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

I just wondered if those with low ovarian reserve have found any issues with using norethisterone or provera for cycle timing? @Dochas12111 or aware of any research @Gardenlady543 ?

I’m planning for embryo banking cycles in the new year. Unfortunately my DH is likely to need to be away for work quite a bit and Sod’s Law my natural cycle will fall inconveniently.

I had a good cycle with the natural start recently. But I have also used progesterone to time cycle when at CARE and they had to schedule (I can’t have OCP due to migraine with aura) and while number of eggs not that different I am just nervous to use anything that may suppress as my AMH a bit lower now.
thanks for any thoughts

@Enfys23 I’m 43 years old so my amh is no longer good. I can honestly say that when I tried provera I had a bad reaction to my cycle. I didn’t have a proper period and could not start a cycle. It put me back a couple of months. When I took norethisterone, I was fine. Also norethisterone slightly lowers fsh and ensures you have a good bleed to start a transfer or egg collection. Norethisterone did not suppress anything for me and I was on it for 30-40 days before.

Thank you @2021ivfagain that’s really helpful. How are you doing?

Hi all .. just looking for advice, had an endometrial biopsy and results came back as a bacterial infection which I took 5 days of antibiotics for (Iinfection was ‘gram positive bacilli, and I had metronidazole antibiotics) and also mentioned white cells ? clinic don’t think I need a repeat of this to check if it has cleared, but I am not sure if I should push for one before putting any more transfers in ?

my background - 1 live birth (DD 22 years old) so long time ago when I was age 19 with a different partner.. had two natural miscarriages at age 36/37 with current partner, then 6 transfers (over 2 round of ivf and 1 ICSI round) resulted in 4 miscarriages) current 3rd round of ICSI round resulted in 4 blasts which we are awaiting PGTA testing results, and have two frozen blasts from 2nd round still. Secondary unexplained for me - we have male factor of 37% dna frag

so I just want to be certain everything is good down there before risking another transfer as I am 41 now (42 next week) so don’t have lots of time left.
If anyone has any advice at all as to what we can do next? I am starting Optibac probiotics also to try balance the microbiome in my uterus also ? Thanks in advance

Sorry for the delay in reply @Enfys23 . I did one cycle with down reg using norethisterone and I did have a muted response to stimulation meds when I got them. For all other rounds I was on a short protocol instead and had a better response however a strong caveat to this experience is I was with a clinic who were useless and I was on half the Stims I was on for other rounds so I am not sure if it was due to the long protocol or not.

when are you planning to start embryo banking? Have you spoken to your consultant about it and are there any other options to delay cycle / do they think that it can cause an issue?

Will you need it for all embryo banking rooms or just the first one?

@hopefullsosbry I would push for re biopsy/ recheck. As there is no other way to know for sure if the issue has resolved. For me I did rechecks and for one the issue had resolved for the other it hadn’t and I needed further antibiotics and probiotics. Also wouldn’t particularly rate optibac. GI pro nutra have probiotics with much higher levels of good bacteria. Good luck!

Hi, thanks so much for the reply, I will look into to the GI pro nutra, thanks so much for the advice,

@Dochas12111 thank you. I hope you’re doing well.
Planning to start with next cycle. We are waiting to hear from consultant as he was on leave. But see what they say. Realistically it’s going to be an issue that causes uncertainty and stress for the next few months as his work schedule is unpredictable as is my cycle between stims! But we might just have to risk it. Not sure if going to be too late to start norethisterone now anyway. It may be better we use my DHs frozen sperm if we have to.

Hi, I have just came across this tread. Just wondering the success people have had after the EMMA & ALICE testing and if they have also done the ERA along side this?
I have had 7 failed transfer through the NHS in Scotland and currently looking into a private round with additional add-ons. Unsure if should get the above testing done as I have had a hysteroscopy and biopsy done so not sure the difference 🤷🏻‍♀️ xx

Thank you for your reply. I had my follow up consultation and my consultant is happy to progress with a lining of 6.5mm. I have started the mock cycle again and am throwing everything at it... pomegranate juice, acupuncture, bone broth etc. They have put me on viagra this time too to see if it helps.

@lemons44 glad things are moving forward for you. Viagra pessaries helped mine a lot.

@Dochas12111 how are you doing?
@2021ivfagain hope all going well?

I have been recommended hydroxychloroquine, intralipids and uterine PRP. I am nervous to start hydroxychloroquine while still doing egg collections. How long were others on this before transfer? Can it affect egg quality @Gardenlady543 ? Is it best to start post the banking and before FETs?

