ERA

kristimh80

Looking into possibly doing an ERA next month. For those that have done it...any thoughts or advice? Are you glad you did it? I want to do everything possible to know that transfer is being done on the correct day for the future. We have 1 PGS normal left and may still do another Retrieval this Summer to bank eggs. But wanted to hear from those that have gone thru an ERA cycle  

artemis618

Hi @kristimh80!  Probably I’ve mentioned elsewhere, but I did a natural cycle ERA this past January after *TW* miscarrying the first PGS normal we transferred in November.  I did this mostly for whatever peace of mind it could provide since my first FET was medicated and I wanted to try natural cycle for this last transfer.  I wouldn’t necessarily say it was a “poor value” because it came back receptive (normal/as expected).  

I got the sense that my clinic didn’t do too many of them, but they were happy to humor me.  My previous RE emphasized that they weren’t “proven,” but she was willing to do one since we had only one PGS normal at the time.

One thing I found odd was that they didn’t have me do supplemental progesterone at all with the ERA - when I thought the idea was to totally replicate what you’d do for your transfer cycle.  So for my natural transfer cycle I was surprised they told me on the day they considered my ovulation that I could start Endometrin that day - I opted to wait two days to start it for a more natural P4 rise.  Fortunately I already had bunch on hand from my last transfer.

Insurance didn’t cover it and it was about $1k.

kristimh80

@artemis618 Very interesting!! My RE said they'd do all meds the same as my last FET including progesterone. My insurance doesn't cover anything, but figure if the 1k shows I'm in that small % of women that needs more progesterone or less, then it would be worth it. My RE said everything about the last transfer looked perfect, so there's no telling why it didn't work. So figured before we spent another 20k in banking eggs or 4k for last transfer, then perhaps this would give us a little insight. My gut keeps nagging me to do this...I really wish all fertility clinics did this off the bat for us all. My doctor said that some do, but she thought was a little over-kill. 

prudence9-2

@kristimh80 ***TW**** after failures with 3 PGS normal - first, the embryo stopped growing at 6w 1d, second was CP and third was BFN ***end TW*** i did ERA before transferring my last PGS normal embryo. My ERA was exactly the same as my medicated transfers. So unlike @artemis618 we did use all the medication as we would for a regular cycle. 

The ERA came back that I need 12 more hours or progesterone which explains the BFN & CP. So I felt much better going into my 4th transfer. Unfortunately, that ended in a BFN.

 I will mention though that a day after the transfer I got this crazy flu that everyone is having this year. So I’m not sure that it helped that I was sick & with fever. 

kristimh80

@prudence9-2 ((hugs)) So sorry for everything you've had to endure along your journey. I do appreciate your response and glad they were able to pinpoint what you needed to change with your meds / cycle. 

How's everything going with your new cycle? I figure, like you, there is a good chance we maybe go into another ER cycle after we get the ERA results. 

prudence9-2

@kristimh80 thanks, it hasn’t been easy. But even though the FET after ERA ended up with a BFN, I would have still done it. 

After the last failure I started another IVF cycle,  1.5 years after my first IVF. But I wasn’t responding well (probably because of the BCP prior to the cycle). Anyway, doctor suggested to cancel the cycle but I decided to continue. And since there were not many embryos, we just transferred them all on day 3. I’ve done a day 3 transfer, so this time we ignored ERA results as it was a fresh and not frozen transfer. **TW** it ended up with a BFP. I’m now 7w 2d and still can’t believe it. But hope this is it! ***end TW***

kristimh80

@prudence9-2 Congratulations!!! Sounds like you were right to trust your gut on your last cycle! Main thing I've learned with IVF & TTC...even though there is all this science, you have to trust yourself and we can't always rely on "numbers".  My last IVF, I over-stimmed with 50 eggs, only 6 made it to blast and 2 PGS normals. So even with if you get a lot of eggs, it's not always the best thing either. FX for you that time flies by and your little one is here by the end of the year!  

prudence9-2

@kristimh80 Wow!! 50!!! Did you have OHSS?
in my first cycle I had 30 eggs, 8 made it to blast and 4 normal. And in my second cycle I had 10 eggs and I transferred all 6 that made it to day 3.

