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

@NewBee21 I am also wirh care and they have suggested medicated but as my cycles are longer and slightly irregular especially after ivf drugs I suppose it makes sense. May explore not using fyremadel next time if this transfer next month ish doesn't work

Hi ladies, I drafted most of my reply below a few days ago so may be slightly out of date!

Yay @Dochas12111 well done on persevering! When’s your Day 1 due? I think you’re doing a medicated cycle?

@NewBee21
sorry for your failed transfers. If you plan to do a modified natural FET with a trigger, I think there is some merit in the ERA, in my opinion, as the timing is more precise than a completely natural FET. But the jury’s definitely out on ERA in general. There is not much difference in cost between doing the EMMA ALICE versus the three test together so that was one of my reasons for doing all three. EMMA ALICE definitely applies to all FET types. Yet, if your ERA is based on a medicated cycle, it is assumed that that’s the cycle type you’ll proceed with for the actual FET.

@ChickenT2b
good you’re feeling a bit better. There are a lot of decent studies on natural v modified natural v medicated FETs on Google. Try Remembryo, he did a good recent summary. You’ll have to register.
Success rates similar overall.The main purported advantage of modified/ natural are the better maternal and neonatal outcomes. This is sometimes put down to the presence of the corpus luteum in modified/nqtural. It’s more physiological.

@Enfys23
take all the time off that you need. I took 8 weeks after my 20 week loss and even then I had to force myself to return to work. Those 8 weeks were a blur and I didn’t really achieve anything apart from trying to learn to cope. Everyone is different so there’s no comparison.

@Gardenlady543 @2021ivfagain @Enfys23
Thanks for your enquirie. On Weds, I opted to cancel my FET, which was due to take place on Monday. This was down to, in my opinion, the lower than ideal oestrogen level and trends towards increased clinical miscarriage. Consultant said everything was fine to proceed so it was a tough call. Who knows, it may have been fine. He's not contacted me since so maybe he's fuming!

@2021ivfagain I really appreciated your message. It helps so much when people get it. I was always going to be on progesterone after FET. When you say HRT, do you mean estradiol too? I think some clinics in USA give that in natural/modified natural FETs as well as medicated. I don’t think it’s recommended prior to transfer as it can turn off the body’s natural feedback loop to produce E2. I might suggest a slightly higher dose than 75IU FSH. Why weren’t you on the 150 per day rather than 300 every other?! Just curious, likely makes no difference. I tested my Day 3 FSH a couple of months back and it was surprisingly low for my age (6.06IU/L). When will you start the FET, do you think?

My issue with the clinic is that they only do transfers 4 days per week and no longer same day blood results. I floated the idea of getting blood tests at another C clinic and even potentially moving embryo to one that did transfers 6xweek. This was by email so not had a response yet. I doubt I’ll get a favourable reply. Scares me to move the embryo anyway.
@ch did you say your branch does them 6xdays per week? Northampton or Manchester? Ok if you don’t wish to say.
In the mean time I’ve been scouring the net to find same day blood test results (hardly any options) and found Cherish in Sutton Coldfield so booked a few there for when I think will be days close to trigger. If my Day 1 arrives when I anticipate (30/03), the days might work with the clinic open days for FETs. But as well all know, futile trying to predict things in this game.
Hope everyone has a pleasant weekend.

@CailinInUK Sorry you cancelled. My clinic always do 300iu or 255iu every other day for modified natural FET with stims. Even though it’s every other day, follicles still grow.

I’m hoping to stop norethisterone on Monday or Tuesday and then wait for period. I always worry about fsh now. Hopefully I will have my baseline scan the end of next week. My clinic is not closing for Easter. It’s open all over weekend for scans.

6 is good for fsh. My fsh was 6.7 at 40 years of age. I don’t know what it is now but dread to think. I do get night sweats near my period and have to sleep with window open but nearly 43 now.

The oestrogen for transfer would be starting in luteal phase two days after trigger. So oestrogen would be before transfer. I didn’t need it last time as oestrogen got to 2000 but that was last June/July.

My son is home from nursery at present as he’s had his 3rd or 4 cold since January and he has mild conjunctivitis. So I have been delaying treatment as well to make sure we’re all better. I’m on so many supplements now. I have realised the oral probiotics are good for digestion and immune system but not done anything for microbiome. My consultant gave me the ok to take vaginal probiotics with the last transfer. I’m doing same this time.

I really hope I respond ok this time.

When are you starting again? Are you going to move clinics? It’s so difficult isn’t it?

@CailinInUK CRGH have same day blood tests.

@CailinInUK I’m sorry you had to cancel but I do think you have to go on your gut. It’s unfortunately not our fault that we have to do our own research as most of us on a long road were let down by our clinics at some point and started to look into things ourselves so I wouldn’t be bothered if your consultant is annoyed!

did you do a natural or medicated FET for your first child?

