EMMA, ALICE, ERA & NKC tests- worth it?

[FierceGrace85]

hi everyone, so, my ‘journey’ (bleurgh!) so far:

1st IUI: chemical pregnancy

2nd IUI: Failed

3rd IUI: chemical pregnancy

1st FET: chemical pregnancy

2nd FET: failed

So, my consultant wants to do the ‘quartet’ of tests on my uterine lining to see if that can give us any clues about the repeated chemicals and recurrent failed implantations.

Has anyone had this set of tests and did it provide answers for you which led to a successful outcome? I’m a bit dubious about the natural killer cells because opinion on this seems very divided in the scientific community. Any experience with these tests welcome . Thank you all so much x

[PinkPanther1234]

Hi, based on my experience these tests are worth it. I had them all, the EMMA showed I needed a course of probiotics. The ERA showed I was post receptive, so needed transfer 24 hours earlier and also needed to take meds for high NK cells. I had 4 BFNs all implantation failure (1 was possibly CP) before these tests. I did a double embryo transfer for my 5th transfer, following on from the test results and treatment and now have my twins from that transfer.

Good luck with what you decide. If you have any questions on the tests feel free to ask x

[FierceGrace85 in reply to PinkPanther1234]

Thank you so much, this is really helpful. I think this has helped me decide on the next steps and has given me some hope. So happy to hear that you have your babies now xx

[Blueberry211]

Hello based on my experience the NK cells was worth it but the ERA test wasn't. I was found to be post receptive by 12 hrs and had less progesterone for 12 hrs in the transfers following that- BFN, chemical and BFN.

In total , l had two chemicals and two negatives and the thing that worked for me was a hysteroscopy - I had a septum found ( missed on imaging) which was excised. The transfer after that (5th transfer) worked.

If you haven't done MRI pelvis /3D scan or hysteroscopy, I would recommend to push for imaging as sometimes there is a cause which can be fixed.

[FierceGrace85 in reply to Blueberry211]

Thank you, this is really helpful. I will ask about these tests in our appointment with the consultant xx

[Blueberry211 in reply to FierceGrace85]

As a side note, I had MRI and 3 D Scan and the septum was missed. A hysteroscopy is the ideal test as you get both diagnosis and treatment and they take a biopsy to check histology as well.

[Blueberry211 in reply to Blueberry211]

Also for this successful transfer , I took progesterone as in standard cycle (not era corrected) which proves even more that ERA was not beneficial for me.

[HedgehogMad]

Hi lovely, a recent large randomised controlled trial showed that the ERA test and adjusting transfer timing doesn't improve pregnancy rates (in fact the non ERA timed transfers did slightly better) - jamanetwork.com/journals/ja... I know a few ladies on here who had the ERA and then success, but also plenty who did ERA and still didn't have success so who knows 🤷 it all feels like a lottery and there are still so many unknowns in this area. I'm in a similar situation to you - 4 failed embryo transfers (5 good quality blastocysts). The HFEA has a good traffic light rating for add ons which is based on how much evidence there is that they help. My feeling is that most things don't have the evidence they help but private clinics do them A) to feel like they're doing something different and B) so they can charge more

I've seen a specialist in recurrent implantation failure (the Warwick research unit) and he said that the vast majority of failed transfers and miscarriages are due to inherent problems with the embryo, and my clinic say the same (maybe 5% of the time is due to problems with the womb). I guess the question is what is your personal threshold for doing more (unproven) testing. Have you PGT-A tested your embryos? We decided to do that with our subsequent fresh cycle to make sure we were transferring potentially viable embryos.

Sorry you're going through this, it really sucks but you are not alone xxx

[FierceGrace85]

Thank you and I’m sorry that you are going through this too. We haven’t done PGT-A testing yet. I’m torn about that one too. Everything is just so expensive it all makes me feel a bit sick. If money wasn’t an object I’d probably do all the tests available. Best of luck with your journey xx

[DreamingOfTwo79]

Hello! I did the EndoQuartet on a natural modified cycle and am glad that I did. I only had two PGT-A tested embryos and wasn't going to do any more egg collections (I am 44) so wanted to give my embryos the best chance possible. I also had a hysteroscopy just to check everything was looking ship shape inside my uterus. Luckily, EMMA/ALICE/NK biopsy all came back normal and the ERA showed my endometrium was receptive which was reassuring for me as my cycles tend to be quite short (<26) and I ovulate around Day 11. I was prescribed intralipids to deal with my slightly raised NK profile and will be getting my third infusion soon, so far I have not noticed any adverse reactions. I am also on Inhixa, Aspirin and steroids due to some thyroid antibodies they detected in my thrombophilia panel. There is unfortunately no way of knowing which of the treatments made a difference, if any, but I can say for myself that the reassurance it has given me mentally having ticked off a lot of the investigations prior to transfer was definitely worth the expense and extra time it took. Wishing you the best of luck for your next steps! Much love x

[FierceGrace85]

Thank you so much, it’s just so hard to know what’s makes the difference isn’t it? I’m also on aspirin 75mg and Dalteparin (heparin) injections every time I’ve been through a cycle due to antiphospholipid antibodies. Sending you love and wishing you luck on your journey too xx