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

Hi everyone. New here. I’m 35yo, no known issues, did 6 cycles of monitored letrozole, first round of ivf gave me OHSS and 3 frozen embryos (21 eggs retrieved but many weren’t mature, and those that were dropped off at each level) and just found out first FET failed last week. Have never had a hint of a positive after years of trying. Really struggling with the concept of time passing, being ‘patient’, and the future i’d pictured feeling further and further away. Having next few steps planned is only way I’m coping right now.

Now need to decide whether to go straight in to another FET, or look in to more tests. I’m fortunately in London so many resources within reach.

Currently at Chelwest but NHS funded so far (and will be I think for one more transfer) so I have only seen nurses except for the big procedures, and don’t have an assigned specialist at the moment to talk to.

Not even sure if they do EMMA and ALICE testing.

If they don’t - can’t anyone recommend where to go in London for this? (Or just general fertility specialist recommendations in London? I’ll probably move on from Chelwest if/when we start self funding for future treatment).

Thanks all - and I know you may have covered this already in the thread so doing my best to screen through without losing myself for too many hours at a time!

@amkw sorry you have been feeling so low, though completely understandable. Keep hopeful. Glad to hear you are feeling more proactive again. Its all we cam do really isn't it! Make informed choices and keep hoping/praying. Good luck x

@2021ivfagain our stories sound somewhat similar, which is very unusual. I also have high nk bloods but low nk biopsy in one marker. They suggested intralipids and not steroids because I am showing high in something called cardiolipin which they have told me to see a specialist haematologist about. I did not know that norethesterone and intralipids can cause high ph/low lactobacilli, I thought it was just the antibiotics that did that!
So did your nutritionist endorse you using balance activ every single day? When you say you use this plus a vaginal probiotic like canesflor, from a practical point to of view, do you insert balance activ gel then follow with the vaginal probiotoc within the same few minutes or space it out?
I haven't been able to do any of this for a month now because I am still bleeding for 23 days now since I got period after coming off of era medications.
Are you currently pregnant with number two, I'm sorry I have forgotten. It's nice to hear you didn't end up needing the nk treatment at all and that it still worked out! X

@Prayformiracles For low nk cells in endometrium, I do have treatment for this. I have neupogen infusion on first day of confirmed ovulation or first day of progesterone. For transfer day, I have hcg infusion which increases implantation and increases progesterone. If progesterone is higher as in over 100, this also helps to promote implantation for people with low nk cells in endometrium. I opted for this treatment but not for slightly high nk cells in blood.

No. I had a missed miscarriage. I was doing well. Did not have any infections. But there was no heartbeat at second scan due to an extra chromosome. I did not do PGS testing. Historically, we never had many blastocysts to test due to husband’s low morphology. When I was 40, we had more blastocysts than when I was 38 as his morphology was better. I researched all the supplements to boost it. Then when I got to close to 41 my egg quality declined significantly. My egg quality was really good until I got close to 41. So at 40, I had 7 day 5 blastocysts which was 100% blastocyst rate from those fertilised. I put two back, one implanted. Now I have 5 day 5 left. So I am putting two back next time. Hoping to do transfer in August. I do natural FET with mild stims and trigger but last time my oestrogen got so high my lining went too thick so they cancelled. I was gutted. My husband is fed up with it all. I have a son who is 3.5 years old. But I want my son to have a sibling as our family is so small. My Dad is in a nursing home: he had a stroke when I was pregnant with my son. My mum needs full-time care as she had multiple falls when I was pregnant and constantly in hospital.

@Prayformiracles I put probiotic in first of all, for example, lacto vaginal, then I put balance activ in immediately after but wash hands in between as hygiene is paramount. I put Vagibiom in on its own in morning. Then evening I put lacto vaginal in or canesflor in then immediately after that I put in balance activ. Hope that makes sense.

Norethisterone is like any type of birth control pill. These are terrible for messing with vaginal ph. But antibiotics will do this as well. Steroids will not allow your body to get over an infection if it’s in state of recovery. I have been using non-stop probiotics and balance activ since.

My nutritionist told me to use balance activ for months as I had recurring bv such as atopobium vaginae and enterrocus faecalis. The constant balance activ speeds up lactobacillus growth but needs vaginal probiotics with it. Vagibiom has its own acid (prebiotic) in it as well as probiotic. Therefore, with Vagibiom you just need Vagibiom.

@Prayformiracles I only use balance activ gels. Pessaries are nightmare. I also don’t use pads at night with them as sweat can cause infections.

@Prayformiracles I would speak to your doctor or ivf consultant about bleeding for 23 days. You might need norethisterone also to regulate things. This sounds excessive.

