it.
Is your clinic’s consultant not able to give recommendations for that?
We didn’t have a sperm problem, including DNA frag, but to give us the best chance, this is what our consultant recommended at the time:

SUPPLEMENTS
Selenium+zinc
Vitamin D 2000iu
Lycopene
Wellman Conception

LIFESTYLE
Max 4 alcoholic units per week
No smoking
Cut back caffeine as much as possible (eliminate entirely ideally)
No hot baths
No red meat
No cycling or sports that constrict or overheat testicles especially
Mo tight trousers or underwear

Have you heard of Impryl supplements?

With all of these things though I appreciate you’ll need to wait up to 3 months to really see the benefit, which I know is not what you wanted to hear so feeling your pain right now and thinking of you x

I agree it’s also about lifestyle and from experience the first thing they’ll say is not to take too many supplements in case you over oxidise the sperm, but that didn’t happen for us and we did add a couple on top of the impryl.

Can confirm the tests run but JR were mostly the same ones run by Tet Yap from what I recall and the other one I know of is Pippa Sangster at UCL. JR didn’t actually test for antisperm antibodies because it wasn’t discovered until after our bad second round, the Lister embryologist found it and then we were told to see Tet Yap who was very helpful in trying to find a cause. Definitely worth seeing one of them about the hormone aspect.

Thank you for understanding @Gardenlady543 @CailinInUK @clhiu @thislittlebird
thanks so much for sharing about another andrologist you can recommend @thislittlebird I’ll look into that straight away.
I’ll ask about Zymot too. Thank you.
Problem we have is that DH is doing all the lifestyle and supplement things already. Poor chap has had to give up his love of cycling! He never drank caffeine or alcohol anyway. So I just can’t see how we change this unless there is something more medical going on. Or he changes jobs because his only lifestyle factor is being around his work environment which is pretty hard to address ☹️. I will look at maybe swapping his Wellman conception to Impryl.
Thanks again everyone. It just feels like one huge hurdle after another sometimes doesn’t it.

@Enfys23 i guessed your dh might be doing all those things, when you’ve been in this game for so long it makes sense to do all the right things. It’s tough, but if they examine him and run the gamut of tests they may well find something awry and be able to help. It’s worth it, even with the extra months. Getting to the bottom of DH’s sperm issues definitely helped us in the last round imo. We didn’t use Zymot, we used IMSI so worth talking to them about your best options for sperm selection.

Hi @Enfys23 sorry to hear this about your DH. What is his overall frag %? Honestly this drives me insane about male fertility - a semen analysis is just not a proper analysis and a dna frag is completely painless so it’s so odd to me why clinics resist doing it.

my DH had a variocele which he had no symptoms of and couldn’t feel it himself. His dna frag was 52% so very high. He had an embolism which he found fine and we had to wait 3 months to get it and 3 months recover before doing more ivf. His dna frag did go down to 23% after that. we did IMSI on our transfer that worked.

We didn’t see JR just a local urologist who diagnosed the variocoele.

DH frag has now gone up to 32% so we are doing zymot test in December - they do a DNA frag test then they run it though zymot and see if it improves the frag. For some men it doesn’t work well so we’re testing first. I can let you know if it works for us.

my DH was also completely healthy btw even before ivf. He takes and does whatever I tell him ha.

Wellman is no good. It’s lowest doses of vitamins. My DH took:

proceive man max sachet
vitamin c x2 daily (better absorption apparently)
mor dha (x 2 daily)
ubiquinol (purer form of coq10)
WHC Uno cardio + vitamin d

@Enfys23 my hubby's volume and count are always low but motility and morphology normal. Frag is 25% but they still feel icsi is just fine but do offer zymot. He's on lots of bits like impryl, fenugreek, lycopene, Mediterranean diet now, reduced alcohol. He has test done when he'd not been so good but his % is in range which icsi works fine for when you look at chart that came with results. He was also advised cooler undies to reduce heat so we get bamboo ones, or boxers are good and he uses a cold gel pad an hour a day which is supposed to help. I think frag has to be pretty bad to not be usable but above things are known to improve damage of sperm x

Good to see the DH's doing their bit.

I had my ERA low dose stim scan this morning (day 4 of stims). Follicles haven't grown much so largest still 14mm as per Monday. Lining up to 7.7mm from 3.8mm. I'll be heading back on Friday, no doubt. After worrying they were gonna grow too fast, now I'm wondering if they'll continue growing!
If I have to trigger on Friday I'll be doing it from abroad as working away for a couple of days. Since starting this journey in 2016, DH has done EVERY single injection (it must run into the hundreds) so Friday will be my first time :-/

@Dochas12111 are you testing/prepping the sperm just in case you go for more retrievals? Hopefully it won't come to that and your next transfer works. Mine will likely be a bit earlier than estimated so Jan rather than Feb.

I'm still waiting on Fertilysis microbiome results. It's been 13 working days. Chased them up and they said they'll arrive this week.

@CailinInUK the lining wouldn't be growing if the follicle wasn't releasing estradiol, so I think it will grow to the size required to trigger.

@CailinInUK yes. The plan is transfer our best embryo and if that doesn’t work do an egg collection next. I think it’s a good plan as I’ve 3 months between now and say a failed transfer in Jan/Feb so we’re back on our vitamins and try to eat healthier and we will repeat the Emma/Alice and try the zymot in December!

Thanks everyone. @CailinInUK good luck with your first ever injection! Hope lining gets there nicely now in time for ERA.
@Loz2467 Hope you’re doing okay.

