Endometrial Function Test through Yale University — The Bump
Infertility

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!
- August 2013 - December 2013 3 rounds Clomid 
- February 2014 - DH diagnosed with bilateral absence of vasdeferens, so on to IVF with ICSI.
- November 2014 - First IVF round/retrieval.  From that we ended up with 12, day 3 embryos.  Fresh transfer - chemical pregnancy
- February 2015 - 1st FET - BFN
- Dec 2015 - 2nd FET  - BFN
- Dec 2016 - 3rd FET - Added endo scratch, endometrial HCG, and resistant uterine protocol - BFN 
- Dec 2017 - Intra uterine scope and biopsy - Found nothing that could be causing us not to concieve
- Jan 2018 - ERA- Found I was post receptive and we needed 12 less hours of progesterone before transfer
- February 2018 - 4th FET - because of needing to mimic ERA cycle, had to thaw all 4 remaining embryos to day 5.  In that process 3 of the embryos arrested and the remaining embryo was very poor quality.  We weren't too surprised when that also ended in a BFN. 
- July 2018 - Full IVF round with PGS testing.  18 retrieved, 12 mature, 5 made it to day 5 testing day, 2 Normal.
-October 2018 - 5th FET with a good quality PGS normal embryo with altered ERA transfer timing - BFN

July IVF 2018 Link - https://docs.google.com/spreadsheets/d/1DfZXNH1ydA731CAEia7ySoE5SYlJkyFlYTQa7MW8gzc/edit?usp=sharing


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:

    https://news.yale.edu/2003/07/14/newly-invented-endometrial-function-test-eft-solves-puzzle-unexplained-infertility-yale-r

    I also found some information on Yale's website:

    https://medicine.yale.edu/obgyn/kliman/infertility/eft/

    The video on their website was pretty cheesy but could be helpful.
    - August 2013 - December 2013 3 rounds Clomid 
    - February 2014 - DH diagnosed with bilateral absence of vasdeferens, so on to IVF with ICSI.
    - November 2014 - First IVF round/retrieval.  From that we ended up with 12, day 3 embryos.  Fresh transfer - chemical pregnancy
    - February 2015 - 1st FET - BFN
    - Dec 2015 - 2nd FET  - BFN
    - Dec 2016 - 3rd FET - Added endo scratch, endometrial HCG, and resistant uterine protocol - BFN 
    - Dec 2017 - Intra uterine scope and biopsy - Found nothing that could be causing us not to concieve
    - Jan 2018 - ERA- Found I was post receptive and we needed 12 less hours of progesterone before transfer
    - February 2018 - 4th FET - because of needing to mimic ERA cycle, had to thaw all 4 remaining embryos to day 5.  In that process 3 of the embryos arrested and the remaining embryo was very poor quality.  We weren't too surprised when that also ended in a BFN. 
    - July 2018 - Full IVF round with PGS testing.  18 retrieved, 12 mature, 5 made it to day 5 testing day, 2 Normal.
    -October 2018 - 5th FET with a good quality PGS normal embryo with altered ERA transfer timing - BFN

    July IVF 2018 Link - https://docs.google.com/spreadsheets/d/1DfZXNH1ydA731CAEia7ySoE5SYlJkyFlYTQa7MW8gzc/edit?usp=sharing


    suzycupcake
  • 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.
    - August 2013 - December 2013 3 rounds Clomid 
    - February 2014 - DH diagnosed with bilateral absence of vasdeferens, so on to IVF with ICSI.
    - November 2014 - First IVF round/retrieval.  From that we ended up with 12, day 3 embryos.  Fresh transfer - chemical pregnancy
    - February 2015 - 1st FET - BFN
    - Dec 2015 - 2nd FET  - BFN
    - Dec 2016 - 3rd FET - Added endo scratch, endometrial HCG, and resistant uterine protocol - BFN 
    - Dec 2017 - Intra uterine scope and biopsy - Found nothing that could be causing us not to concieve
    - Jan 2018 - ERA- Found I was post receptive and we needed 12 less hours of progesterone before transfer
    - February 2018 - 4th FET - because of needing to mimic ERA cycle, had to thaw all 4 remaining embryos to day 5.  In that process 3 of the embryos arrested and the remaining embryo was very poor quality.  We weren't too surprised when that also ended in a BFN. 
    - July 2018 - Full IVF round with PGS testing.  18 retrieved, 12 mature, 5 made it to day 5 testing day, 2 Normal.
    -October 2018 - 5th FET with a good quality PGS normal embryo with altered ERA transfer timing - BFN

    July IVF 2018 Link - https://docs.google.com/spreadsheets/d/1DfZXNH1ydA731CAEia7ySoE5SYlJkyFlYTQa7MW8gzc/edit?usp=sharing


    Kp214
  • @katie35 this information is amazing! I look forward to your updates about this new test. Good luck! 
    katie35
  • 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

