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

@Gardenlady543 we are in the same clinic with same consultant, as we discovered! I pressed for Modified natural FET too and think consultant is using it a bit more often nowadays.

@CailinInUK I wonder if my case pushed the change! He is very good and made the effort to speak to me about the rationale for decisions which isn't usual for the clinic but is kind of needed in complex patients.

@Gardenlady543 he still recommended medicated FET to me and never mentioned Modified. I had to push it. But I'm sure your case helped. If it was up to him, think he'd recommend Modified more often if he wasn't constrained by the ongoing management decisions regarding cost saving (clinic opening days, transfer days and no more same day blood results).
He got back to me this morning. Clinic now totally closed on Saturdays so hands are tied. He said it's up to me whether to take ganirelix as I understand the risk. He'd trigger tomorrow Day 10 if follicle 18mm and lining >8mm. I think it'll be borderline. If under, I'll probably push to Monday with the high risk of surge and cancellation. I know some clinics work with natural surge and transfer +6 days but I'd rather stick with transfer at HCG trigger +7days as it's more precise.
Trouble is, I might be in same boat on next cycle but I'll have to go with it.

@CailinInUK they aren't doing collections or transfers on Saturdays now either? This is so ridiculous, they already don't do them on Tuesdays and Sundays. I seriously don't know how it's possible to have an industry as lucrative as fertility treatments and it's not 7 days a week, but 4 days a week 🤯

@Gardenlady543 nhs did 3 days a week at mine to save money I think 😂 I was never quite ready when they took me and had a Saturday collection this time which was best we had. However, the proper care does come with a price tag.
I still don't understand my fet as they want to start me on oestradiol d1-2 with fyremadel for 7 days, then increase oestrogen with scan d12, 5d cyclogest added in then transfer. They said they had loads of cancelled cycles due to follicles growing but surely that's not the end of the world if you can trigger if lining good and still transfer 🤔 this is a whole new world

@Gardenlady543 did you continue taking vaginal and oral probiotics during pregnancy?

@APSR yes daily oral probiotics all pregnancy, vaginal daily until 8 weeks then once a week :)

@kerrym87 my specialist told me people make a follicle in 10% of medicated FETS and they convert to modified natural, I've seen it happen in less cases anecdotally though. Sounds like they would rather give an expensive medication that may impact on implantation (I don't know the source for this but was told), all the prevent some minor disruption in 1 in 10 cases at most.

@Gardenlady543
Thats right, theatre days have officially been Mon, Weds and Fri for some time (couple years or more). Last year they used to open theatre on Thurs and occasionally on Sat if demand was there and consultants pushed for it, but generally not. There seems to be a firmer closure of theatre nowadays at weekends.

@kerrym87 I’m not familiar with that protocol. The more common way to avoid ovulation during medicated FETs is to do a ‘proper’ down regulation from D21 of previous cycle. Then once down reg is confirmed via scan, to commence oestrogen and continue with lupron. If you’re not comfortable with it, do challenge. I had success with medicated on my first euploid transfer but I'm changing to modified natural this time. Hopefully not a decision I'll regret!

I had my Day 10 scan this morning (mild stim mod natural FET). Up to it, I was concerned about the lead follicle growing too fast, triggering too early or having to add antagonist over weekend or risk surge (I was going to go with latter!). Turns out, there’s been little growth in follicles!! Lead has gone from 14mm to 15mm. Lining has grown from 6.5 to 7.6-8.8mm. It looks good. Consultant recommends 50IU over weekend (down from 75IU) and come back on Monday, with trigger likely that night (Day 13).Anyone else go into a frenzy of googling and reading a tonne of research papers in between scans??!