@Sierra26 Sorry to hear of your unsuccessful fet. Its so very hard. Its such a personal choice about whether you want to look into other tests before trying for the next time. I guess being well informed is thr best place to be before making that decision. Things you could look into are Era, Emma, Alice, nk but these are often only recommended when you have recurrent implantation failure or miscarriage so if you want any of these now then you would have to ask for it and see if your clinic agrees. Another easy option is endometrial scratch. There's also embryo glue but I have not done this (but will also enquire about this at my next/final fet). There are so many clinics to choose from. You could go to some open evenings and get a feel. Good luck, keep hopeful.

@2021ivfagain so kind to send these replies. I'm so sorry that you had a missed miscarriage. That must have been so devastating. Well done for getting back on it. Also sorry to hear aboit your mum and dad. I think we are of that age where our parents have issues that we have to look after them too. I am also 41. Its positive that you have 5 embryos so keep hopeful.
I have never heard of neupogen. But I might discuss with my Consultant that I am worried about intralipids (can't have steroids or ivig) and see what he has to say. I have so never been told about mild fet but I suppose now is not the time to change or experiment as it is the very last embryo. They use norethesterone as standard every time I had a cycle for egg collections or fets.
I will probably follow your lead on balanc activ daily with vaginal probiotic first- thanks for that piece of advice. I won't be retesting emma again though as I have done it twice now. I may just give myself a couple more months so that I can implement these things after this bleed ends. Then I will have to go for it and pray.
I have been advised to go in for a scan to check bleed if its still there tomorrow but dont know if necessary as it has started turning brown in last 48 hours so I'm assuming it's on its way out.. hopefully this brown stage doesn't drag On too.

@2021ivfagain sorry forgot to answer your question. Husband and I are using a company called 'screen me' as recommended by the nutritionist.

@Prayformiracles Yes. Brown blood suggests period stopping. You might need to check iron levels. I usually eat red meat once a week or do liver casserole once a week but avoid near transfer.

The neupogen infusion and hcg infusion is just for low nk cells in endometrium not in blood.

My Mum and Dad are in their 70s but have had health problems since I was in my 20s. I so want a sibling for my son and cried when my husband told me about his friend’s wife being pregnant with her second. It’s hard as I am happy for them but it triggers miscarriages or the ivf stress to get to the successful point.

All we can do is hope, so our best and see what happens.

@Prayformiracles I mean I avoid liver near transfer.

I also have read that gut health is important and linked to vaginal health so I try to eat lots of prebiotic foods my nutritionist told me about like flaxseeds, onions, garlic, leeks, celery, sometimes goats cheese, tempeh and quinoa. I struggle to fit in all these!

@Prayformiracles thanks for your reply. I had a scratch before this transfer as I needed a mock ET so they did the scratch while in there. I might as a min add embryo glue this next time.

On one hand I’d like to try avoid further EC/IVF as my EC was very traumatic and painful, which would mean doing all the tests now before using up remaining two embryos so we could make any necessary adjustments.

But on the other hand I also know some people have success on later transfers without changing anything, and due to this clinics won’t recommend the tests until several failed implantations.

@Prayformiracles I feel like I have been doing ivf a long time. I’m 43 now. I was 39 nearly 40 when I first started trying for number 2. Are you aiming to do transfer in August? Are your blastocysts tested? I think you were younger than me when you did your last retrieval so you have a good chance.

@Sierra26 it is all so personal / individual with all these decisions we have to make. Personally I Try to make decisions on what I would least regret. But that's just me. Everyone is different. Hope you get clearer.. the not knowing what to do parts is so tough on our mental health.

@2021ivfagain sorry to hear about your parents health. Thanks for your messages. I don't overly focus on age because 2 of my 3 pgs viable embryos that were collected when I was 36 did not implant and one did. I collected more last year so that spanned over age 39 and 40 and that left us with one viable embryo after testing. Anyway not focusing on age. I think other factors are just as (if not more) important once you know they are chromosomally normal. Plus alot of luck / miracle ! 🙏

Hi,

about two weeks ago I had an Emma and Alice done which has confirmed no Lactobacillus, but also no endometritis. Previously I’ve had a battle with Bv which I now seem to have (hopefully) got under control. About 2 weeks prior to the Emma and Alice I had taken a course of metro gel as juno test showed I still had varying types of prevotella. I have been doing probiotics consistently for months so I’m not sure if the metro just wiped it back out or I’m just not getting repopulated. I do get swelling and discomfort if not using balance active. I am due to have a transfer this month of what is my last embryo. My consultant thinks I should go ahead, when everything I can see says you shouldn’t. I suppose really I want to understand thoughts on going ahead and possible time to repopulate. I will have had 5 weeks between the Emma and Alice and the transfer? Thanks

@Toes1 I attended a webinar on this topic and the doctor (Gynaecologist from Clinica Tambre in Spain) said it takes about 3 weeks to get from zero lactobacillus to the desired range. If you have 5 weeks then I think it's doable. I would encourage you to have both oral and vaginal probiotics though. Also, you might want to look into changing the brand of probiotics you have been taking if it appears it's not working as expected.