    - August 2013 - December 2013 3 rounds Clomid 
    - February 2014 - DH diagnosed with bilateral absence of vasdeferens, so on to IVF with ICSI.
    - November 2014 - First IVF round/retrieval.  From that we ended up with 12, day 3 embryos.  Fresh transfer - chemical pregnancy
    - February 2015 - 1st FET - BFN
    - Dec 2015 - 2nd FET  - BFN
    - Dec 2016 - 3rd FET - Added endo scratch, endometrial HCG, and resistant uterine protocol - BFN 
    - Dec 2017 - Intra uterine scope and biopsy - Found nothing that could be causing us not to concieve
    - Jan 2018 - ERA- Found I was post receptive and we needed 12 less hours of progesterone before transfer
    - February 2018 - 4th FET - because of needing to mimic ERA cycle, had to thaw all 4 remaining embryos to day 5.  In that process 3 of the embryos arrested and the remaining embryo was very poor quality.  We weren't too surprised when that also ended in a BFN. 
    - July 2018 - Full IVF round with PGS testing.  18 retrieved, 12 mature, 5 made it to day 5 testing day, 2 Normal.
    -October 2018 - 5th FET with a good quality PGS normal embryo with altered ERA transfer timing - BFN

    July IVF 2018 Link - https://docs.google.com/spreadsheets/d/1DfZXNH1ydA731CAEia7ySoE5SYlJkyFlYTQa7MW8gzc/edit?usp=sharing


  • ninamininami
    10 Comments Name Dropper Photogenic
    member
    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!
    - August 2013 - December 2013 3 rounds Clomid 
    - February 2014 - DH diagnosed with bilateral absence of vasdeferens, so on to IVF with ICSI.
    - November 2014 - First IVF round/retrieval.  From that we ended up with 12, day 3 embryos.  Fresh transfer - chemical pregnancy
    - February 2015 - 1st FET - BFN
    - Dec 2015 - 2nd FET  - BFN
    - Dec 2016 - 3rd FET - Added endo scratch, endometrial HCG, and resistant uterine protocol - BFN 
    - Dec 2017 - Intra uterine scope and biopsy - Found nothing that could be causing us not to concieve
    - Jan 2018 - ERA- Found I was post receptive and we needed 12 less hours of progesterone before transfer
    - February 2018 - 4th FET - because of needing to mimic ERA cycle, had to thaw all 4 remaining embryos to day 5.  In that process 3 of the embryos arrested and the remaining embryo was very poor quality.  We weren't too surprised when that also ended in a BFN. 
    - July 2018 - Full IVF round with PGS testing.  18 retrieved, 12 mature, 5 made it to day 5 testing day, 2 Normal.
    -October 2018 - 5th FET with a good quality PGS normal embryo with altered ERA transfer timing - BFN

    July IVF 2018 Link - https://docs.google.com/spreadsheets/d/1DfZXNH1ydA731CAEia7ySoE5SYlJkyFlYTQa7MW8gzc/edit?usp=sharing


    Kp214bkatpcallingthestork
  • nesslindemannesslindeman
    Sixth Anniversary Photogenic First Comment
    member
    edited March 24
    Thanks for detailing the process. 
  • This is great, thanks!
  • katie35katie35
    100 Comments 25 Love Its Second Anniversary Name Dropper
    member
    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
    - August 2013 - December 2013 3 rounds Clomid 
    - February 2014 - DH diagnosed with bilateral absence of vasdeferens, so on to IVF with ICSI.
    - November 2014 - First IVF round/retrieval.  From that we ended up with 12, day 3 embryos.  Fresh transfer - chemical pregnancy
    - February 2015 - 1st FET - BFN
    - Dec 2015 - 2nd FET  - BFN
    - Dec 2016 - 3rd FET - Added endo scratch, endometrial HCG, and resistant uterine protocol - BFN 
    - Dec 2017 - Intra uterine scope and biopsy - Found nothing that could be causing us not to concieve
    - Jan 2018 - ERA- Found I was post receptive and we needed 12 less hours of progesterone before transfer
    - February 2018 - 4th FET - because of needing to mimic ERA cycle, had to thaw all 4 remaining embryos to day 5.  In that process 3 of the embryos arrested and the remaining embryo was very poor quality.  We weren't too surprised when that also ended in a BFN. 
    - July 2018 - Full IVF round with PGS testing.  18 retrieved, 12 mature, 5 made it to day 5 testing day, 2 Normal.
    -October 2018 - 5th FET with a good quality PGS normal embryo with altered ERA transfer timing - BFN

    July IVF 2018 Link - https://docs.google.com/spreadsheets/d/1DfZXNH1ydA731CAEia7ySoE5SYlJkyFlYTQa7MW8gzc/edit?usp=sharing


  • Please let us know how it goes!
    katie35
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