ERA test - anyone have experience of this?

[Bistbee]

We’ve just gone through our fourth failed transfer and have been speaking with our doctors about what further tests they think it would be prudent to do before we do any more. Background is that husband has zero sperm following cancer so we’re using sperm he froze before his treatment which (as far as our clinic can tell) all looks to be in good shape - apart from the fact it’s been rendered pretty much immobile as a result of being in the freezer for 15 years...

I have no problems diagnosed so far - AMH is normal for my age, internal check of my uterus all fine, no indication of any issues from the ‘standard’ pre screening tests.

I’ve read about ERA and asked my doctor about this before we did our last transfer but she advised against it based on my age (35) and that most women fall into the ‘receptive’ category so it doesn’t usually give you any usable information. So we didn’t go for it but instead focused on getting a good quality blast (which we did for the first time using IMSI and calcium ionophore) - but it still failed.....

So now I am really thinking that there’s something wrong with me. I just can’t believe that all 4 of our embryos so far have been abnormal and feel there must be something on my side which is preventing implantation.

Does anyone have experience of going through this test and what did it reveal? Did the result help you to make a decision about where to take your treatment next??

[Cinderella5]

I had this test done and I wasnt receptive until a full 24hrs of progesterone later than usual. So I need 6 days worth instead of 5 before transferring. We had actually moved to around 6 days of progesterone and I got positives but they didnt stick and when I worked it out we were transferring just a little too early or too late. Unfortunately we havent really had the chance to properly try it out yet but have frosties for when the clinics reopen. Here is a link to my results as I posted them up if you want a nosey.xx

healthunlocked.com/fertilit......

[Bistbee in reply to Cinderella5]

So helpful thank you! I’m just really not clear on what to do because my doctor seems so dismissive of the test but I just can’t face putting myself through another cycle thinking the whole time we could have checked receptivity but didn’t if it doesn’t work again...

[Cinderella5 in reply to Bistbee]

I had so many negatives and wish we had done this test earlier. However we could have easily found out we were just having bad luck. When I spoke to the consultant doing our test (not our clinic) we asked if she had seen much success and she said yes but only in the cases where they actually found the implantation window was out. It's expensive but knowing what I know now at least we are going into our next transfers with everything as it should be! Good luck with your decision. Happy to answer any questions you want to ask. Oh and incidentally I know of 2 ladies on here that this test got them success.xx

[WinnieM]

Hi bistbee, what progesterone support have they given you each of the four times? Have they tested your progesterone on transfer day and adjusted the dosage as necessary?

They tested mine and saw it was lower than they wanted so increased my pessaries to twice a day instead of once a day. I was also taking lubion injection in the belly twice a day and a PIO shot in the bum every 3 days and 2 x estrogen morning and night. This is a lot compared to most clinics but my place swears by it, saying you can never have ‘too much’

As your sperm reserves are so precious have you thought about PGS testing?

[Bistbee in reply to WinnieM]

Hi Winnie, yes I have a lot of progesterone support as my clinic is very on top of that. They test on the day of transfer and adjust accordingly.

For my second and third cycles I was taking tablets 3 times a day, plus PIO, plus vaginal gel and for the last cycle I added in daily lubion shots. I also take blood thinner injections to prevent clots forming. There’s really not much more they could be doing on that front and to be honest my progesterone levels have always been more than fine. My lining is always thick, never had any issues there.

It’s so frustrating as each of our cycles, on the whole, go well (our blast rate is low but we managed to better slightly better numbers last cycle with imsi). We do have 1 frozen pgs tested embryo - out of the 3 blasts we had last cycle we decided to transfer the top graded one and biopsied the other 2 and 1 can back as normal - it’s crazy that it’s lower graded than the one we transferred so it’s becoming clear to us we are going to need to do more genetic testing as clearly the grading system doesn’t help for us!

The issue we’re facing is whether to transfer our pgs embryo next or whether to embryo bank a couple more round for more embryo testing (we can have up to 8 blasts tested at any one time) so we need to work out what to do. Whatever we decide, I really want to make sure that we give the our embryos the absolute best shot and this is why I think we should tick the ERA (plus EMMA & ALICE) tests off the list more to give us peace of mind....but it’s all additional cost, delay and more invasive procedures which feels a really hard thing to put ourselves through !