@2021ivfagain I scrolled back on the thread. Thanks for the feedback on the microbiome, it’s reassuring.
Yes my DC is in nursery full time. Difficult to avoid germs, isn’t it. I had a few illnesses, including COVID, a few months ago so hope that’s it for a while. We just try the usual - washing hands, good diet, sleep, stress management, etc. I know it must difficult for you to manage stress, given your dear mum’s situation and other things.
Regarding your loss, I hope there is some comfort in knowing that it was nothing you could have done to avoid it, it was the aneuploidy. It really doesn’t mean all your other embryos will have the same fate so you’ve still got a good chance. Implantation is proven for you.

@Dochas12111 hope your results finally come back favourable. When are they due? Are you getting the biopsies done in your luteal phase around when transfer would take place?

I received my Fertilysis menstrual microbiome repeat results today. Lactobacillus has increased from zero to moderate but gardnerella and eubacterium still present. My recent EMMA ALICE was spot on and suspect I am prone to a dysbiotic microbiome at the start of my cycle when Fertilysis sample taken. Age?! It is disconcerting though. I could cancel my FET but wonder if that’s a bit extreme. Another Google frenzy ahead.

@ChickenT2b I am really sorry. It’s so heartbreaking. I hope you’re doing okay.

@CailinInUK I am sorry it wasn’t a straightforward result. But good news about the follicles!

It is bonkers especially when we pay extortionate amounts for private fertility care, that procedures are limited to certain days and no weekend working.

That is certainly something in Manchester Fertility’s favour of having 7 day working.

@Gardenlady543 I am doing okay. I had a lot of pain in the first week post op my incisions are a right mess vs the neat job I had pre-Xmas but I guess all to be expected with emergency surgery. It will forever be a lasting reminder now. My DH says I should have pride in my battle scars. I’ve felt quite emotionally numb which isn’t a bad thing as crying hurt!

We have a consultation next Saturday to discuss whether we return to IVF or carry on with natural TTC from May (we’ve been advised a month break to allow healing and timing from a period as it’ll be really important I have 6 week scan now in case of future ectopic). Our gut feeling is to try naturally for a bit. Drs seemed to say it does seem promising we had natural conception for first time ever in first cycle TTC post the excision of endo. However I am now down a tube so that’s got a 20-30% knock on fertility. Hard to know. It’ll be good to chat through with specialist. I’m not sure I’m emotionally ready for IVF again after this experience anyway. DH certainly voicing he isn’t right now.

Oh @Enfys23 I'm sorry, I remember after my fibroid surgery being told most likely on this thread that having a c section scar when I don't have a baby and may never get a baby was just the cruelest :( scars from this stuff are just the worst, did they do it via a lap? If so then I hope they will be less noticeable as time goes on. I had heard that the body adapts and will ovulate from the side with the tube after one is removed.

@CailinInUK how are you doing? How was your check today?

@Enfys23 sending hugs. I agree ttc yourselves could be a good idea. Gives you a break from invasive procedures and to heal and hopefully a good chance of conception.

@CailinInUK no results yet! is your transfer going ahead this week? The very best of luck!!!

Yes I do the biopsies between day 15- day 25. Hopefully I’ll hear this week. I just started a new cycle so it’ll be an end April or early May transfer here. I think we are going to go ahead with transfer regardless as I’m just getting older and we can’t keep doing biopsies forever!!! Really hoping it’s improved so I feel happier about this ☹️ @2021ivfagain thanks for the information that you did a similar approach and it did result in pregnancy.

@Enfys23 sending hugs. I'd say go with your gut instinct and try naturally when you're ready.

@Dochas12111 hope your results are favourable and not definitive like mine.

@Dochas12111 @Gardenlady543
Yesterday at my clinic my leading follicle was 18-19mm and lining 9.3mm triple lined etc, so all looked good. So I triggered last night based on consultant's recommendation. HOWEVER, as the clinic doesn't provide BT results on the same day any more, but next day, I just got my E2 and LH levels today. E2 is 642 pmol/l and LH 3.3. I'm concerned my E2 is low and in two minds about proceeding. The nurse said the consultant reviewed them and happy. It's so upsetting and frustrating as if I'd known the E2 yesterday I wouldn't have wanted to trigger. Trouble is, I may be in same boat next month.
Unsure what to do. :(
There are studies showing significant lower implantation, higher miscarriage and lower live birth with lower E2.