I think my doctor looked at the numbers and realized that we might not get many that make it to day 5 and won’t be able to do pgs. But since my goal is 1 baby and I was already stimming for 8 days. I decided to keep going and I do hope that the one that stuck is a normal one.

kristimh80

@prudence9-2 I got lucky and because estrogen was so high as well, I was able to trigger with Lupron. So only got minimum OHSS symptoms. Was thankful when AF showed 5 days later which wasn’t a huge relief! 

RE did say this time she’s wanted me to Aden DHEA into supplements. So we’ll see it that makes a difference along with lower stim cycle. 

Thanks amazing that your dr let you transfer that many! I’m praying the next cycle we have a decent amount of normals so can at least do 2. 

prudence9-2

@kristimh80 keep in mind that from day 3 to day 5 most the embryos don’t survive. So for someone my age, the odds were that 2 will make it to day 5-6 and hopefully one of these 2 is a normal. 

If i was a new patient maybe they wouldn’t have let me transfer as many. But with my age, and my history of 4 PGS failures there wasn’t really a fear of twins. And def no chance of triplets. 

Glad to hear you didnt have OHSS!! So when are you expected to do the ERA cycle? Will you go for another IVF cycle after that?

kristimh80

@prudence9-2 For sure! I'm not too far behind you girl, so I get not being cautious and not wanting to waste any time!  

ERA cycle should start mid-May, so I'll humor myself and keep up with "bump friends" on the April / May board We are still going back and forth to do the retrieval or go ahead and transfer after the ERA cycle. Lots of pros and cons on both sides. I figure we technically have til June to make our minds up. I can see us getting antsy by then and transferring anyways. 

prudence9-2

@kristimh80 yeah. Such a tough decision. Do you transfer first or do another IVF cycle. 

AlohaKumu

@kristimh80 I will be going through at least 1 ERA cycle in the upcoming months.
*TW loss*

We transferred a 6-day hatching, PGS tested embryo for our first transfer and it resulted in a chemical pregnancy. We transferred two embryos (1 PGS tested and the other not) for our second transfer and I got a BFN.

Hindsight being 20-20, I wish I would have been able to do an ERA before we ever started the frozen embryo transfer process, especially since research shows it's a sizeable number of women who need their protocol changed from what might be considered to be the standard.

kristimh80

@AlohaKumu Same here!! Esp if you have a lower # of embryos, it seems like it would be even more beneficial. Good to see some else will doing it soon as well. I think mid-May (next cycle) I will start my ERA cycle. Feel free to join me! Hopefully we'll both get some answers.  

JamieH2000

@kristimh80- My whole background is in my siggy, but the short version is I had 1 cancelled and two failed IVF cycles before we moved on to DE. After some bumps in the road, we got 12 perfect blasts from our donor cycle. We transferred two in Dec and were devastated when it was a BFN (my clinic has a 90% DE success rate). So we moved forward with an ERA. Our ERA showed I was post-receptive (needed LESS progesterone than 5 days) which is really rare. So we repeated the ERA and got a receptive result with only 4 days of progesterone. Essentially every embryo we transferred was too late and never had a chance to implant. I am happy to have an answer, but I honestly wish we had done the ERA early and before moving to donor egg. While I have never got a ton of eggs or embryos, its hard to know we have never really transferred when my uterus was actually receptive. My receptivity during a natural cycle is also probably early, so its likely I could never get pregnant naturally either. Again, my result is very rare, but i think the ERA is worth doing for anyone with a failed cycle. Most (85%+) will be receptive with the standard timing, but at least you will have checked this off the list as an issue. Best wishes!

artemis618

@JamieH2000. Good luck with your upcoming transfer!!

mtpbadger

Hello! I would recommend doing the ERA. I had one done last summer after several failed FETs and CPs. While I came back receptive, it was still good information to have as we were able to rule that out as an issue. 

