Endometrial Function Test through Yale University

Hello All.  Long story short, after 6 failed transfers (details in my signature), my RE is recommending that we do an Endometrial Function Test through Yale University.  We have already done an ERA, but sounds like this is different in that it tests the endometrium for various issues and markers which could be preventing implantation.  Has anyone heard of this or done this test?  Google searching is giving me some information, but not a ton.  I am just curious as to if anyone found this test and the results useful, and if so, how did the results alter your treatment?

Thanks in advance!

Re: Endometrial Function Test through Yale University

  • So we have decided to move forward with this test.  Since I didn't have a lot of luck finding people with experience as to what this test entails and what the results might mean, I think I will post some information here as I get it.  Hopefully it might help someone else in the future who is looking for information.

    A fellow Bumpie on the July IVF thread found me a really good article that explains the test in a way I could understand:

    I also found some information on Yale's website:

    The video on their website was pretty cheesy but could be helpful.
  • We received our protocol/schedule for the Endometrial Function Test.  Basically we will do a Mock FET cycle but instead of the transfer, they will do two biopsies on cycle days 15 and 24.  

    Here is a break down of the schedule:

    Pre Procedure Month
    - Cycle day 21:  Start Lupron 20 units nightly

    Procedure Month

    - Cycle day 1-2: check estrogen levels

    - Cycle day 3: start vaginal Estrace 2mg once daily, lower Lupron dose to 10 units nightly

    - Cycle day 6: US Check

    - Cycle day 7: Increase Estrace to 2 mg twice daily

    - Cycle day 10: US Check

    - Cycle day 11: depending on previous US, may increase Estrace dose

    - Cycle day 13: US Check.  If lining adequate, start progesterone vaginally.  Only one dose today, 25 mg in evening.

    - Cycle day 14: Increase progesterone to 25mg twice a day

    - Cycle day 15: Biopsy

    - Cycle day 16: Increase progesterone to 50 mg twice daily

    - Cycle day 18: Increase Progesterone to 100 mg twice daily

    - Cycle day 23: Increase Progesterone to 200 mg twice daily

    - Cycle day 24: Biopsy

    It sounds like this is Yale's standard protocol for the test.  I will be starting the Lupron on December 14th.  I am looking forward to getting the process started!

    On a side note, my RE also decided that she wants me on long term Prednisone for our next FET.  Since I will be on it for the real FET, I also have to be on it for the testing cycle.  I started with 20 mg daily last Saturday.
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  • @katie35 this information is amazing! I look forward to your updates about this new test. Good luck! 
  • We had our first biopsy this morning so I thought I would add in the additional information that I have so far.

    The biopsy itself wasn't bad.  My RE took two biopsies as this is what the RE at Yale recommend her to do.  I was pretty crampy during each but the biopsies/cramping only lasted about 20-30 seconds each.

    I found out today that Yale won't actually start processing the results of the biopsies until they receive both specimens and then they will process them together.  It sounds like it will take at least two weeks from the time they start processing the specimens for me to get any results back. 

    I had to make sure all of my paper was signed today which included Yale's Patient Privacy Agreement and the Financial Agreement.  

    For costs, I confirmed today that for Yale to process the samples, they will charge me $595 per specimen.  In the grand scheme of everything we have done so far, this didn't seem so bad!  So for cost for the entire testing process, I am figuring the following:

    Medications (Estrace, Progesterone Suppositories, Lupron): $110 (after insurance)
    Ultrasounds: 100 (after insurance)x3 = $300
    Biopsy Specimen Processing: 595x2 = $1190
    Biopsy Procedures: Forgot to ask, but I don't remember this being too aweful from my ERA

  • Hi @katie35! Found you on this threat. Great info, sounds like its totally worth it for those of us "unexplained" . Just really feels like its timing issue. Especially from my own experience, since I did implant on my own, just miscarried. Yale is a great place. Got my friend pregnant after years of failure.
  • Just another update on the EFT progress...

    After almost 4 weeks of waiting from my last biopsy, we finally have our results.  To sum it up, they found:

    1.  I am an "over responder" to the estrogen and progesterone.  Receptivity wise, the first biopsy showed that I was a few days more progressed than what I should have been at that point.  With the second biopsy she described that parts of my endometrium had basically arrested.  They are recommending that I do a "quarter protocol" (will give more information once I know what that means).  Keep in mind that the dosages they gave me for this EFT were already smaller than what they give for a typical FET. 

    2.  I am showing signs of endometriosis.  I never would have guessed this.  I have never had any symptoms.  They are giving me the options of either doing a Laparoscopy to go in and find it and remove it, or I can go on a long Lupron protocol.

    They are giving us the option to jump into an FET following their recommendations or to repeat the test with their recommendations.  At this point the plan is to repeat the test doing the quarter protocol and the long Lupron protocol to make sure we get closer to where we need to be.  Here's to hoping that we are finally moving in the right direction!
  • nesslindemannesslindeman member
    edited March 2019
    Thanks for detailing the process. 
  • This is great, thanks!
  • Glad you guys are finding the information helpful!