I am doing medicated as I want to follow the same protocol that worked for my daughter after several failed transfers. I did two ERAs and found my exact receptive window along with upping progesterone, fixing microbiome and taking low dose steroids so as I don’t know which thing made the difference im planning to do it all again. I don’t have great embryos left unfortunately so am hoping if everything else is optimal one might work.

Will you go again on next cycle?

@2021ivfagain when are you hoping to transfer?

@Dochas12111 I’m still taking norethisterone and zumenon for oestrogen priming so I’ll be starting meriofert for modified natural with stims at baseline scan on cd 3. That should be around Easter holidays as in Easter Saturday or Sunday or even on the Monday.

@Dochas12111 thank you. Yes I'll start in my next cycle.CD1 due around 39/03 so almost exactly same time as @2021ivfagain . That's one good thing about FET, not much delay to next try. I'm assuming consultant will agree!

I did down reg medicated with my DC (Day 5 5BB) and was only on 200mg progesterone x2 a day. I had previous gone an ERA. It was my first euploid transfer. My next two medicated FETs were a euploid biochemical at 5.5 weeks (Day 6 5BB) and then my 20 week loss (Day 5 5BB). The one in the freezer is a Day 5 5BB too. Ive never made a higher grade! Have yours been tested? I think you said they have been. What dose steroids will you be on.

@2021ivfagain thank you. Yes it is tough. I won't move clinics, too late in my journey for that. It's good that CRGH do same day bloods, it should be standard, especially with OHSS management, for example. Clinics without same day will end up being super conservative with their stimulation.
I've got confirmation of my same day bloods appointments from Cherish in midlands, which is only one hour from me. I hope you can avoid any serious germs during this cycle, and you respond well like last time. I'm thinking of suggesting an increased dose of stim.

Should say 30/03, not 39/03!

That’s great there’s not too long to wait @CailinInUK makes even more sense to have cancelled when you weren’t happy. Glad you found somewhere to do same day bloods. I do think that’s important. I can see why you want to try natural FET given your history. Really hope this works for you. Is it definitely your last transfer?

my embryos aren’t great. I’ve a day 5 euploid 5AA but it was biopsied twice to get a result and remembyro posted recently that re biopsied embryos have a significantly lower live birth rate and significantly higher miscarriage rate. My other embryo is a twice biopsied mosaic in chromosome one. I’m very reluctant to transfer it tbh at all! Then I’ve an untested day 6 4AA from my Irish clinic. My DD was an untested day 5 4BB!

@Dochas12111 great grades but I understand your concern. I expect the high grades of your embryos will improve your chances compared to lower grade rebiopsied embryos. Which one will you transfer first?

@Dochas12111 I didn't answer your Q. I struggle to overtly accept that it's my last transfer but it really is. It's my only euploid embryo in the freezer that's free of the inheritable genetic condition we're avoiding. I'm 45 so although, against the odds, I made two euploids over three cycles at age 44 (one at risk, one not), I think it would take me several cycles to get another transferable, if at all. I have around 5 euploids and two mosaics in freezer but they're deemed high risk of genetic condition so we wouldn't transfer.

@CailinInUK you have to be 100% happy that conditions are right as this embryo is so precious, I'm so frustrated on your behalf that they aren't doing same day bloods to allow patients to make informed decisions.

Hi all,

I thought it would be best to ask on this thread. Just for a bit of background I’ve had recurrent miscarriage and no living children yet, however I have got pregnant quite quick when I did conceive. I had all the testing available on the NHS and also did the CERM trial through Tommys which found Endometritis. Due to it being a trial I wasn’t sure if I was given the placebo doxycycline or real thing (although suspect placebo). I am also a carrier of Strep B. I also have a diagnosis of mild Endometriosis.

I’m still under both Tommys and my NHS gynaecologist, I’m waiting for a follow up with my NHS gynae. I’m not currently under any fertility clinics. I was wondering if there is any way I can access the EMMA/ALICE testing on the NHS or through Tommys or is this only available privately?

@Notsure31 I don't know what they offer at Tommy's, if they're doing a microbiome trial then I assume they have some sort of test, if you're involvement in the trial is now over can you ask which arm you were in so you know if you had treatment? You could always try the treatment arm yourself if you were in the placebo group. I haven't heard of people getting EMMA ALICE on the NHS. It will cost about £1000 to do it on its own I think and £1500 to combine it with ERA, which is only really useful if you're doing IVF with a medicated frozen transfer and even then it's debatable how useful it is. The alternatives are:

• menstrual fluid microbiome test through fertilysis www.fertilysis.com/tests/female-infections/fertilysis-female-microbiome
• a vaginal microbiome test, I haven't done either of these but here are a couple of options- https://www.yourdaye.com/products/at-home-vaginal-screening/?irclickid=V4zy9rV0TxyPUPtWdR2QDRUVUkH1LH2lnTg13M0&utmsource=impact&utmmmedium=affiliate&utmcampaign=Skimbit%20Ltd.&irgwc=1

screenme.co.uk/product/vaginal-health-swab-test-100-of-bacteria-yeast/

@CailinInUK @Gardenlady543 tjanks for the advice. I think I will go for natural.
@NewBee21 I think Care only said I could do natural because I specifically asked about it given I have endometriosis and was worried about pumping additional estrogen into my body. I don’t think they would have mentioned otherwise and not sure if other clinics tend to either. It’s our first round too so first frozen transfer coming up.

