ERA EMMA ALICE testing thread 10

[Gardenlady543]

Last thread is maxed out... happy for anyone new to join to chat about anything ERA EMMA ALICE or pretty much anything else fertility investigations and treatment related

@2021ivfagain @Enfys23 @clhiu @CailinInUK @Loz2467 @Mybabydream @ChickenT2b @kerrym87 @Sar1010 @thislittlebird @APSR @VenusStarr
@Dochas12111 @SallyLovelady @Lyrabee @Lauralozzle @Sera9 @Twigg12 @Wren123 @Summerishere83 @Vicky81B

@Faith2024 it’s really just a decision you have to make. I did an Emma/alice and got 0% good all bad bacteria. I took antibiotics & probiotics and I retested - up to 72% good bacteria. I didn’t retest but kept taking probiotics and had a successful transfer.

I am now trying for a second. I repeated the Emma/alice and got 0% good all bad bacteria again. I took the exact same antibiotics and probiotics. My DH didn’t want to retest as that worked last time but I did and I got 0% good all bad again. So I am glad I retested as if I’d assumed it worked like it did last time I would’ve gone ahead with transfer. I took much stronger antibiotics and the same probiotics and a retest showed 90% good no bad.

@2021ivfagain I would take what you need. I think a transfer is different to egg collection. A nasal spray won’t effect already created embryos and the affect uterine environment.

@Enfys23 glad to hear you are doing better with your recovery. How long are you planning to try naturally for? Wishing you the best of luck with it!

PS I transfer on Wednesday!!!! 🤞🤞🤞

@Dochas12111 Well it’s just that close to transfer hayfever medication can affect implantation. I am taking it this month as I cannot afford to do the transfer this month.

@Dochas12111 thank you
@Enfys23 thank you. All the best for your natural cycles. I have everything crossed for you.
@Gardenlady543 I'm doing ok thank you. 11 + 4 now which is crazy to think. Another scan booked for Tuesday which will be a day before 12 weeks which feels like a huge milestone. Just need to decide now whether to go for more IVIG at this point which will be my third. My bloods have come back from Chicago all fine on cytokines, slightly high on NK but I just don’t want to risk anything and I know peripheral isn’t necessarily a reflection of what’s going on in the uterus anyway!
Great news is that my LADs are finally in the 90s !

@Dochas12111 thinking of you tomorrow!

I’m 11dpo today and BFN. There might be a faint indent on Wondfo which got my hopes up this morning but easy@home is stark white. I’d sent a progesterone blood test just to check levels ok on the pessaries. But doubt this cycle has worked. I just don’t feel it in myself. My boobs haven’t done a thing. Guess will let myself feel the disappointment and try again.

Thanks @Enfys23 all went ok. My progesterone came back at 19 so I’ve started on Prontogest. Shows how important it is to test it on transfer day.

sorry if it hasn’t worked. Did you do another test?

my consultant said to test on the 21st - that’ll be 9 days after transfer. Seems a bit soon to me? What do you guys think? I am not doing a home test - will get a HCG but I don’t want a false result or false hope if it’s negative that I did it too soon etc but also want to know as soon as I can.

Hello everyone. I could use some advice. I have not done EMMA/ALICE, I keep asking my doctor about EMMA but he is not convinced of its efficacy.

So instead I did a Daye at-home test for vaginal microbiome and result was horrendous. It showed I have only 2% Lactobacillus, also had 11% Candida. I have taken Canesten for Candida. My doctor has advised taking probiotics to improve good bacteria. But the thing is, I have been taking probiotics for the past two years, so I find it really shocking that I have only 2%. Since the test I have switched the probiotic to another one specific to vagina.

I am here for advice on any specific probiotics that you could recommend or anything else I can do to improve my level of Lactobacillus.

@Serendipity24 hope you're doing ok. I did quite a bit of research on probiotics and I understand its lactobacillus crispatus that is meant to be good for vaginal area. I've been using the one at the link below, bit pricey but it has the crispatus ingredient in it. I was using Obtibac female prior to this which I understand is meant to be good too but I switched because it didn't have the crispatus in it. I never got my levels tested in the end but I understand the one below is meant to be good and I'm still using it:

healf.com/products/invivo-bio-me-femme-v?variant=44655940829423&currency=GBP&gad_source=1&gclid=Cj0KCQjwsaqzBhDdARIsAK2gqndw89QRg53z6QDkab26xrVXkJRqCZUdRz8DiyRAskHY3EOVxnHun_saArQvEALw_wcB&selling_plan=5699633391

@Serendipity24

Think it was this article that I came across about lactobacillus crispatus

www.ncbi.nlm.nih.gov/pmc/articles/PMC10673025/

Thanks so much for both links @Sunflower360 , I will check them out. Just today I mentioned to blahblahetc that I heard about Daye test from you, and it's lovely to hear from you! Hope everything is going smoothly for you 🍀

@Serendipity24 It’s good to use a probiotic that has an acid product in it like Vagibiom. I never found oral probiotics helpful at all. Vaginal probiotics are much stronger as the amount of live bacteria is usually greater in a vaginal product. Plus with oral probiotics it has to get through your gut. Do you use balance Activ? I use something gels twice a day with a strong vaginal probiotic. If I use Vagibiom once a day, I use balance activ in the evening with a probiotic. Flora femme is also good but very expensive. Flora power has vitamin c in it for vaginal use which helps to increase lactobacillus with its live bacteria but I would avoid close to transfer this one.