[Bistbee in reply to Bistbee]

Also we’re very lucky we still have 11 vials of sperm left - the benefits of it being stored when my husband was a healthy 19 year old haha! So we’re not running low just yet but I think we’d find it hard to stop until we do run out but 11 more cycles without a result would absolutely break us!

[WinnieM in reply to Bistbee]

Hey bistbee, just to make sure I’m following correctly....you’ve had four cycles and four transfers, is that right? Does that mean in the four transfers to date, you haven’t transferred a PGS tested embryo yet? (as the previous ones weren’t tested?)

I do think this will make the difference but I understand you wanting to tick off all the tests before taking your precious cargo onboard. I had the same predicament. And my Dr. wasn’t keen on these extra tests either.

I would say that if you hope to have more than one child...and you can afford batching... it’s best to get one or two extra PGS tested embryos in the freezer now, while you’re eggs are 35, rather than come back after you have a child and go through it all again at say 38. Your eggs quality will be much lower then. (I’m 39 and I batched mine at 38...I think it would’ve been much easier at at 35 as it took me 5 rounds to batch!) Plus having extra will put less pressure mentally on the transfers

In terms of making good quality blastocysts are you confident in your embryologist team? Do you know the head embryologist and know they’re using the latest equipment etc . Your case in particular calls for someone highly skilled I would’ve thought. how many follicles are you getting each cycle and how many are mature/fertilize and make it to blastocyst?

If you are able to I would get the embryos banked first and then worry about the additional tests because as you say, it’s added time. But...if you find that cycles are delayed when things re-open but you are able to get appt for the tests then of course do those first.

Anyway just my thoughts! Very best of luck to you, I’ll be thinking of you!

[Bistbee in reply to WinnieM]

Thank you! You’ve really confirmed where my mind was going that really we should batch now rather than transfer our frozen embryo and potentially have to go through further fresh cycles laster on anyways (either because it doesn’t work or by some miracle we’re in a position to try for a sibling!)

Yes correct we’ve never transferred a pgs embryo before so that would be something new and perhaps enough to make the difference in itself but I know I would never forgive myself if it didn’t work and we hadn’t first discounted all other possible causes i.e receptivity and immune system issues. I’d feel like we’d really wasted a potential life.

My mental block is the additional

cost, time, invasiveness and emotional strength needed to put myself through those tests. I’ve already had to give up my job because it was just getting too much to juggle with all this treatment so its hard not to feel like this is just taking over and impacting every aspect of my life. That’s something I need to work through with my counsellor because the only alternative to to give up treatment altogether, which also is not a realistic option for us. It’s not like we can try a less invasive treatment as we’ve learnt I need the max level of stims to produce decent numbers (which is super hard going - makes me feel incredibly unwell) and we’ve also discovered we need all the flipping add ons available to get even a few decent blasts - ICSI plus IMSI plus calcium ionophore (AOA). We really threw the kitchen sink at our last cycle and came out with a top grade embryo, which we transferred, and a spare which is genetically normal. We’ll never know whether the one we transferred was normal or not, or whether it didn’t implant because of issues with me, and that is really playing on my mind.

Doing the ERA, EMMA & ALICE tests feel like the logical next step, but we’ll have to work out what is actually possible to do next when the clinics reopen - either tests first or start stims for a couple of freeze all rounds to batch for pgs, then do tests prior to any FETs. I’m just sad whatever way I look at it, it involves soooo much more treatment and the time this is all going to take to even have another shot at pregnancy - it’s so overwhelming! We’ve already been through years of treatment for my husbands cancer, just feels like all we do is spend time in hospitals being poked and prodded 🤦🏻‍♀️

[WinnieM in reply to Bistbee]

Oh darling, it is overwhelming. I find just the fertility stuff overwhelming let alone the years of cancer on top that you guys have been through. Let me know if you ever wanna chat, I went through the same conundrums with considering ERA/Alice and I also spent £1k on immunology testing! I’ve had all the same thoughts.

Just know that most of the time it doesn’t work because of a genetically abnormal embryo. That’s the no.1 reason, so feel good that you have a good one on the freezer. Also FETs are good because your body gets a chance to recover from all the stim drugs (which sound like they take their toll on you) so they implant on a cycle where your body has had a chance to recover and is relaxed.

🤗 sending you lots of positive vibes xxx