    We are jumping into our next testing cycle so thought I would update again.  As mentioned above, for this round we are doing Lupron for two months and then jumping into the actual testing protocol, but this time doing a quarter protocol.  Here is what that looks like:

    Leading up to biopsy month

    - Cycle day 1:  Lupron Depot IM injection

    - Cycle day 28: Start Lurpon 20 units nightly - continue for 28 more days.

    - Cycle day 56: Did an ultrasound to ensure my lining was thin and did blood work to ensure my estrogen level was low.  Since being on the Lupron will cause me to not get a period, we started from here as "Cycle Day 1" of the actual testing cycle.

    Procedure Month

    - Cycle day 3: start vaginal Estrace 2mg once daily, lower Lupron dose to 10 units nightly

    - Cycle day 6: US Check

    - Cycle day 7: depending on previous US, may increase Estrace dose

    - Cycle day 10: US Check

    - Cycle day 11: depending on previous US, may increase Estrace dose.  Last dose of Lupron.

    - Cycle day 13: US Check and blood work to check estrogen and progesterone levels.  If lining adequate, start progesterone vaginally.  Only one dose today, 6 mg in evening.

    - Cycle day 14: Increase progesterone to 6mg twice a day

    - Cycle day 15: Biopsy.  Increase progesterone to 12.5 mg twice daily

    - Cycle day 17: Increase progesterone to 25 mg twice daily

    - Cycle day 18: Increase Progesterone to 50 mg twice daily

    - Cycle day 19: Increase Progesterone to 100 mg twice daily

    - Cycle day 23:  Increase Progesterone to 200 mg twice daily

    - Cycle day 24: Biopsy
  • Please let us know how it goes!
  • katie35katie35 member
    edited September 2019
    It has been a while since I have updated and wanted to be sure to see this through!

    I am so glad that we decided to test again rather than just following the initial recommendations and transferring our last embryo.  The results of the second round of testing came back showing the same results as the first round.  I am still over responding to the estrogen and progesterone and I was still showing inflammation/signs of endometriosis.  My RE discussed my results with the RE at Yale and at this point they are more concerned with the inflammation than they are with me over responding to the medications.  

    They decided after the second biopsy that we should go ahead with the laparoscopy to look for endometriosis or any other issues.  They also decided to do a pelvic wash and flush my tubes as well.  Good news and bad news from the laparoscopy.  Good news, they didn't find any signs or endometriosis or any other issues.   Bad news, we still don't know why I am showing the inflammation.

    My RE has decided to refer me to a Reproductive Immunologist in Chicago.  However, we can't get in to see her until the end of November.

    In the mean time, we have decided at this point to do another round of testing but to do it completely natural, just to see what will happen.  No estrogen or progesterone.  It sounds like this is the first time they have done this testing on a natural cycle, so we will see how it turns out.  The only medication they had me take was an Ovidrel trigger shot when I was close to ovulating.  They counted this as "day 13" and we biopsied on day 24.  I should be getting the results back soon hopefully!

  • @katie35 Thanks for all this info! I’m so sorry that it’s been such a long journey with no clear answers. I’m also an “overresponder,” but with a diagnosis of level 3 endometriosis. I’m glad you don’t have endometriosis, but I imagine that the frustration of not knowing what’s happening is just as bad or worse! I was told that I might also have adenomyosis, but that only gets confirmed with MRI or a hysterectomy. Best I’ve understood is that adenomyosis is extra lining in the uterus, rather than other places. It’s so frustrating that there is such little info out there and too little data to feel like the doctors know what they’re doing. I hope you get some answers to make this situation turn around!
  • I found this post recently and wanted to check and see if there was an update? I am currently in the process of an EFT test and am trying to gain as much information as possible. Thanks!
  • Hello @alpaca5000 apologies for the delay in responding.  And apologies for not finishing out this post until now.  I am assuming you have had your EFT done at this point?

    But to complete the story...

    We received the results of the natural cycle EFT and they looked much the same in that I was still looking like an "over responder".  Which was odd considering I didn't take any supplemental estrogen or progesterone.  Good news with this cycle however is that the inflammation shown on my other testing rounds was gone.  They weren't sure if this had to do with the pelvic wash or more to do with no medications.  I believe my RE was leaning more towards the pelvic wash.

    After this we decided to take a long break.  I wanted to give my body time to rest and mentally we both needed it.  We didn't jump back into another round of testing until December of 2020.  I am not able to find my paper work from that round, but I believe we mixed up the protocol again by giving as little estrogen as possible and increasing the amount of progesterone.  If anyone is interested in exactly what we did, I can keep trying to dig that up.  At the end of the day though, the results still came back as showing me as an over responder.

    At this point my RE, after speaking with the provider at Yale, sat us down and advised that it might be time to consider other avenues.  One of those avenues being the use of a gestational carrier.  This had come up in our conversations prior to this from time to time, but honestly I wasn't ready to consider it previously.  After doing these rounds of testing though I was starting to see that it might be our best option.  And to make an incredibly long and beautiful story short, one of my best friends volunteered to try and carry for us and we have since been blessed with the most incredible baby boy. 

