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

@Enfys23 how are you doing? Thinking of you.

I’m on day 9 of stims for our first round of ICSI. I’ve just had my endometrial biopsy results back this morning. Dr Gorgy’s office advised to use Matrice Labs in France. I think there’s some issue with Chicago.

Does anyone have any experience in these results? I can’t see Dr Gorgy until Thursday and our transfer is supposed to be a week on Fri so I’m worried I won’t be ready.
What’s with the Ovitrelle recommendation?! Doesn’t make any sense to me.

@Enfys23 thinking of you, how are you? Are you still in hospital ❤️

@ChickenT2b I haven't seen these results before but it sounds like quite a few options are discussed, could you speak to Dr Gorgy and see what he thinks and do a freeze all cycle if needed then have the immune protocol in a FET?

@Gardenlady543 that’s the plan to speak to Dr Gorgy and see what he recommends. Freeze all if necessary. It is a worry as I’ve already been taking hydroxychloroquine and prednisolone so I can only assume it’s not working for me. Did you do IVIG in the end? I can’t remember.

@ChickenT2b he puts everyone on hydroxychloroquine as far as I've seen. I did IvIg twice in pregnancy otherwise I did intralipids, IvIg is really expensive.my NK cells in my blood were always high, nothing brought them down.

@Gardenlady543 @ChickenT2b thank you. I am now home. I’ve had a repeat scan today and bloods yesterday and things look okay to continue expectant management. The consultant did re-offer surgery today but weren’t pushing it. I think they just know watching and waiting is hard and obviously always a risk being home too. I go back and forth a lot on the decision but I do think trying to avoid surgery is better if I can. I’m lucky DH can be with me for as long as this takes. It’s just emotionally very difficult. I am a lot more comfortable by today which has got to be a good sign and matched with fact the free fluid/internal bleeding has settled on the rescan.

@ChickenT2b hope all goes well with stims. I hope you can get a clear plan and reassurance soon.

Hope everyone else doing as okay as can be ❤️

@Enfys23 I'm just catching up on this thread and so sorry to read your updates. It's just devastating how things change in an instant from positive to negative outcomes despite all we try. I hope the expectant management resolves as quickly as possible.

What's people experience of fet? Looking at April but they're suggesting medicated, which makes sense as my cycles are well scrambled for months after ivf. However, I am concerned that the transfer date would not correspond with when my natural ovulation and embryo 'arrival' into my uterus would be. My lining usually responds quickly and well to oestradiol and the embryo will go in after 5 days progesterone. Will it make a difference when it goes back as theyre giving fyremadel to stop natural ovulation? It made a big difference with my last ivf cycle when they started stims (all different drugs) and collected a little later in cycle

Hi @kerrym87 I’ve done a completely medicated FET with down regulation beforehand and had success. I’ll be doing the same for my transfer in hopefully April too. I did the era and timed it to the receptive window. Sure it’s not a natural cycle but they are mimicking a natural cycle so I was happy with that.

@Enfys23 I’m glad you are home. I’m so sorry for all you’re going through x

@kerrym87
If you're doing a medicated FET, when you naturally typically ovulate doesn't matter and it won't be considered. The drugs will prevent you ovulating. The timing will be based on when your lining is ready and when you start progesterone.

Have you had your PGT-A results back then?? Four sent for testing was a good outcome, considering your Day 5 update, although the update was early Day 5, I recall.

@Dochas12111 a while back you asked me how I was feeling about upcoming FET. I've honestly not tried to dwell on it as it's too massive! It's by all accounts probably my last chance for a sibling. How are you feeling about your FET? Is your motivation better now?

I'm so sorry @Enfys23 I hope that things happen quickly for you so you can move on. The whole thing is so cruel.

@kerrym87 as others have said your normal cycle isn't relevant for a medicated fet, the estradiol will cause the ovaries to be "quiet" they won't product a follicle or ovulate, in 10% of cases the body can decide to make a follicle and ovulate, but this would be picked up on the scans. If this happens they can convert to a modified natural FET. Saying that I don't think it's as common as 10% but that's what my fertility specialist told me.

@CailinInUK @Gardenlady543 I've got 3 euploid and one mosaic they were blasts by lunchtime d6 (they were collected like 10 30am) but all worth keeping frozen. They aren't down regulating me prior but giving me fyremadel to prevent ovulation alongside oestrogen. Thanks guys, its a new experience and having a FET just delays the fear and worry a bit longer !

@kerrym87 I've not needed fyremadel in a medicated FET before, are your clinic sure you need this, someone told me they'd read that it can prevent implantation so I made sure I didn't take it in my natural modified FET. With estradiol you shouldn't be producing a follicle so shouldn't need the fyremadel.

@Gardenlady543 i’m so relieved after my follow up consultation with Dr Gorgy re the endometrial biopsy results.
He just wants me to add in HCG 2000iu one day before transfer, one day after and 2 days later. This is to help with the cytokines, was this ever an issue for you?
Plus IVIG on positive test which I am ok with. I think if this first transfer doesn’t work, maybe we will do IVIG in advance of the next one. Honestly thought he was going to say don’t bother transferring 😮‍💨 !

Has anyone else done HCG boosters around transfer? Kind of stumps any plans for early testing but perhaps not a bad thing!