Thanks @Enfys23 and @Gardenlady543
I had my day 8 scan this morning (day 6 of low dose stims) and largest follicle still 14mm so no growth. Lining not grown either, May have slightly shrunk. Now it's the weekend, they want me to add antagonist to prevent possible LH surge. @Gardenlady543 what was your experience of antagonist? I recall you having to take it too but not sure if you took it for both your chemical and successful cycle? They are upping my dose to 75 from 50IU.

@CailinInUK I refused to take it as it shut down my body and everything went backwards, given you are static right now I personally wouldn't take it and would say I'll do LH sticks over the weekend instead. I think the likelihood of you ovulating a 14mm follicle has to be quite low and the way the cycle is going right now it may get cancelled as it isn't progressing, in which case adding the antagonist doesn't seem like a good idea.

@CailinInUK

My experience was:

Modified natural FET with letrozole, antagonist added, cycle stopped, added menopur 75 units for two days and it got going again, got to transfer and had a chemical.

Next cycle same plan, good initial response with several follicles so consultant added the antagonist, once added all the follicles disappeared, low dose stims didn't help, lining dropped to 3mm, cycle was cancelled and I was put on the OCP in order to build the lining and get a bleed on the withdrawal. Consultant decided next time to remove letrozole.

Went to start with the OCP induced bleed, but had made my own follicle so had to trigger and await another bleed.

Next cycle was low dose stims, no letrozole and I refused the antagonist, was able to get a good lining and triggered, cycle was successful.

All the specialists said the antagonist doesn't shut down cycles but did acknowledge that it was happening in my case although they couldn't explain why. Someone I talk to said that the antagonist also interferes with implantation.

Thanks @Gardenlady543, they were my thoughts too. I've packed my LH sticks while abroad today and tomorrow so I'll use those.
This cycle was on the back of an unusual short cycle for me so wondering if thats were the issues have started, or I just don't respond to such low doses. I have six follicles growing slowly. Did you change anything between your chemical and successful cycle in terms of FET protocol / endometrial prep?

@Gardenlady543 we cross posted, thanks for all the info. I remember that happening to you. I'm concerned that the antagonist will halt things completely at this stage. At least I can proceed with Emma/Alice and might take ERA result with pinch of salt if we get that far.

@CailinInUK I think with a natural modified FET this is the issue, it's not as predictable and can get cancelled. In this case it's an investigation cycle and the microbiome results will be the most evidence based test you'd be doing anyway which as long as you have a fair amount of lining they should be able to get a biopsy. After my chemical, I just wanted to get to transfer, there are so many anecdotes about people being more fertile after a chemical and I'd never had a positive test before, I also had the impact of LIT running out as that only tends to last 3-5 months, so it was annoying with all the delays.

@Gardenlady543 yes, so glad I've done this mock cycle. It is disheartening when it doesn't go smoothly and does make me wonder whether I should revert to medicated FET. That's what consultant recommended as I had implantation 3 out of 3 times. But... only one take home baby (all euploids). Its difficult when so much weighs on the decision. Research shows lower miscarriage rates and complications with natural and modified natural cycle, hence why I've been veering towards those. But I do infer whether I'm doing the right thing with making the change, especially as it's not gone smoothly this time.

So I had the usual afternoon call from the clinic and they’ve thankfully had a rethink. They now don’t recommend antagonist over the weekend and believe the 14mm follicle is remnant from last time. This makes sense to me, I’m relieved. Back on Monday for another scan and bloods. I don’t normally Lh surge until Day 19 in natural cycles (35 day cycle) so expecting things to take a bit longer albeit got some FSH to boost things perhaps. Thanks @Gardenlady543 for the speedy response and support.
For the real deal, I’ll make sure to have a baseline scan. This time I was away from home/weekend.

@CailinInUK I think if it's a transfer cycle in the future, get in early for a baseline scan and have a low threshold to hold off until the next cycle if there's a fairly big follicle there as this one seems to have interfered. This is why I had to trigger and start with the next bleed after I developed a follicle while on the OCP.

will do @Gardenlady543 . I’ll also track previous cycle to FET cycle to see if it’s a regular one as I knew the cycle previous to this wasn’t normal. A good learning point and I’m so glad I trialled it.

@CailinInUK i think that sounds like a good plan- glad they had a rethink!

i was just wondering what everyone’s opinion is on sex during a FET cycle? I know that some couples try naturally still. I’ve never done this before. Obviously the clinic warns you not to. But then I’ve heard that some people time their sex to be just the night before transfer and it’s been successful. I don’t know whether to hold off or not?? I’ve never had a BFP from transfer so just thinking if there’s any i can do to help.

we’re currently at CD12 and yesterday leading follicle was at 18mm. Been asked to test surge today (natural modified cycle) but it was still negative. I am getting on cramps occasionally. I feel like OV isn’t going to happen til cd14/15 due to previous cycles but I could be wrong.

@Sar1010 so there's pros and cons both ways. There are some studies showing semen around the time of transfer improves implantation rates, Dr Gorgy told me this is the case for people with a certain immune profile in the endometrium. My worry is it would set off my microbiome issues.

Clinics definitely say don't try with more than one follicle in modified natural FETs. If there is one follicle then it may still risk a multiple birth if the egg released becomes an embryo that implants and the transferred embryo also implants. I know of someone who transferred a euploid embryo of one sex and had a loss with a aneuploid embryo of the opposite sex so they had conceived with the egg they released.