    While doing the EFTs did not get us to the point of truly understanding why I was not able to carry, it did help us to determine that no matter what adjustments we made to the protocol we probably would not be successful ourselves.  It was so much better to come to this realization with testing rather than continuing to use our embryos.  It also helped me to get to a point where I felt at peace moving forward with a gestation carrier rather than continuing to push forward myself.  For that, I am so grateful, because it led us to where we are today.
  • Oh wow, thank you so much for responding to this @katie35. I'm so happy that you have your happy ending and everything worked out. I agree, it's so much easier looking at the option of a gestational carrier after you've done all of the testing possible, instead of just assuming the worst and jumping right to it.

    My story is long and convoluted, but I think I'm in a similar boat and (unfortunately for us) it feels good to not be alone, or feel completely crazy.

    Here's my story:

    I had a successful egg retrieval and one PGT tested normal embryo last November. After that, they wanted to do the ERA test with Igenomix to make sure we were transferring on the correct day. That test came back as my body was pre-receptive by 2 days. So, we did another test the following month to confirm this, and to everyone's surprise, that test showed that my lining was in a state of proliferation now (this happens to less than 1% of the patients according to Igenomix). So, for the next 4 months we kept doing that same test over and over again, adding more estrogen and progesterone to my system, with the same results (I was told by this company that they have never seen this result before in anyone who was not taking progesterone blocking medication, which of course I'm not). I found Dr. Kliman from Yale online and finally did an EFT test, thinking this was going to give me answers and be the missing puzzle piece, but unfortunately it was not. I was told by him that I have severe Glandular Developmental Arrest (GDA) and my only option to have a child is to get a gestational carrier. In my EFT report, Dr. Kliman suggested that I am in a group of less than .1% of people who were born without progesterone receptors in their lining...which actually doesn't make any sense as the original test came back as pre-receptive, so there was something happening there at the beginning with my receptors, which is an added layer of confusion and frustration. I can't be mad at Dr. Kliman in the slightest, as he did exactly what he was supposed to do, which is analyze the sample he was given. 

    My local doctor (who is amazing) has never see this before, neither has anybody she's reached out to, so we still have no answers. 

    I ended up getting really pissed off about all of this contradicting information and I e-mailed my story to the top 10 fertility clinics in the U.S. about a month ago, and I have slowly been setting up consultations with some of them that have responded. I sent all of my medical records (every ERA test, EFT, lab work, Ultrasounds, MRI, cancer screenings, etc.) to all of them and asked them to please look these over before we meet and if there's nothing you can do, or no advice you can offer, please don't meet with me (it's going to be a waste of both of our times and my money). Unfortunately, the first doctor that I met with via Zoom a few weeks ago did exactly that. He got on, had me retell my story, and literally said what I asked him please not to "wow, that's the craziest story I've heard, I have no idea how to help you, sorry". So frustrating. I have another consultation with a clinic on Tuesday and this doctor at least wants to meet with me, knowing my story, and thinks he might be able to help (at least that's what I've gathered from the appointment booking gal.) Fingers crossed he knows something more.

    It's crazy to be told that you're a medical anomaly and there's not one person on the planet that's had this issue and nobody knows what's happening, especially since my body was perfectly normal before all the meds and all this testing. Before the meds I would have 100% normal cycles and always ovulate on day 14. After all the meds and these tests I stopped ovulating all together and my periods were more like hemorrhages each month after the ERA's, not normal cycles. Before I would have perfect 28 day cycles, normal periods and ovulate exactly on cue. After the drugs, everything is getting back to normal, which leads me to believe it's all related. None of the medical doctors seem to think that the exogenous hormones are the issue, but that's the only thing that makes sense, at least to me.

    I'm seeing a naturopath doctor here locally that is currently working on helping me completely reset my system because it was so messed up. I was looking for somebody who is going to treat the whole patient, not just the symptom, which seems to be difficult in the medical world. He put me on a group of UNDA numbered compounds that seem to be doing the trick, as my cycles are getting back to normal. He's not guaranteeing anything for sure, but he did assure me that we have a ton of receptors in our body all over, and they can very easily be turned on and off depending on what we put in our systems (something that the medical doctors don't seem to agree with). 

    So, here I am next steps are to do exactly what you did, with some naturopathic help, and reset my system for a bit. Once I feel like everything is like it used to be and I feel good, I'm going to have them do another few ERA tests right around the same time to see if there's any sort of receptivity in my lining. Once I get those results, I'll know for sure that I've done everything possible to get to the bottom of this and my husband and I can make a clear decision about our future, with all the facts. 

    There have been a few family members and friends who have offered to carry our baby for us if need be, which is incredible, but I do honestly wonder how they'd react after all is said and done and if we actually do need it. It's a stressful thing to think about and a conversation for another day I suppose.

    Thank you again for getting back to this post. It really does mean a lot to know that I'm not alone out there. I wish you and your family all the best. :)

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