ERA / EMMA / ALICE / NKC tests - would welcome advice

[Falafelrovers]

Hi folks,

I have been fortunate enough to generate three euploid embryos for transfer (the product of 5 egg collections - we lose half our embryos due to screening for a genetic condition).

I have unexplained secondary infertility (only diagnosis is mild adeno / endo), and my consultant has recommended I repeat the ERA / ALICE / EMMA tests as these were done (depressingly) two years ago and potentially out of date. In addition, ERA was also done on a natural cycle whereas she has advised that this would need to be done on a medicated cycle for results to be relevant for my next transfer.

I am weighing each test up given the costs and the fact these tests are still considered experimental. A couple of tweaks were made to my cycle previously which did nothing.

does anybody have any experience or advice on this?

Is ERA relevant if you have had successful implantation in the past? Do results really differ between medicated and natural cycles?

Can results change significantly or will they generally folllow the same patterns?

huge thanks in advance for any advice.

Further info:

I am fortunate enough to have one child which I concieved with my first transfer, and since then have previously had 5 transfers (x 2 miscarriages, 3 BFN). We haven’t tried naturally due to my partner’s genetic condition.

Previously ERA and ALICE results were normal, EMMA threw up a small ‘insignificant’ amount of harmful bacteria (treatment with probiotics). NKC - low immune activated profile, a couple of slightly off results but not deemed major. Treated once unsuccessfully with steroids / intralipids.

[LadyM2019]

Yes definitely. After a Stillbirth (from FET) I did two rounds of IVF with pgta then the Endiome Trio. My ERA showed pre receptive by 24 hours. It was definitely worth it for us. If you can afford it, I’d absolutely go ahead xx

[Falafelrovers in reply to LadyM2019]

Thanks so much for posting LadyM2019, so sorry to hear about your stillbirth x

[Tinkertinkerbell]

I’m a big advocate for the EMA, Alice and ERA - it’s what worked for me. I had 4 unsuccessful transfers and then stopped for the EMA, Alice and ERA. It showed I had no good bacteria so I treated with LOADS of probiotics. But most significantly, it showed I needed an extra 30 hours of progesterone and an extra day and a bit before my FET. This adjustment worked and BFP! When I thought nothing would work. I understand why they would need to do it again- the meds and the timing of the biopsy need to be recreated exactly (but adding those extra hours if needed). Mine was strict and timed to the minute I had to start meds. Good luck x

[Falafelrovers in reply to Tinkertinkerbell]

Congrats, it’s good to hear positive stories. interesting to know re the era timings, I did natural ERA last time so the focus was on the timing of ovulation. I didn’t have a great experience in that my transfer got delayed by the clinic and they said it wouldn’t matter, so I was a bit fed up that they offered the test hit didn’t take the results seriously. So have a bit of hesitancy about doing the tests again but beginning to think I should just bite the bullet.

[Tinkertinkerbell in reply to Falafelrovers]

That’s crazy that they delayed you after an ERA! I had a couple of transfers delayed prior to having the era because they couldn’t fit me in so I was concerned Once I’d had my ERA - they took it very seriously that I needed exactly 150 hours of progesterone and then transfer. They booked my transfer and calculated the exact minute I needed to start progesterone. I was prepared to keep reminding them and was prepared to fight if they tried to delay - but no need. Maybe speak to your consultant and stress that if you go ahead with the ERA you wouldn’t accept any delays - insist they would have to take the timing seriously if you’ve gone yo that effort and cost x

[Falafelrovers in reply to Tinkertinkerbell]

Yeah it was only a couple of hours but I was so stressed out and emotional because of that it was no surprise that one ended up being a BFN. Apparently they have now changed processes so it shouldn’t happen again but they’re not the best. Part of me thinks I should switch clinics as they’re not the best, but just a bit risk averse as I know the processes inside out. x

[MontsJ in reply to Tinkertinkerbell]

Tinkertinkerbell can I ask which probiotics you used and for how long?

