Microbiome, ERA/EMMA/ALICE- Are they REALLY worth it? How accurate are they?

[Katiluna]

After the recent failed fresh transfer with donor eggs, I'm now thinking of exploring the vaginal microbiome and some other issues. I have never had the microbime looked into and have never taken vaginal probiotics before.

I had a GBS infection detected during a routine antenatal check just before my 2nd miscarriage, but I took some antibiotics to get rid of it. Based on some medical studies published online that I've recently come across, miscarriages, and some procedures such as a hysteroscopy and D&C may disrupt the vaginal microbiome. I had three miscarriages, a hysterscopy and two D&Cs. Now I think it's time for me to look into this.

As we all know, the ERA/EMMA/ALICE tests require an endometrial biopsy (which must be painful) and the tests are very expensive. But what's really holding me back is the lack of evidence on the effectiveness of these tests. The use of these tests is rated red by HFEA. According to them, there is no evidence from randomised controlled trials (RCTs) to show that they are effective at improving the chances of having a baby for most fertility patients.

Some studies published online state that the implantation window may change and may not be the same in every cycle.

-Did you find the ERA test accurate and helpful in terms of how much progesterone you actually needed before your embryo transfer? Did it help you to have a successful pregnancy?

- What was your experience with the EMMA/ALICE tests and how did you find them in terms of accuracy?

-Did you manage to optimise/restore your microbiome with just taking probiotics and without actually having to do the EMMA/ALICE tests?

-What probiotics did you take?

Any input would be much appreciated.

Many thanks

[Tinkertinkerbell]

Hi, personally I’m a big advocate for the EMA, Alice and ERA because it was what finally helped me.

I had 4 unsuccessful transfers - 5 embryos as one was a double transfer. The last 2 of those unsuccessful transfers were ‘outstanding’ embryos from donor eggs and everything always looked perfect with my lining so I was frustrated that they continued not to stick.

I had one frozen embryo left so I paused and did the EMA, Alice and ERA. The biopsy is uncomfortable but it lasts seconds and it’s bearable. My results said I had 0% good bacteria. I had 3 weeks following the result to my transfer and I didn’t want to cancel so I did an intense course of vaginal probiotics- 3 a day. I was advised to use way way more than the packet says to get your good bacteria established. Plus you can’t use too much good probiotic. I used canesflor but it’s been discontinued.

The result also said that on day 6 of using progesterone (all my transfers had been on day 6 of progesterone so my biopsy was also) my lining was ‘pre receptive’. In other words - not ready for transfer. The report advised an extra 30 hours of progesterone before transfer. My clinic took this seriously and my protocol was timed with exactly 30 extra hours of progesterone before transfer. I was sceptical but it worked! Finally a BFP! The doctor who did the transfer told me at the time that they had a lot of success with the EMA, Alice and ERA and she just knew this was going to be the one for me. So yes - all my previous transfers had been too early and my body needed extra time on progesterone. Also the biopsy is basically the scratch as well so who knows but that may have helped.

I’m sure there will be others who it didn’t work for but it’s what worked for me

[Katiluna in reply to Tinkertinkerbell]

Hello Tinkertinkerbell, thank you for your input and for sharing your personal experience with the ERA/EMMA/ALICE tests. I'm pleased the tests have worked for you and led to a successful pregancy. Congratulations again on your BFP

If I were to take probiotics without doing the EMMA/ALICE, would that not make any positive impact on my microbiome do you think? XX

[Tinkertinkerbell in reply to Katiluna]

Thank you. Yes my consultant told me that everyone should use vaginal probiotics- even if you haven’t had the biopsy. Good luck

[Katiluna in reply to Tinkertinkerbell]

Thanks very much XX. Oh yes, now I remember you mentioned that in my previous post I'll have a look online and see which one I'll get. Some ladies on here have suggested a few brands that I will look into XX

[Vix12345]

I have discussed this with my clinic and have been told that if you have had any type of implantation previously then it is unnecessary. As I had a previous miscarriage and two chemicals it wasn't recommended for me.Also, apparently it is only effective for one or two cycle as your cycle can naturally change cycle to cycle. They did say there would be no harm in taking probiotics regardless.

My clinic did not advocate for the era tests, but instead recommended PGTA as they say the embryo is the main component and if that isn't normal then it doesn't matter what else you do, it won't work.