This is my report. I’ve been trying to repopulate since February so I’m unsure if the metrogel could have wiped it out that I took start of July or I’m just not getting anywhere on repopulating . Thanks for any help

@Toes1 so metronidazole is felt to spare lactobacillus compared with other antibiotics. I wrote a post about the microbiome here: www.reddit.com/r/infertility/s/AmCjEvA46T

It doesn't look like you need antibiotics,
My approach is to create the acid environment while recolonizing and to use vaginal probiotics with a lot of lactobacillus in them, the best one on the market is flora femme (only available from USA) for the amount of probiotics in it and the other one to consider is vagibiom as this has acid in it (also only from USA), I know some people have had issues getting them recently but I have managed in the past to get flora femme from their official website and vagibiom from ebay. Whether you go ahead with the transfer depends on whether you've had this issue before if so then waiting longer could just worsen the situation or whether you previously had a good environment in which case repeating a microbiome test may be a good idea. I took a daily probiotic in my FET and continued up until a 8 week scan if you wanted to go ahead with the transfer that's an option.

@Gardenlady543
thanks for responding

some history sorry it’s so long it’s been an arduous journey.
first transfer in 2021 worked but had a miscarriage at 8 weeks confirmed as immune issue.
post this Emma/alice showed endometritis caused by streptococcus.
2nd. Transfer January 2022 was unsuccessful
then I did 5 egg collections with a transfer in dec 2022 with another miscarriage but confirmed chromosomal.
pre that Emma/alice confirmed yo be fine and lactobacillus at 97%
in May 2023 I had a another transfer which was chemical.
september 2023 Emma/alice confirmed again streptococcus endometritis again treated with co amoxiclav around this time was also having issues with Bv which went on for sometime. Fertilysis confirmed this again in February 2024 and I’ve been on a mission since to try to get rid without antibiotics as consultant thinks overuse has caused this. In June juno confirmed gardenlla gone but still prevotella so consultant suggested to use vaginal antibiotics which I did a full course of metro gel and 2 doses of clyndamici just pre the Emma/alice. I have had vaginal burning/dryness for months now, but estrogen is not low, not sure if this means I’m not retaining the lactobacillus. I’ve been using vagibiom/lactovaginal/cannesbalane and various others. I’ve ordered flora femme. So really not sure what to do I’m not 2 weeks from transfer. Thank you again for taking the time to respond

Sorry I meant balance active

@Toes1 clindamycin will wipe out lactobacillus, so it would have been that I expect. Given the history that you have and that you've previously had a very good microbiome I would not go ahead without getting clearance that the microbiome issues are resolved. With the recurrent streptococcus you may benefit from seeing a specialist, my friend saw clairewell clinic who did their own swab and treated her based on the results of that. Some people can have stubborn infections and need intrauterine antibiotics, I've heard of people going through fertilysis for treatment for that. How many embryos do you have, I suspect with the number of collections you have a limited number and need to ensure the environment is optimum?

@Gardenlady543 yes I’m a carrier of Strep B. I think the strange thing on the report is there doesn’t seem to be anything at all, which almost feels like the test hasn’t worked. Just to confirm that vaginal clyndamicin can impact the endometrium? I have one PGS normal embryo left and collecting anymore is not an option for me any longer due to poor egg quality. So this is my last shot.

@Toes1 vaginal clindamycin wipes out everything including lactobacillus as far as I'm aware. So you most likely need longer to recolonize. You can do cheaper tests than Emma Alice, there is the fertilysis menstrual test and there are various vaginal ones which give an indication of what's happening in the uterus. If this is your last shot I would not go ahead with this result, I would order enough flora femme for recolonization before a repeat test and for use in the FET. When you get a good result on the repeat test keep using the flora femme in the FET, I know it's expensive but if it's your last shot then I would use daily if possible (except when bleeding), if cost is a factor then use 6 days of it after the bleed stops in the FET and use again around transfer and implantation time and use a cheaper vaginal probiotic daily when you aren't using it. This is just what I would do.