@Enfys23 I'm not sure about that, I know a lot of people are on it for rheumatologist conditions. You need to be on it for 3 months in advance before the transfer really according to USA RIs as it has a long half life, so takes a while to get in your system. Could starting it after and waiting to transfer be an issue? I ended up on it from summer and the transfer that had worked was the following May and you stay on for a lot of pregnancy. They get worried about the impact on the liver and eyes. So I ended up having to have checks for those things before more would be prescribed. I think those issues are very rare though and it's a pretty standard drug to go on for RI patients.

Hi @Dotty1988 I would avoid the ERA there are a few papers that show ignoring it doesn't make a difference. I ended up ignoring mine and having success with regular timing in a natural modified FET with low dose stims.

@Gardenlady543 thank you. I think I would prefer to start it after. It just feels such a long wait but maybe that’s okay. Hope you’re doing well.

@Gardenlady543 thank you for your reply. Yes I have decided not to go ahead with it x

@Dotty1988 is it implantation failure you have? there is a good group on Facebook called infertility and repeated implantation failure (RIF) support and there is the reproductive immunology support group and uk reproductive immunology group too.

Has anyone had low Treg cells on their immune bloods and know what potentially can be done to help? I’ve read vitamin D level is important to get right - I’m going to re test Vit D levels soon as been on extra (previous level wasnt bad at 80 but aiming to get over 100).

Hi, hope it's ok to pop on here!

Can any of you advise the difference between EMMA / ALICE testing and something like Fertilysis or ScreenMe menstrual blood testing?

From what I understand both are testing the uterine microbiome but the difference is that EMMA / ALICE are a biopsy and fertilysis is a swab l… surely that means they’re different levels of accuracy or test for different things (because why would anyone do a biopsy if you could go without it)

Has anyone tried the menstrual blood testing in addition to Emma / Alice? Were the results agreeing with each other?

Feeling worried today.

Off for my first scan, hoping my lining is the minimum 6.5 set by my doctor so I can start progesterone.

However I have awful ear ache and wondering if I am getting an ear infection ☹️ I know you are not meant to take antibiotics before the test. Not sure what I can do except hope it doesn't get worse and goes away on its own. I can't really afford for this cycle to be cancelled like my last mock cycle was cancelled as it's £600 cancellation fee a time plus the cost of the medications, acupuncture and travel.

Just a little update for anyone interested. My lining did reach 6.5mm however they noticed a pocket of fluid in my uterus. Because of this my consultant also wants a hysterscopy done at the same time as the Ema/era/Alice biopsy in case I have scarring. (Not sure if fluid and scarring are linked?)

Has anybody in here had a hysterscopy too?
Not sure what to expect. If you had one, did it find anything? What happened?

Hi @lemons44 this sounds like a good plan, I feel everyone should have some kind of investigation of the cavity- either a hsg, saline scan or if required hysteroscopy, if doing IVF. As ultrasounds can't pick up some cavity issues. I have had a couple of hysteroscopies, which should only be undertaken if there is a reason to do one, as there is in your case.

Do you know whether it will be an diagnostic hysteroscopy or an operative hysteroscopy and whether you will be under sedation/ a general anaesthetic?

I hope your ear is feeling better?

Hi @sotif I wrote a post about this subject here www.reddit.com/r/infertility/s/OAxE9fGEnl both fertilysis and Emma Alice use the same technology, they look for bacteria rna. I had Emma Alice twice followed by treatment and then did fertilysis. If I repeated in the future I would do fertilysis. You could argue that the Emma Alice is extracting tissue directly from the uterus, but fertilysis you collect menstrual fluid in the first few hours of your period, I used a menstrual cup so it wasn't likely to become contaminated from the vagina, mid cycle you take a vaginal swab and the results assess both results. Mine was clear (after having 0% lactobacillus twice on the Emma Alice), so I was reassured. I then went on to have 1.5 years of ongoing IVF, major surgery, etc and didn't revisit a microbiome test, I just kept an eye on my pH and symptoms and used some antibiotics if I noticed the pH going up, I also took 3 days of doxycycline at the time of my transfer, as done in the USA.

@Enfys23 I don't know much about tregs, the immune stuff is so complicated!

@Gardenlady543 what fertilysis test did you get done? I have looked at it but unsure how it all works and how to get bloods etc done here as our GP is a nightmare

@Dotty1988 I did quite a few of their test, I'd didn't do them all at once though

Female microbiome
Male microbiome
DNA fragmentation index
Reproductive full

Overall I think I've had all the different tests they offer but with different providers.

@Gardenlady543 thank you. I will take a look. Yeah I think somethings are the same or similar. I am just currently looking into private treatment after failed rounds with NHS and I guess there is all these add ons but nothing seems to have much evidence to back them. Hard deciding what to do best

@Dotty1988 what's your history, was it no implantation for your transfers or losses?

@Gardenlady543 7 failed transfers all
failed implantation. I am in the middle of getting some blood work done and going to go for PGT-A testing. We have since
decided against doing the EMMA & ALICE testing