[Katiluna in reply to Vix12345]

Hello Vix12345, thank you for your input on the ERA/EMMA/ALICE tests. I'm sorry to hear of all your previous losses. Such a difficult journey. The quality of the embryo is indeed the most important factor to achieving a successful pregnancy. But it's worth giving the other factors a bit of attention to optimise chances of success. Wishing you best of luck with your next transfer. Your chance of success should be higher with the PGTA embryo that you will use XX

[Boo718 in reply to Katiluna]

Hello I had had 2 negative and 2 chemicals also. We went for the era Alice and Emma tests and it showed I needed an extra day of progesterone so we transferred on day 6 instead of day 5 and it worked xxx

[Babytocome]

Hi,

I did those tests and I ended up with a result of 0% good bacteria.

So I had to take vaginal probiotic for at least one month before transfer.

Also I followed a doctor from Harvard and she recommended 3-5 days to stay from bed, to a chair, and from the chair to a sofa and a,ternate. On that tarnsfer I stay in a hotel, and literally enjoyed movies, late breakfasts and very little time outisd of the room for a fresh air

Those were the only things I did different from the other transferswith an donor and it did work!

[Katiluna in reply to Babytocome]

Hello Babytocome, many thanks for your response and for sharing your experience. Congratulations on the success of your pregnancy I hope you're enjoying motherhood x. That's an interesting tip by the Harvard doctor alternating between bed, chair and sofa 3-5 days post transfer! Clinics usually recommend to take it easy the first few days. Can I ask what probiotics you took before the transfer? Was it a PGTA embryo? XX

[Bimsie1310]

Hi, I've been thinking of doing these tests too but my clinic don't advocate them. I then learnt about a company called DAYE where you can do microbiome testing using an at home test kit when you then send back to them and it helped to reassure me that everything looks normal. If you decide to go that way, DM me and I can send a referral code.

I'm not sure how this test stacks up against lab tests but it's a good first call I think.

[Katiluna in reply to Bimsie1310]

Hello Bimsie, Thank you for your response. I've just DM you XX

[Looom in reply to Bimsie1310]

Hi Bimsie1310, could you please send me your referral code for DAYE test? Thank you!

[H4PP1]

hi Katiluna

I have had my first ERA and it showed my WOI at 5days post progesterone was pre receptive, had I just gone ahead with a transfer I would have failed implantation again.

I am on a modified cycle so I think this makes a difference with being able to control your WOI more than a natural one with the answers from a biopsy.

With the microbiome I have read so many posts on here that show the probiotics have added to success so I will be following that regardless.

As for PGTA, first step I would say is always make sure you have tested partners/donors sperm, pgta can be a next step .. maybe others can guide on this.

Good luck !

[Katiluna in reply to H4PP1]

Hi H4PP1, many thanks for taking the time to respond and for your advice. I'm still waiting for my clinic to reply with recommendations and the next steps to move forward. I've asked them about the ERA test and what protocol we should use in our next trasfer. Once I get a reply from them, I'll see how we can proceed. I've ordered some probiotics recently and I will start taking them soon. I hope they will help with the next transfer!

We are using my husband's sperm which has high DNA fragmentation (51% when tested in early 2023). But with this donor egg cycle, we have used ZyMot Fertile Chip to filter the sperm. My husband strictly rejects the idea of using donor sperm. I didn't have the confidence to do PGTA as we only got 3 blastocysts from this cycle. If you don't mind me asking, what treatment was prescribed for your modified cycle? Good luck to you tooXX

[H4PP1]

sure thing !

They gave me a decapeptyl injection that controls my cycle for 3 months. Then estrogen patches to start with and then progesterone pressarys at the 5 or 6 days from transfer/biopsy to mirror a cycle.

I have high thyroid antibodies so have been given predisonole steroid and hydroxychloroquine for 5 weeks before transfer to get my levels down.

I have had transfer failures previously but could be embryo rather than uterus but not taking any chances this time.

Also using a clinic in Spain ! Much much cheaper than here and they seem really switched on.

[Katiluna in reply to H4PP1]

That's great! Clinics in Spain seem to have an excellent reputation overall and high expertise. I hope this transfer will bring you success XX