Emma and era?

[Sofie19]

Hi,

I have some questions re the Emma and Alice test.
Re. Emma (the one re. the biome) I have read it's to do with the endometrial biome and the treatment is probiotics. What would the disadvantages be of taking probiotics and not doing the test? If that was the problem, would probiotics be the treatment? Are there specific probiotics that need to be taken or do the probiotics depend on the test results?

ERA - is there any point getting this done with a history of a miscarriage as well as implantation failure following IVF (yolk sac seen but m/c a few days later around 5.5/6 weeks) and in addition a chemical pregnancy. These were both since having a healthy child (via IVF). I have had 5 transfers so 3 failed completely since he was born, not that the outcomes of the other 2 were what I wanted either.

Sorry if these questions offend people, I'm basically thinking how to save costs on potentially unnecessary treatment. I'm being tested for endotritis on the NHS whenever my appt arrives so that will save a little bit. I'm also paying for PGTA testing for a final egg collection so I am sort of expecting that to show no normal embryos but I am also wondering what to do if I get any that are normal as I will be lucky to get 1 normal and I have 1 untested one left over.

Thanks for any advice

Marking in the place as will need to be looking into the same

I can answer the EMMA question as I did it but not the ERA. If the microbiome in your uterus has an imbalance (I.e. % of lactobacillus not high enough) it needs to be treated with antibiotics to get rid of the bad bacteria first, then you can take probiotics to re-colonize the uterus with good bacteria.

I know some doctors (especially in the US) give you antibiotics + probiotics as part of a “kitchen sink” protocol instead of doing the EMMA, but to treat this issue properly the type of antibiotic you are prescribed should be based on the type of bad bacteria that’s present in your uterus. The type of probiotic supplement they’ll give you will always predominantly contain lactobacillus.

The ERA will determine your optimal implantation window. I just had it done and need more than 120hrs of progesterone prior to transfer. I haven’t yet had my transfer though so can’t say if it’s accurate..

I haven’t done EMMA; I was just told to be on probiotics (oral and vaginal) during stims and then only orally prior to transfer. I have done the hysteroscopy and they found nothing so no treatment necessary.. unsure if they look at the same thing though

Just re read your original message and wanted to add a couple of thoughts.

In your case investigating endometritis is the right thing to do and I would definitely do the EMMA test even if it’s costly, especially because you’re paying for PGTA. You want to make sure those nice euploids you’re working hard to make are in the best possible environment to succeed. Having said that I suspect you could skip the ERA since you have effectively achieved implantation 3 times already (of which one went to term) so it’s not a question of getting the progesterone hours right.

My case is/was somewhat similar. Did two transfers with untested embryos, both ended in losses because of chromosomal issues (but at least we knew they could stick and my body would carry them). Then two transfers of euploid embryos, one complete implantation failure, one suspected chemical pregnancy. My doctor did not recommend ERA because I had already got pregnant twice, but I did do a hysteroscopy (clear), biopsy for endometritis (clear) and EMMA/ALICE which showed a bacterial imbalance. Treated with antibiotics, then probiotics, repeated the test, got the all clear, transferred another euploid embryo, I’m now 21 weeks from that 5th transfer. Not had a live birth yet but EMMA + PGTA was very likely the answer for me.

Did you have a D&C after your miscarriage? I had two and I suspect that’s what caused the bacterial imbalance in my endometrium. Any procedure involving getting into the uterus can increase that risk.

Thank you, they're really helpful comments. It probably is worth paying for if we get any euploids.

@giraffesauce I hope the weeks are ticking along quickly for you. Yes, I know what you mean about knowing your body could carry the pregnancies. It would still have been a horrid situation to be in though. I didn't actually have a d and c, I passed it all without. I did have a forceps delivery and do wonder if that's caused some problems but equally there are many people in the world who go on to have a second child after a forceps delivery.

@blahblahetc I hope your transfers goes well! Which probiotics are you taking may I ask?

Thanks!

This is the one I take orally - https://herfreesoul.com/products/intimate-flora-for-women

and canesflor vaginally.