@CailinInUK ask for a repeat? You have until next week to decide to transfer and the follicle will be releasing increasingly higher amounts of estradiol until it ovulates, when you trigger you have the lh surge the next day and ovulate the day after, I bet it's higher now.

@Gardenlady543 good idea, I hadn't considered that, even though I like to measure the Hell out of everything!
However the studies I've read are based on E2 on trigger day....?? If I did get my E2 measured and it was higher, would I be happy to proceed, I dunno.
My mock cycle E2 was in optimal range and I know yours was too ;)

Consultant got back to me on email saying my level is not low, and my level will be lower due to using recombinant FSH (Gonal F) and not HMG, and that low E2 can cause low P4 (progesterone), which can result in increased miscarriage rates but we are supplementing anyway.
Im not sure, reading the studies. My E2 isn't as low as the threshold in most of the studies but it's not near the means for the control groups.

www.fertstert.org/article/S0015-0282(20)31584-3/fulltext

www.fertstertreports.org/article/S2666-3341(21)00065-9/fulltext

www.fertstert.org/article/S0015-0282(20)31542-9/fulltext

Are you converting @CailinInUK uk unit is pmol/L I just clicked on the first one and it's in pg/ml

@Gardenlady543

yes I'm converting. My level is 642pmol/l which is 174pg/ml.

@CailinInUK I honestly think it will be higher now, did you ask about retesting it?

Good news from me! Good bacteria of 93% and no bad bacteria. Delighted! All going well FET will be end April/start May!

sorry @CailinInUK I am no good on this sort of thing but if you are worried I agree with @Gardenlady543 that it would be good to try for a retest.

Thanks for the replies @Gardenlady543 :)
I asked if a BT today would be beneficial via email but consultant didn't answer the Q. He just said trigger timing not based on oestrogen but on follicle size and lining thickness.

I'm asking myself if I'm being OTT due to it being my last embryo and everything riding on it but think I'm maintaining objectivity here. If id known my E2 yesterday I would have not proceeded with trigger yesterday.

I'm even contemplating cancelling and moving embryo to somewhere that has same day bloods, lots of monitoring and FETs seven days or at least five days a week. :(

@CailinInUK I know what it’s like as I’m only using frozen embryos now which aren’t even tested. I would say anything over 500 is ok but you would need hrt 3 times a day in the luteal phase. I didn’t need it last time as my oestrogen got to over 2000 but I think it was as I had done oestrogen priming. I was on 300iu meriofert every other day. I had to fight for it. I was also on ubiquinol 200mg twice a day but Dhea 25mg x3 in the cycle beforehand. If oestrogen is lower, it’s important they add in hrt. I had this issue with my clinic. I had to keep fighting. I’m starting to lose the fight now as I have so much to think about.

My son has been ill every week since he went back to nursery in January. I am on my second cold but it’s the aftermath. I only have a slight cough at times but I’m dragging out norethisterone for as long as I can. I still have to sort out blood tests and pay my invoice but I have lots of things to sort out for my mum and dad too. With all the colds, I barely get to see my Dad who’s now got dementia due to stroke and in nursing home. Mum was in hospital 2 months and now she’s home can’t see her either due to her low immune system.

Hope you come to a decision. I would push for hrt in luteal phase 3 times a day. The thing is I had 4 large follicles but you only need one. When I was on a lower dose and had one follicle, my oestrogen was only 400 but I have high fsh.

Hi ladies, apologies for the silence and thanks for messages re our transfer fail.
It’s certainly disappointed but I feel like I’ve picked myself up somewhat quickly, possibly an emotional crash is pending soon!