First ever egg retrieval tomorrow!!! 🤯

@ChickenT2b I didn't do this, my cytokines were ok, I had high nk cells in the blood. I did IvIg with the positive test, it would have been really expensive if I had it before as it took me quite a few transfers to implant. Good luck for tomorrow :)

@ChickenT2b good luck! @Gardenlady543 I thought once oestrogen reached a certain level it triggered an LH surge for ovulation? X

@kerrym87 in a medicated FET estradiol is started from the beginning of the cycle which suppresses the ovaries. In an unassisted cycle the estradiol comes from the mature follicle and rises a few days before the LH surge and then ovulation occurs. Is your specialist looking at supplementing estradiol rather than starting you on it from the start? That I would think would be a modified natural FET rather than a medicated one.

Hope you're doing ok @ChickenT2b :)

@Gardenlady543 I think oestradiol from early on, with fyremadel. So it makes sense what you've said so why would I need fyremadel? It's all a bit confusing and I may need something to time a bleed as it's hard to predict for a few cycles. Thanks for explaining

@kerrym87 I haven't heard of fyremadel in a medicated FET before so you should check with your clinic. I've had noresthisterine to time a bleed.

Thank you @Dochas12111 @CailinInUK @Gardenlady543

@ChickenT2b wishing you so much luck today. Egg collection sedation has been my favourite part of the whole process 🤣so I hope you have a good experience.

@kerrym87 I have a friend undergoing treatment at another CARE clinic and she has been given fyremadel in her medicated FETs in the past year. So I think some do. Not sure if entirely necessary but they clearly want to remove any risk of escape ovulation.

@Gardenlady543 @kerrym87 @Enfys23 thank you.
Egg retrieval went very well, we got the call this morning to say that out of 12 eggs retrieved, 10 were mature and 9 fertilised. So we we await transfer on Wednesday. It’s nice to finally get some positive news. I’m aware usually 50% drop off from now but that still feels like a good number of chances.

My clinic are having me do utrogestan pessaries 3x per day. Which in itself is fine. But I’m concerned this means I won’t be able to take probiotics anymore? When can I possibly pop a canesflor in now? 🙈

They also gave me antibiotics during the retrieval so I’m keen to make sure the microbiome remains in good shape.

@Enfys23 sedation was lovely 😂 apparently I woke up in a panic that I had missed my morning alarm 🙈

@ChickenT2b great news! I once had 12 mature and the other three times I had 10 mature each time it's a good number :) I used cyclogest which can be used rectally I couldn't take utrogestan as I reacted. I spaced out probiotics when on vaginal antibiotics though.

@Enfys23 how are you doing?

@ChickenT2b that's great! My fourth collection was the first time I remembered nothing, it was amazing! First 3 I had piddly doses of sedation and was in agony all through as they didn't have an Anaesthetist. Fingers crossed for your embryos. I always do cyclogest rectally as it prevents leakage and irritation.
@Enfys23 I'm with care too

@kerrym87 oh gosh, no sedation on 3 occasions?! I’m with Care Northampton and couldn’t fault them yesterday.

hmm I might need to switch to cyclogest a day here and there then as I really want to get some probiotics in. I’m not on vaginal antibiotics, it was just precautionary during the procedure due to my endo.

@Enfys23 i hope you’re doing ok.

@ChickenT2b I did have sedation but it was such a small dose it didn't feel any different 😕 they didn't have an anaesthetists just nurse so they couldn't give bigger doses in case something went wrong

@kerrym87 3 euploids out of four is a great result. I can’t recall your history - is there a suspected implantation problem or have you just not had many good embryos to transfer before now?

@ChickenT2b
great numbers! Your first and hopefully your last egg collection!

I got the results of my last Fertilysis microbiome a few weeks ago. So here is the expanding history of my results so far:

13/10 high strep, eubacterium, moderate staph and mobiluncus, low lactobacillus Fertilysis)

22/10 Cephalexin antibiotic for UTI (7 days) so didn’t use metronidazole recommended by Fertilysis as Cephalexin is broad spectrum and I had upcoming Emma/Alice anyway.

20/11 96% lactobacillus on Day 21 (Emma/Alice)

07/01 very high eubacterium, high gardnerella and no lactobacillus (bought this Fertilysis re test prior to knowing Emma/Alice result) vaginal swab fine

14/02 10 days of metronidazole
08/03 will retest microbiome with Fertilysis and paid for quick turnaround of results

I’ve done lots of Googling and sounds like the microbiome does shift according to the time in your cycle, though lactobacillus should normally still be the dominant bacteria throughout. I wonder if, due to my age (err.. 45 now!), I’m more susceptible to dysbiosis early in my cycle when oestrogen low. Having said that, it seems that gardnerella can follow when the other bacteria are first treated ( as per you @Gardenlady543?) so maybe mine will be ok for this retest.
My dilemma at the moment is whether to commence modified natural cycle mild stim FET on the same menstrual cycle as I retest, i.e. late next week?!?!
If poor results come back, I could always cancel FET and pay the fee of approx £550. I’m just really struggling with delaying another month as I’ve had so many delays up to this point with COVID then ‘Flu. We made the euploid embryo last July, but it is our one and only.

@Gardenlady543
can you recall how long between your hard core antibiotic therapy for gardnerella and your menstrual sample that came back good? It seems gardnerella does normally get annihilated pretty instantly on antibiotics and microbiome recovers quickly, however high recurrence rate.