My insurance actually covered the biopsy part of it, so I only had to pay for the processing or the results - might be worth looking into seeing if anything could be covered!

kristimh80

@JamieH2000 Thanks so much for your response! So glad they were able to give you some insight and answers! Best of luck on your next transfer! I agree with you, I really wish they offered the ERA for everyone off the bat. I know my doctor thinks it's a little over-kill, but it could save so many of us a lot of heartache and $$ along the way. Did you repeat the ERA the same cycle? I see some RE's will do 2 biopsies in same cycle for this reason...guess I need to check with my doctor.

@mtpbadger So good to have answers! Either way, when this far into the journey, I feel it's helpful to have any much information as possible. Bets of luck to you! I hope your IVF journey is getting better That's wonderful that your insurance covered part of it for you! So far, if it's anything to do "fertility related" my insurance denies all, but I will look into it just in case! 

JamieH2000

@kristimh80- I had do to another cycle for the second ERA. I don't think most clinics do 2 biopsies, since like 90-95% probably don't need to repeat it. I don't think it would have helped me anyways bc I think they do like day 5 and day 7 or something if they do two of them (I would have needed day 4). My RE only repeats it usually if you are post receptive or pre-ceptive by more than 24 hours I think. Usually if you just need 12 or 24 more hours of progesterone, they feel good just taking that reco. 

@mtpbadger- how thick was your lining for the ERA? My friend with lining issues is doing an ERA since my RE says if they are receptive at 5mm or 6mm, they would still do the transfer then.

kristimh80

@JamieH2000 Good to know! I saw a couple of girls on YouTube say they went did there's 2 days apart...so only reason I wondered. I need to stop "googling" lol Guess a 2nd month would't be that bad if gets answers  

prudence9-2

@kristimh80 I did it two days apart. But for @JamieH2000 the results were that she needs it earlier. So she had to do another ERA cycle. 

kristimh80

@prudence9-2 Makes sense. I didn't know they could get answers that quickly, so thought maybe was done "just in case".

mtpbadger

@jamieh2000 I’d have to find my more detailed notes but my lining was most likely fairly thin...definitely no more than a 6 and it was probably more like a 4-5. The only note I can find right now is that my RE cancelled my FET due to crappy lining and converted it to an ERA instead so that the cycle wasn’t completely wasted. I do remember that they were worried they wouldn’t be able to get a big enough sample bc my lining was so thin. 

JamieH2000

@mtpbadger- thats great news for her! They are going to do an ERA as long as she gets above 5mm. I think as long as someone is receptive with trilinear lining, the changes aren't so bad even if the lining is thinner than ideal!  Thanks for the info, I have shared your story with her and its really given her hope.

@kristimh80- the results take 1-2weeks, so the double biopsy would be done without knowing the results. I think sometimes the lab won't test (and charge you) for the second one unless the first one comes back pre-receptive.

prudence9-2

Yes, @JamieH2000 is right. The lab didn’t charge me for the second biopsy. And then since my results were another 12 hours, they didn’t have to test the second biopsy. So I ended up paying the lab just for one biopsy analysis which was nice. 

For me the results took over 2 weeks. (Thanks to the holidays!) but they told me it should be 14 days usually. 

shauna43

Hello,
 I would  recommend the ERA test. I have been ttc for 12 years. During the past 3 years I had 5 failed ivf with day 5 AA pgs norm embryos.(miscarriages and chemicals) I've lost over 10 norm  embryos. 
I also wil add I had hydrsalpinx. I got my tubes tied last jan 2017. After my 5th fail my Dr recommended the ERA. If only i had done it sooner.

Era test found that i needed 12 more hours of pio. So in Jan ( after waiting 7 months....moved to fl ) I had my first transfer post ERA.