Thanks so much @2021ivfagain for the suggestions. May I ask where you get Vagibiom in the UK? I found it at Ninelife but the cost is £50.40! It apparently costs $17/18 in the USA, so quite a difference.

@Serendipity24 That’s actually quite reasonable. I have paid a lot more unfortunately so I would stick with that. EBay sell it. I have got it from Amazon.com before.

@Dochas12111 I’m glad to hear it went smoothly. Have you retested progesterone?
It is accurate to test blood HCG from day 8 post transfer so that should be fine.
mine was at 127nmol/l which made me worried it was too high 🤔
BFN and AF started today. It’s hit me as it’s our 5th wedding anniversary, which I want to be happy about but just feels like a milestone of time ticking of us TTC, and friends who got married years after us told us they are expecting near what would have been our due date. It sucks.

Hi everybody. Hoping to get some advice. I got the results of my EMMA/ALICE and it’s not good! Hopefully you can see the picture. Doctor has put me on 7 days of co-amoxiclav then told me to do course of vaginal probiotics. He thinks the sample was potentially contaminated as he thinks it’s very strange that staph was one of the bacteria detected which is usually a skin infection. So he is suggesting I don’t retest. What do you think about this plan? Thanks x

@Enfys23 I’m so sorry. I have been there and it’s so tough. We used to write that hopefully next year would be our year on our cards and then the next year still no further on, and the next. I hope you manage to find a nice moment in the day to celebrate that you’re together, you love each other, you’re still trying. I hope that this year is your year.

I retested and after 2 days of intra muscular injections it’s up to 90. Clinic v happy with that. I don’t think it can be too high really. They say over 50 but I think that’s a minimum and I’ve read near the 100’s is better so you were not too far above that.

@Diamondpearl123 I also had staph in mine along with strep so I’m not sure about the contamination comment. For me whether to repeat depends on your journey so far and how many embryos you have. It could go either way! My first Emma/alice I repeated and it showed the antibiotics had worked. My 3rd Emma/Alice showed the antibiotics hadn’t worked when I rebiopsied so I needed stronger ones and then my 5th one showed all clear. (These were done over a number of years with a successful transfer in between).

@Diamondpearl123 definitely retest, you have a mix of bacteria there, co-amoxiclav is a broad spectrum antibiotic, but 7 days isn't that long of a course and with 0% lactobacillus you have some way to go to get to a good level. I had 0% and was treated on co-amoxcilav, then took probiotics and on the retest still had 0%.

@ChickenT2b did you decide what to do, I did the IvIg with a good beta and at 20 weeks when my nk cells were high. Otherwise I stuck with intralipids.

@Dochas12111 I've seen quite a few USA clinics do a beta at 9dp5dt, there's an interesting write up here about when you should expect a positive by: www.reddit.com/r/IVF/s/ZET7ubm7dD
90 progesterone sounds good :) my RI likes it over 80 and some of the London clinics like over 100.

@Serendipity24 what bacteria was present in the test? With a low amount of lactobacillus you will likely need antibiotics to get rid of the dysbiotic bacteria present. I've written a post of the microbiome here: www.reddit.com/r/infertility/s/ReKgEsApcY

I'm sorry @Enfys23 :(

Thanks so much to you both for responding. Do you know if co-amoxiclav is the right antibiotic for atopobium vaginae? I’m considering taking metronadizole as well and maybe some vaginal clindamycin to try to make sure I wipe out any bad bacteria. Also do you know if I can take probiotics at the same time as antibiotics to give myself a head start? My consultant says no but I feel like they are maybe not that up to date on latest research on this.

@Diamondpearl123 atopobium vaginae is an anaesthetic bacteria so is better treated with an antibiotic that targets that. I would do the coamoxiclav first then follow it with metronidazole, vaginal clindamycin or both at the same time for 7-10 days. Then follow it with the vaginal probiotics. What happened in me was I had the coamoxiclav that killed off some bacteria and then the anaerobic bacteria took over. With some a high amount of the anaerobic bacteria you probably do need something to target that. The treatment the lab recommend tends to be on the minimal end.

You can use a vaginal probiotic while on the antibiotics, fertilysis recommend alternating daily between a vaginal probiotic and either clotrimazole cream or a low dose pessary.

Thanks so much for responding. Yes that is my concern that the co-amoxiclav is not enough to wipe it out. I feel quite confident that once I have got rid of the bad bacteria I can rebuild the good bacteria. I actually had an Emma/Alice before my son which showed zero any bacteria and I followed a lot of the stuff you mention on this group (been following you all for a while) and had a successful transfer! X

Do you think it’s worth me trying to get hold of doxycycline as well or is that the same as some of the other antibiotics? Many thanks

@Diamondpearl123 I did 3 days of doxycycline 200mg twice a day starting 2 days before the transfer. They do it a lot in the USA for microbiome issues and I heard it may help with implantation. Don't take later on in pregnancy though. But it's very commonly used at the transfer stage.

Anaesthetic bacteria 🤣 anaerobic bacteria!!

Thank you. Can I ask how you got hold of the doxycycline? Many thanks

@Gardenlady543 Thanks so much for sharing the link. I am attaching a screenshot of my result. Most of the bacterial mass was comprised of Candida and ureaplasma. I have taken Fluconazole capsule and Clotrimazole pessary for Candida. Do you have any advice?

@Serendipity24 it's a bit strange the bit about the reference value, as the ureaplasma is lower than the reference value. My friend had ureaplasma and went to the clarewell clinic, they did their own swab which showed it so she was treated on moxifloxacin.