[Tinkertinkerbell in reply to MontsJ]

I had used one box of Canesflor prior to my biopsy and the results of the biopsy said that I still had no good bacteria. My clinics advice was then to use a box of canesflor and as I already had and it obviously hadn’t worked, I bought 6 boxes of Canesflor and used 3 a day for a few weeks - way more than the instructions say but following the recommended dose didn’t work for me and i had read that it hadn’t worked for others. So as I only had 3 weeks before my next transfer I went all out and shoved LOADS up there. I also took oral ones just in case - 2 a day of a brand called happy mammoth - Venus vital. Anyway, it must have worked x

[MontsJ in reply to Tinkertinkerbell]

Thank you! 🙏

[Sansan87]

hi there

That’s brilliant re your embryos wishing you all the best. Interestingly I had these (once before a successful transfer) and then a year after giving birth in preparation for a second transfer. The results were very different, apart from ERA which was the same. I agree they are expensive and still experimental but I think after all the time and effort to get your embryos it’s worth spending that little bit more

[Falafelrovers]

thanks for your reply. It’s good to know your results were different (and that other clinics are suggesting retesting after some time has gone by, I was a bit thrown by my consultant suggesting this initially). Did the different findings significantly impact your protocol? I have a lot of faith in the tests showing up issues but a bit less in the treatment - sort of fees like they just prescribe probiotics, IVIG, steroids, and intralipids regardless? (My consultant said if we don’t do the tests she will prescribe this anyway).

[Millbanks]

Hi lovely,

I have a similar(ish) back story to you and I have a little boy from my 6th transfer and have just got a BFP from my 9th transfer.

I did the ERA / ALICE / EMMA back in 2020 and it showed pre-receptive by 24 hours. This time change alone wasn't enough to make an embryo stick, I had high NK cells which were treated with steroids and also we PGT-A tested our embryos as we were lucky to have a high number.

End of 2023 we did our 7th transfer to try for a sibling with the same protocol and it failed. I was shocked because I thought we'd found the silver bullet so to speak. Did the same for our 8th transfer and same result. So my consultant suggested repeat ERA / ALICE / EMMA - I asked if the ERA timing was likely to have changed and she said "there's no evidence to say so" I felt like they were just peddling me expensive tests because they didn't really know why it wasn't working. The 9th transfer worked - so I'm fairly certain that my window of implantation hadn't changed - despite it being 3 years later....

xxx

[Falafelrovers in reply to Millbanks]

congrats on your BFP!

I asked my consultant the same question on whether the implantation window could change and she didn’t really have an answer. I’ve read (Dr Google) that adenomyosis may change the window which made me think perhaps I should go for it, but I’d really like to hear this kind of reasoning from a clinician. My last transfer resulted in miscarriage, and I am also a bit unclear as to whether I could even get pregnant if the implantation window was out of whack.

My consultant doesn’t really seem to buy into the add on tests that much, so I struggle to get answers from her. As you say there feels like an element of suggesting them out of desperation. Did you redo ALICE / EMMA / NKC in the end or not bother? xx

[Millbanks in reply to Falafelrovers]

Thank you ❤️

I'm sorry to hear of your miscarriage - I would agree that if you got pregnant initially then your WOI is probably right and another ERA might not tell you anything you don't already know. Having said that - if it gives you more confidence going in to your next transfer then it may well be worth it...

I didn't redo the ERA / ALICE or EMMA - but I did have the NK bloods done again - I know I have a silly high immune system so I just wanted to double check what dosage I should be on. To be honest, I was tempted to do them again but I have been through so much and had so many invasive tests done and I have run out of steam with it all - I just didn't want to do any of it again.

xxx

[Falafelrovers in reply to Millbanks]

thanks ❤️

Yep I know that running out of steam feeling all too well. I nearly bowed out after my last miscarriage as it was such an ordeal but somehow here I am again. It’s as hard to stop as to carry on x

[Millbanks in reply to Falafelrovers]

Oh love, it’s so rough.

What I would say is go with your gut. I feel like I’ve been through so much IVF that I have a fairly good grip of what might or might not be the issue and I felt fairly confident to push what I needed and decline what I didn’t want. Happy to chat through my experience if you like xx

[Falafelrovers]

Thanks 🙏.

I started IVF in 2018 but don’t feel like I have a grip on anything lol. I have an appointment with a consultant next week which I’m hoping I can use to thrash some of this out and take some decisions, but may well take you up on that, thanks!

I’m feeing a lot better since the last miscarriage thanks but at the time I was a complete mess and wasn’t sure I could go on x