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 😊

We’ve always had 100% fertilisation with IVF so I’m guessing this why clinic hasn’t flagged it up at all. So maybe it isn’t an issue at all. But given how things are going we’re keen to make sure everything looked at esp DH.

@thislittlebird if you’re having ERA, that has to be done as part of a mock transfer cycle, that is you’re given all the exact same meds as in a real ET cycle except on the day of estimated transfer (5 dpo) you have the biopsy taken. If you’re also doing EMMA and ALICE or NKC even that’s a single biopsy at the same appointment for all of them and should get all results back at the same time.
If you’re just doing EMMA and ALICE no need for a mock cycle instead and timings are what @kerrym87 suggested.
If I recall correctly, at least with my clinic, if you’re not having ERA you can go straight to your FET cycle when you next start to bleed (although period may be so light you might find it difficult to pinpoint your first day of full bleed), whilst if you do you have to have another break month taking Norethisterone or similar and the FET happens the following cycle so it’s a longer process.

@Enfys23 so if the count is very high then it's good because even with issues in the other areas there are enough normal sperm, but the dna fragmentation is different. I seemed to have very good results with my husbands sperm but of euploid embryos weren't implanting and I've seen people say with fragmentation there can be euploid embryos but they won't work because of genetic issues. So the clinics had been using the centrifuge technique but this damages sperm more. I got the dna fragmentation tested through fetilysis and they said while the percentage was ok, the abnormal sperm were very abnormal, so we went for the sperm chip and did get a better result.

Thanks @Gardenlady543 we might ask about using the sperm chip next time

Hi @Enfys23 yes I was also told sperm count, motility and morphology can be perfect, but there is no or little relation with DNA damage. Good DNA isn’t needed for fertilisation if the other parameters are good, but high fragmentation can be the cause of poor blastulisation rate, implantation failure, low euploid rate and miscarriage. I was also told that the 4% abnormalities missed by PGTA testing are usually caused by the sperm.
When did your DH have covid? I heard that can impact sperm DNA fragmentation.
I think a sperm chip is a good idea if your clinic offers if, I wish mine did or that I’d known what one was at the time.
Sorry to hear about your infection and need for antibiotics, I hope it clears up without impacting your microbiome too much.

@Enfys23 my hubby's sperm is all over the place with morphology and motility although has improved with lifestyle and supplements. His count and volume have always been really low and our embryos have always fragmented so much so we're checking dna fragmentation. Do think on balance of probability we'll need to use sperm donor as with 30 odd eggs and 17 embryos only 2 got to blast and didn't take, rest were useless 🤷‍♀️

@clhiu thank you! COVID was last year but you can see in his result that’s when it dropped to 2% soon after. Then recovers to 3%.

@kerrym87 I am so sorry to hear this. When are you doing the DNA fragmentation test? Are you getting some counselling about sperm donor now or just thinking it may be necessary?

I’ve been looking at Dr Anil Gudi at Fertility Plus Harley St as someone expert to see with DOR issues but not sure we can afford the per cycle cost right now or the time off work travel to London for a treatment cycle would entail. Maybe something we’ll save for and do one last ditch attempt if next couple of cycles don’t work out, might have to take unpaid leave from work to do it though. Anyone heard about him?

@Enfys23 did I say this is who my friend was after and he's really good, he did all her scans so there was continuity, he would see her early before work.

@Enfys23 we do have sperm issues in general but it is one of my biggest bug bears that clinics don’t investigate it properly. If I were you I would do a DNA fragmentation test and see if there is an issue. sometimes if it’s high it’s a case of taking antibiotics or seeing a urologist to see if there is a solvable problem. In my opinion all men should be getting a SA and DNA frag test and seeing a urologist as a minimum before starting IVF.

@Gardenlady543 I didn’t know, that’s useful that you know someone who found him good. It sounds an amazing service. But obviously a high cost to that.

@Dochas12111 thank you. We’re definitely going to be asking all these questions again.

@Enfys23 we have male factor. Worth getting DNA frag imo, it can have an effect. But morphology isn't a category they're especially worried by, count and motility are key. My husband increased From 3-8% at one stage) his morphology with supplements, Imperil for example, sadly it doesn't have the same effect on motility!

Thanks for the info on the tests @kerrym87 and everyone else. I'll have a read through. I don't want the test, but if this embryo fails I know my doc will push for ERA at the least, maybe the full set.

I don't know whether to take Metronidazole (I have some here) or just go straight into vaginal and oral probiotics leading up to the transfer. Very confused!

@clhiu so far I've been having natural modified transfers, but I guess if I head in the ERA direction I'll be going into medicated transfer territory.

*Impryl

@thislittlebird as my transfer was planned as natural modified so was my ERA, unless there’s a specific reason for you to have a medicated transfer then the ERA will be the same protocol as the transfer.

@clhiu Interesting, didn't know they did it for natural mod. I'll probably go the medicated route because I've tried 6 embryos now (by then 7 or 8) and had no luck with pregnancy, so I guess it makes some sense to move to medicated.

@Enfys23 he's had hormone profile which was normal, ultrasound of testes to see if varicocele and urology review. Had sperm dna frag and antibodies done same day I had uterine biopsy, clotting and immunoglobulin bloods done. Going to ring tomorrow see if results are back to sort f/u appt. They have said they can liaise with a clinic closer to me for most bits as we live in north east england and can't just pop into London clinic easily. Depending on what we need to do down there we might invest in a rail card for example

@clhiu Sorry for the delay. Not been feeling well. Progesterone does keep dropping, so will get it checked. It was last 132. I’m on 400mg cyclogest 3 times a day a lubion twice a day. How are you getting on?

