The long awaited test results

The biopsy results are in.

Back in early October we did 4 tests to help determine a better treatment plan for embryo transfer. Check out that post here if you haven’t read it yet. I was a bit on the fence, but so open to doing anything and everything that could help our chances of bringing home a biologically similar babe.

We set up a call with our doctor, who might I add now feels like a member of our family more than a member of our clinical team, to review the results. I can’t stress enough how having continuity of care impacts how I have felt about treatment. I feel supported in such a different way, where my doctor knows my face and my situation.

Anyway, the results you’ve all been waiting for (hah, I feel like I am the only one anxiously awaiting these)…

EndomeTrio:

ERA Test:
We have found out that I am “pre-receptive”. Here’s an excerpt from my clinic on what the receptivity test does:

“The rationale for the test is based on the fact that the endometrium will only allow the implantation during a finite time frame known as the window of implantation (WOI). If the embryo is delivered to the uterus too early or too late, when the window is closed, implantation cannot occur […] However, until the ERA test was developed, there was no meaningful way to measure it in any given individual. More importantly, the ERA was actionable: if the endometrium was found to be non-receptive a plan to optimize receptivity was provided.” (Source)

Pregnancy can’t occur if:

• the window of receptivity is missed
• the embryo isn’t mature enough
• the endometrium is not expressing the correct genes or is not in a receptive state

The idea of a window of receptivity exists in both natural conception and IVF.

In my particular case, a very specific window of transfer/implantation has been recommended – between 141-147 hours of progesterone. This means my endometrium wasn’t ready on the day of biopsy, and additional progesterone is recommended (so an ideal transfer would take place approx a day after the normal transfer date of day 5 for most frozen embryos).

Here’s a really good article that explains receptivity and how to interpret your results if you do the ERA: https://en.e-stork.com.tw/article/view/71

EMMA Test:
The EMMA test came back recommending vaginal probiotics for 10 days prior to FET. I have taken these before, but not every time. The recommended probiotic is Flora SAP.

ALICE Test:
Nothing found

UtimPRO
This test was the beast. This one is not done routinely, but due to my implantation failure and recurrent miscarriages, my doctor recommended I give it a shot. I don’t know anyone else personally who has had this test, but the findings were very interesting. Once again, I am happy to try anything and everything at this point in my journey.

I didn’t see the report directly, but given the recommendations I was able to draw a few conclusions.

1. Heparin was recommended for my FET. This likely indicates that a clotting disorder may be a factor in my repeat failure. Here’s a good study on use of Heparin in Assisted Reproductive Technology (ART): https://academic.oup.com/humupd/article/14/6/623/631770

2. Endometrial biopsy prior to FET was recommended (AKA scratching). SUPER excited to do that again (sarcasm). Scratching can enhance the receptivity of the uterus to the embryo. It’s not a guarantee, but it ‘can’ assist. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294834/

3. Addition of HCG – HCG can aid in the implantation of the embyro,

Experiments have indicated that hCG influences the level of hormones in the uterus and even within the embryo itself around the time of implantation. hCG may also influence cells involved in the immune response of the uterus to the embryo, allowing the uterus to accept the embryo.

Here are two good studies on adding HCG during FET and the outcomes.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289495/
https://www.fertstert.org/article/S0015-0282(19)31176-8/fulltext

4. Addition of Seminal Plasma (basically intercourse one day prior to and one day after transfer)

“Seminal fluid contains several proteins that interact with cervical and uterine epithelial cells inducing active immune tolerance.” (source)

Studies are conflicted, but here are two that demonstrate benefits:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9979547/
https://www.iris.unina.it/retrieve/handle/11588/698105/212311/Saccone_et_al-2019-BJOG__An_International_Journal_of_Obstetrics_%26_Gynaecology.pdf


After reading all of the above, I am assuming that there’s a suspected immune response happening during implantation of an embryo in my uterus.

So how do I feel about this? Relieved to be honest. For the first time in our IVF journey, something actionable has come about that gives us hope. So many people have success in IVF during the first or second retrievals, and although my egg quality and our blastocyst production has taken a hit recently, this testing has made me feel more in control of my outcomes. Will it work? Who the hell knows.

The moral of the story here is that embryos are precious and everything should be done to ensure the ones we have actually implant. I am not sure why these tests aren’t offered more often before transfer, especially after subsequent failed implantation or miscarriage. I feel that I was over confident after our first egg retrieval, thinking “we made 7, we can make more easily!”. That wasn’t the case.

Going forward I feel more confident that any embryos we do create (fingers crossed), will have the BEST shot of survival. That we’re doing all we can on our end to make this dream a reality. I always tell my IVF friends, ADVOCATE ADVOCATE ADVOCATE for yourself in this process. Be it in asking for a test, pushing for a second opinion, making your wishes known. So many of us pay out of pocket for this, and we should use that power to do everything we can to achieve the outcomes we can for our future. You’re in the drivers seat, so don’t just sit there in the parking lot waiting for change to happen.

PS – I’ll be adding all of the studies I link to in my blog in my Resources page, once I have some time to organize them! If you know of a study that is informative that should be included, feel free to comment below!