Tw****************

In jan I transferred 2 day 5 AA blasts with my ERA protocol. And now happy to say I'm pregnant with twins

prudence9-2

@shauna43 that’s great!!!! Soooo happy to hear!!!!

kristimh80

@shauna43 Congratulations!!!!! That's amazing! 

shauna43

Also i will add that after my transfer thi past jan i was on high amounts of pio.  At first  thet only had me in 1 ml injection once a day. But after i had them test my progesterone on 5dp5dt (got positives every day right after transfer) because i notice my test didn't seem darker. They ended up increasing my pio to 2 injections daily of 2 ml plus vag pills 3 times a day. 

Tw**** 18 weeks 1 day pregnant with twins.  It seemed to work .


I wish u all sucess.  I know the pain and struggle your in. I never thought I be pregnant don't give up. 

shauna43

@prudence9-2 thank you!! I feel very grateful and lucky.  I think you had a transfer  near me....i was sad to hear it didn't work. ( your friends with my friend hopeful)


@kristimh80 thanks girl......had a lot of heartbreak to get here. I know what you all are going thru. 

shauna43

@prudence9-2 just read your pregnant wooohooooo

prudence9-2

@shauna43 yeah the transfer in January was horrible. I felt great on the day of the transfer. But the following day got the horrible flu that is going on. So for the next week had fever. At some points high fever. That was my first transfer after ERA so I was very hopeful. But that totally went wrong. And was my last PGS embryo (I had 4 PGS embryos... they were all failures). 

So after that I started new IVF cycle. But wasn’t responding well and the doctor even suggested we cancel at some point. But I decided to complete it. And transferred all 6 embryos on day 3. ***TW*** And I’m now 10w 2d pregnant. For the fresh cycle we totally ignored the ERA finding. As it is different type of cycle. And it worked. I’m still terrified something will happen. But taking it one day at a time

prudence9-2

@shauna43 I actually think we transferred the same day in January. Did you have your transfer on January 24th?

shauna43

Yes prudence jan 24 lol I cant beleive u transferred 6?!?!??!? Are u pregnant with multiples??? And i cant beleive u disregarded the era findings
....crazy..... and it worked....

kristimh80

@prudence9-2 Congratulations!! I may have already said that, but just in case! That's great that they let you transfer all 6!

AFM: My ERA cycle starts today. Is it bad that I'm super excited to start estrogen again? Hopefully, it'll continue to be my happy pill  

prudence9-2

@shauna43 @kristimh80 this was a day 3 not a day 5 transfer. In my age (42.5) the odds were that out of the 6 only 2 will make it to day 5-6. And that out of the 2 maybe 1 is normal. 

Also ***TW*** with my history of failures with 4 PGS normal embryos, transferring 6 on day 3 wasn’t a big risk for multiples *** end TW***

edited to add this:

also @shauna43 ERA is only valid to the exact cycle. So you can’t apply ERA results of frozen cycle to fresh... we didn’t and obviously it worked!

prudence9-2

@kristimh80 good luck with the cycle!! Hope you will find some answers!! Do you only take estrogen? Or also Lupron?

kristimh80

@prudence Only estrogen, luckily! I was happy when she told me I didn't need to do PIO for this cycle. 

prudence9-2

@kristimh80 really? No PIO? But when you transfer, would you use PIO? 

prudence9-2

For me though, the worst injection is Lupron!! Worse than PIO!

kristimh80

@prudence9-2 Yes, when I do an actual transfer I'd be on it for around a week prior. I guess at my sonogram I'll find out for sure. I was kind of shocked they wouldn't have me on any progesterone for event he ERA since they are measuring to see if I need more / less at the biopsy. Thinking about it...I'm going to email my head nurse to double check!

Ugh Lupron...I did 2 of those for my retrieval, but it was compounded Lupron so don't remember any side effects besides lovely hot flashes!