@Enfys23 I’m sorry you’re having more concerns. My husband has the same issue but with a bucketload of supplements and really healthy diet his morphology went from 2 up to 4%. We were on all the supplements from the Rebecca Fett book It Starts with the egg. It was a game changer as my number of blastocysts was higher at 40 than 38. Obviously, when I was 41, my egg quality became an issue too. I also found covid impacted our fertility.

I would say that also at CRGH we did IMSI which really focuses on collecting the best sperm but you can also do pimsi. Both are better than icsi. I did find that when my husband had more coloured fruit and vegetables, avoided sugar, had occasional 70% dark chocolate, avoided alcohol and only had one cup of tea or coffee a day, his morphology improved with supplements like l’carnitine. It did take at least 3 months.

I really hope you can get an appointment for all the results soon @kerrym87

@2021ivfagain thank you! My DHs only vice is sugar!! He is as skinny as anything but just has a hugely sweet tooth. He is doing better though! This might help him keep to being a bit better. There is a limit on fruit and veg unfortunately because he has a condition that is made worse by too much fibre in his diet (though also means he can’t have alcohol or caffeine or chocolate!). I might see if I can change/inc his supplements.

@Enfys23 we've got some results sent to me, looks like a have a possible risk for clotting/ dvt/heart disease etc which fits in with pcos. Also one if my immune percentages is out of range but not sure what it means yet. Hubby's fragmentation is 28%, the other one is 20, abnormal is above 25% but with track record of embryos arresting and fragmenting who knows.

@2021ivfagain hope they can optimise progesterone for you
@Gardenlady543 I have a couple of results that I'm not sure what it means exactly, I'm guessing I may need some form of blood thinner, possibly steroids. I will be booking a f/u appt but my emma/alice still outstanding as is hubby's c&s. appreciate any info you have to interpret

@kerrym87 I have the same PAI-1 mutation and I take Inhixa 40mg from CD6 and Dr Gorgy told me it's associated with PCOS so I had an insulin resistance test which was fine. If it wasn't they would have put me in metformin.

With KIR Bx is the good one to have and Dr Gorgy looks for 3 receptors, see picture, which it looks like you have.

I don't really get the NK cells all the labs show them differently so you'll have to find out the impact of having the high result in one area.

@Gardenlady543 thanks, that makes sense. I have had hba1c done previously and it was 36 I think, the last clinic started me on metformin anyway when they tried me on clomid and wanted me to stay on it, been on 3 years. Hoping to get a clearer view of our situation and a plan, hate the limbo in between and finding being childless extra hard at moment. How's your little bubba coming along? X

@Enfys23 we also did IMSI similar to @2021ivfagain after 3 rounds using ICSI and we did get better results. Agreed too on supplements. I have a diet plan I got from a fertility dietician I was seeing - if you want it send me a PM.

Back to Lister today and had my AMH and immune bloods taken and had the Emma/Alice biopsy. DH had semen analysis and DNA frag. Couple of weeks now for the results!

Catching up slowly.

@Dochas12111 @Spin101 thank you for your kind words previously 💙

@2021ivfagain @Spin101 really glad your scans went well :)

@Dochas12111 I can’t recall our previous encounter on rollercoaster though your name now sounds familiar ! I guess it was the PGS thread. How will you decide whether to do another stims round or transfer what you’ve got? I partly regret not doing more rounds before I transferred but I really thought my euploid at age 42 was a one-off. I now suspect I could’ve batched more, given I got a euploid at age 43 and 44. In your case, I’d probably do more stims. They probably wouldn’t let you transfer more than one of your frozen embryos in one go given two were tested? If they did, I’d be tempted to transfer two. what grade are they?
Would love to see the fertility diet you have, if you wouldn’t mind sending it. I find The Fertility Kitchen cookbook quite helpful.

@Enfys23 hope you’re doing ok. Along with the great suggestions already given, perhaps consider PGT-A? I know you haven’t so far made many embryos but at least you’d know you have a viable embryo before embarking on lots of other tests/treatment. At age 37 I made a high number of aneuploids. (Turns out it was partly due to how I was stimmed/triggered.) I see Create do PGT-A at certain clinics incl Manchester and they do it with their multi cycle package. They have an online session on 22nd Aug. I definitely think it makes sense to move clinics, given the lack of monitoring at your current one.

@thislittlebird have you used PGT-A with your last 6 transfers?

Hope everyone else is doing ok.

we’re still waiting on our PGT-M/PGT-A result for our lonely single embryo. It’ll be any day now. We have our review on Thursday but will plough on with next cycle even if we don’t have the result by then. After all, chance of it being transferable is really slim.

Has anyone used growth hormone before/during stims? Would you recommend?

@CailinInUK good luck for your upcoming result, fingers crossed!

I didn’t PGT-A test the 3 from round one (because nhs), and didn’t test round 2 at the Lister because it was just a very bad round for us, covid and a fever meant DH had no good sperm so the embryo quality was very poor. They transferred two iffy morulas at day 5 but mostly because they didn’t want to leave me with nothing, so they couldn’t test those. And then we finally tested on round 3 (also Lister), but only tested 3/5. 5AA was transferred fresh and untested, and they weren’t convinced 5CC would survive so that’s untested and frozen. The 4AA, 4AB and 4AB I had left were tested, and only the 4AA was euploid so we’re transferring that one next month.