In other news, I’ve just found out I’m highly intolerant to dairy and yeast. I’m wondering if this could be contributing to our failures so far, in relation to inflammation (presumably eating these foods would cause that) and potentially the cause of my high cytokines.

Has anyone else eliminated certain foods in a bid to improve success?

Thank you @CailinInUK and I’m glad you can get going again soon. 🤞🏼smoother time next month.

@ChickenT2b I think you’re right it’s the default at many like my previous CARE clinic to do medicated. I think a lot of it is down to making their schedule easier to manage and tackling the issue of not doing transfers daily.

I have found lactose and gluten free diet helps my endo and was advised by my endo specialist for post op too. It must be something about inflammation. I find fermented dairy eg kefir okay though and good for my gut symptoms. I have also found reducing sugar helpful so try to just stick to natural sweet things like mixed berries fruit that I cook with a smidge of maple syrup or honey to have with Greek yogurt if indulging or kefir, rather than any processed sweet things, though I don’t deny myself some treats occasionally given the long journey we are on need to make it realistic to do and not make life too miserable! I couldn’t give up chocolate after the first couple of rounds IVF so I switched to dark chocolate (usually milk chocolate would be my thing as am such a sweet tooth) so at least it’s a bit less sugar 😂and my taste buds did adjust!

Hi everyone, I had my ERA, EMMA ALICE test done on Monday. Everything went well, I had a bit of spotting after the procedure.

But today the bleeding got worse and I am actually getting a bright red blood (sorry😬).

I called the clinic, and they said it could be my period? I doubt so. I was on oestrogen and progesterone and only stopped it on Monday.
The consultant said it would take around 2 weeks for the period to come.

Did anyone have similar experience? When did your period start after stopping the medication?

I also did a run yesterday, so now blaming myself 😓 I've read that it's ok to exercise after 24h post procedure.

@NewBee21 even though I’ve been told it could take much longer as well, I started period/withdrawal bleeding within 4-5 days of stopping the meds after my ERA/EMMA/ALICE so it certainly could be that.

@NewBee21 a period normally comes 2-5 days after stopping progesterone.

@NewBee21 my period came six days after my biopsy/stopping progesterone.

@Notsure31 I'm really sorry to hear about your losses.
I don't think NHS does Emma Alice ERA so you'll probably have to pay for it. The cheapest I found was Liverpool Womens clinic but I didn't end up going there as negotiated with my local clinic. You'd need to pay for a consultation first if not already a patient.
On the NHS, you could possibly ask for a hysteroscopy and biopsy at the same time. They will do a CD138 test on the biopsy to check for similar things to Alice Emma.
Best wishes

Thank you so much @CailinInUK @Gardenlady543 and @Enfys23 ☺️ Hopefully it's just my period. I got so worried, but after reading your responses I feel better.

How are you getting on @ChickenT2b?

Any progress with new cycle @CailinInUK ?

How are you feeling about things @Dochas12111 ?

I’m quite up and down but know it’s to be expected. A wound infection hasn’t helped and it’s been triggered by me being super reactive to the dissolvable sutures under the skin and then the wounds reopening! First antibiotics didn’t work so now on co-amoxiclav after swab. Terrible diarrhoea and thrush after 48 h of them so any tips on making sure my microbiome recovers gratefully received. We are currently planning on trying again in May, which is the earliest they recommended. Hopefully microbiome has some time to normalise 😕

@Enfys23 I'm sorry, you don't need this on top of everything :( it's because the antibiotics are affecting your gut microbiome, i went on flucloxacillin recently and had the same issue, ordered symprove, I think there's evidence it doesn't get killed off in the stomach like a lot of oral probiotic products. Pricey but I felt it was worth it to try and get my gut in a good state: amzn.eu/d/7r30WqW

Thank you @Gardenlady543 that’s so helpful ❤️. I’ll take a look at that.
It’s 4 weeks now and while the emotional healing is going to take time it’s not helped that all these physical symptoms are there/ wounds sore whenever I move! We’ve booked a holiday though so that’s something to look forward to.
I hope you’re doing well and recovered from infection?