Has anyone had endometritis testing during fertility treatment in the UK?

[InWithPeaceOutWithStress]

Hi all - I have 5 embryos from my recent NHS funded IVF cycle. My fresh transfer failed. It’s likely my transfer failed due to chromosomal abnormalities and the process is to transfer embryos one by one until we find one that is genetically normal. Out of my batch of 6 I can hope to have one or two chromosomally good embryos.

I’m 39, and by the time my clinic transfers all 5 embryos, one by one, I’ll have turned 40. I won’t be eligible for more NHS funded cycles and I’m aware my egg quality will only decrease.

I’m nervous that I could be the minority of women who have an issue in my uterus that prevents implantation. UK clinics, at least on the NHS, don’t appear to look into the uterine environment (other than a basic ultrasound) until you’ve had repeated implantation failure. Due to my age I don’t want to wait that long.

Through my research, I’ve found that chronic endometritis (bacteria that causes inflammation inside the uterus) is more prevalent in infertile women than in the general population and is a leading cause of recurrent implantation failure.

Im curious if anyone has looked into this as part of their uk fertility treatment? It seems that an endometritis biopsy (with CD138 staining) is the way to detect this. The EMA/ALICE test is less effective and apparently doesn’t diagnose chronic endometritis.

Sorry I have no answers for you but will watch this post to see if there's any suggestions. Am in a similar position and similar age. I had 6 embryos, now down to 4 as the first 2 didn't work. Pretty sure I have endo based on symptoms and endometriomas they have found during scans. Good luck!!

I’ve come across the Endosure test which costs £400-£500 and is relatively easy to access - it is a non-invasive diagnostic tool; however it identifies endometriosis not endometritis (although both can occur and having one can predispose you to the other).

Did they adjust your protocol in response to your suspected endo?

Thanks, that's really useful, I'll look into it. And no they did not, when I asked about it both times they were very dismissive. Last appt the Dr told me to stop stressing about things that aren't proven and focus on the next steps he was putting in place (which are just doing the same protocol again) 😂

Are you able to do the test through your clinic or do you need to go externally?

I could do the Endosure test privately but that wouldn’t identify endometritis which is more important for implantation. I have a review appointment with my consultant next week, following the failed fresh transfer and to discuss my next steps which will be a FET.

I would love if they could check for endometritis and other markers of inflammation inside my uterus but I highly doubt they will. They don’t appear to proactively check the uterine environment.

They’ve not done, or even mentioned any checks such as hysteroscopy, HSG, SIS, EMMA/ALICE. For them it’s a numbers game as most women won’t need these checks. However for me as the patient, my embryos are precious and I don’t want to waste them. I’d be willing to pay privately for tests but my clinic doesn’t allow you to pay for private add ons, in combination with nhs funded treatment so I’d have to find another clinic

Latest trials show no difference in live birth rate whether endometritis is treated with antibiotics or not. I've just done ALICE for the hell of it but I agree with my consultant that it's pretty pointless.

Fingers crossed the appt with the consultant is useful. It's a shame they won't allow you to pay for private tests before doing your next FET.

Depending how many Fets you'd be entitled to on the NHS, the wait time between these (ours is a 9 month waiting list between nhs funded transfers), and how much money you have.. It could be worth doing the tests and losing NHS. Alternatively you could do your next fet without testing and it work! I would also check if they'd accept the results of the Enclosure test, if it's not tested to a standard the NHS finds acceptable, they might not even take the results into account.

A 9 month waiting list between transfers?? Wow I had no idea. I’m with Care Fertility who take nhs funded patients and there’s no waiting list as such, other than waiting a couple of weeks for the review appointment and then for your next cycle.

Yeh it's a pain tbh, have had to pay for the same clinic to do a private transfer inbetween our NHS ones! Glad you've got a better one and not everyone has to wait so long 😊

You can start by doing ScreenMe test. They are better than Alice Emma. Purchase uterine microbioma test and start with that

I’m not sure there’s good evidence of the link between vaginal microbiome and fertility. Endometritis is a bacterial infection in the uterus that can affect implantation.