We just had our follow up appointment with our consultant. I was wondering, how does everyone decide between medicated FET and natural?

My gut is saying natural because whenever I’ve happened to have a scan for whatever reason, my lining has always been good. I’m cautious of taking estrogen since I have severe endo and worried I’m only going to be ‘feeding’ it. I surprisingly trust my body to prep itself (Just don’t trust what it does from then on!).

Interested to know how you all decide and what you base your decision on? Care basically said it’s up to me but they usually do medicated because logistically it’s easier and less risk of cancellation since they don’t work on Sundays…

Any studies that natural is more effective?!

Hi ladies, I hope you don't mind me joining in.

I had two failed transfers and doing ERA, EMMA, ALICE this month. They just found a polyp so will need to get it removed 🥲 The clinic said that can still go ahead with the test. Is that normal?

I am also thinking about natural cycle next time. Will this test help with the natural cycle?

Is there anything else any of you recommend testing?

I feel like I have no hope left 😞 I understand that two transfers isn't a lot, but it's still hard to stay positive.

Thank you everyone

@Dochas12111 woop!!! This is amazing news!

@CailinInUK how are you feeling about things now?

Hi @NewBee21 :) you and @ChickenT2b have asked the same question about modified natural FET. I am pretty sure there are articles showing they have either equal or better outcomes than medicated. Anecdotally people in a recurrent implantation failure group have said it was something that worked for them having tried other things and it's what worked for me, this was my 6th transfer (2 untested and 4 euploid). If you are ovulating and have a regular cycle it can be a good thing to try. For me the advantages are that it's using my body's own hormones in a way that is more reflective of the normal cycle, estradiol is given from early on in a medicated cycle which isn't what happens, it normally only occurs in the days before ovulation, I would go from very low levels to very high after starting and it would make me vomit, I also had issues with my lining and had a mock cycle where my specialist couldn't get a biopsy as it looked like my lining was there and it wasn't. I was told this wouldn't be an option for me because of thin lining but actually it can be modified and through adding low dose stims I was able to get a good lining.

@NewBee21 if you're thinking about modified natural then ERA isn't likely to add anything. There are other ways to test the microbiome like a menstrual fluid test if you don't want the biopsy. Although if you're having the polyp removal probably easy to get the biopsy at the same time. Polyps are pretty common and easy to remove as far as I'm aware.

Thanks for the good wishes everyone. I’m doing okay as can be. I have just under a couple more weeks off work which is good as I keep randomly crying and not ready to face pregnant women or postnatal etc that I might see in the course of my work.

@CailinInUK sounds such a tricky decision and I completely get how anxious you’d be with your one precious embryo. How are you doing?

@Dochas12111 wonderful news!

@NewBee21@ChickenT2b I had terrible lining with medicated (it seemed default for my clinic at the time as they didn’t do Transfer every day) so had to move to natural. But research does suggest that there’s less complications later with natural cycle eg reduced rates of pre-eclampsia, also there’s a wider implantation window for natural.
@ChickenT2b completely agree with your gut feeling about less oestrogen feeding the endo.
@NewBee21 So no real point you paying for ERA if doing natural cycle. What kind of cycle are you doing for ERA/EMMA/ALICE biopsy? How are you timing when ERA done?

Hi everyone,

@Gardenlady543 oh I am so glad it worked for you! I am thinking about trying natural cycle next time, but will see what the doctor says as well. I understand that from their point of view medicated cycles are easier to plan appointments etc, but I just don't want to take so much unnecessary medication, especially with being prone to getting polyps.

@Enfys23 I am doing ERA this month, currently taking oestrogen and progesterone, so it is a fully medicated cycle. As I already paid for it I will just go ahead and see what the results are.

@ChickenT2b I am also with Care, and I feel like they haven't even mentioned that I can do a frozen transfer different way (natural). Can I ask if you are happy with the clinic? It's my first round so not sure what to look out for.