ERA test result

ERA test result

Joined: June 10th, 2014, 6:19 pm

March 27th, 2018, 8:35 pm #1

I finally got my ERA test result from March 1. The endometrium came back as "pre-receptive", with the following comment:

"Recommendation: Blastocyst/s transfer at P+6 (145 ± 3 hours with progesterone administration)*
* This recommendation is only applicable to the same type of cycle treatment as the one used for this endometrial biopsy and if the endogenous progesterone measured prior to the first progesterone intake is
<1ng/ml.
An 89% of women with similar endometrial profiles reached receptivity with 1 more day of progesterone administration (confidence interval of95% [86%-91%]), so in these cases new endometrial biopsy is not needed. Therefore, blastocyst/s transfer is recommended at P+6 (145 ± 3 hours with progesterone administration).
For a day-3 embryo(s), the transfer should be performed two days earlier than indicated in recommendation for blastocyst transfer above."

General comments on "pre-receptive" endometrium: "This gene expression profile is concordant with an endometrium at a pre-receptive stage. It may be due to the displacement of the
window of implantation, and to confirm a second biopsy on the recommended day could be required."

My understanding is that if the endometrium appears "pre-receptive" and they don't indicate when they expect it to be receptive, then you should deduce it is "non-receptive". Luckily not my case.

My local RE believes that another ERA test to test "receptive" is not needed, and I should just delay transfer by 1 day.

I am inclined to do as suggested, but I am still considering all options, and had the following questions:

1. What happens if you transfer Day 3, but the embryo actually becomes a blast on Day 6? Could it then be too late, and you might enter post-receptive state if your window of implantation is narrow?
My RE said that the normal window of implantation is 48 hrs, and a narrow window of implantation happens only if the uterus has anomalies, which would not be my case (I saw such cases on forums).

At this moment, I am still not clear about the timing of implantation, e.g. on wikipedia I saw that the embryo could wait till Day 8 or Day 9 to implant, so then why would you put a blast right when the endometrium starts being receptive? But maybe I need to understand more. In a different place I read that unlike Day 3 embryos, blasts are very sensitive to the window of implantation, and should be transferred right in the window.

2. I still don't have a proof that my endometrium will actually ever be receptive (89% is not 100%), so I wonder if it is worth having a 2nd test.

3. According to info I found, the dose of progesterone administered when doing the test does not matter, only thing that matters is the timing when P4 is started. However, the estradiol dose does matter (changes the window of implantation), and my RE actually keeps making variations from one cycle from another, so I wonder if there is an impact on the window of implantation.

4. My lining is only 6 mm, so even with a receptive endometrium, is this a problem?? A receptive endometrium sure helps, but how could thickness influence implantation otherwise? I read that thickness could affect placentation (don't understand how), and I read a theory that a thin lining would bring the embryo closer to thicker blood vessels, and too much oxygenation could affect the embryo.

I did try G-CSF this cycle with no results - actually the endometrium receded a bit after the wash. So G-CSF does not work for me.

I am reluctant to using again Tamoxifen - I am sure I would gain 1 extra millimeter at least, but I am afraid of possible negative effects on the faetus.

My local RE pretty much thinks that I should transfer with 6mm. It is true that with Estrofem + Lenzetto I gained 0.5 to 1mm compared to previous cycles, when I was using cyclo-progynova (valerate estradiol). Also, I took a very high estradiol dose, which might have mattered. This RE does not believe in taking estradiol for a long time, and I am very happy I don't have to do this anymore like in previous years - I feel it was useless.

Right now, I am contemplating a new hysteroscopy next cycle, and then a transfer in May. But I am not decided yet. Anyway, I will also contact NH after a bit, and see what they suggest. I see they have now stem cell treatment for thin endometrium, but who knows the cost, and if it is effective.

This is a link to a presentation of the ERA test, which I found useful:https://youtu.be/wcLC2VNy7EA

As a side-note, I have again 2 small subserous fundic fibroids (how on Earth???). But the RE said they don't affect the cavity at all.
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Joined: January 27th, 2015, 5:04 pm

March 30th, 2018, 5:51 pm #2

Hi Alma!

I am so sorry-i have read your message a couple of times but I don't seem to be undestanding how the ERA test works.

What does...Recommendation: Blastocyst/s transfer at P+6 (145 ± 3 hours with progesterone administration)* mean?

Again I am so sorry I can't offer any advice....

I am planning to do the ERA test too at some point but it seems it is not easy to interpret the results of it,

Thanks a again for all your help Alma!

xx
Joy
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Joined: June 10th, 2014, 6:19 pm

April 2nd, 2018, 8:13 pm #3

Hi Joy - P+6 means at 6th day after starting progesterone administration. The first day is Day 0 (not Day 1!).

I am still trying to make sense of this test. The window of implantation (WOI) is the time interval when the uterus is receptive, and a blast can attach. Normally, the window of implantation should last about 4-5 days (or more?), but in some cases (e.g. endometriosis, abnormal uterus shape) it can be narrow.

Now the implantation of a blast goes thru the following phases:

Apposition (unstable adhesion)
Attachment (stable adhesion)
Penetration (invasion)

These phases should last a few days, so if your WOI is narrow, it just won't cover all these phases? The ERA test, in my understanding, just determines 1 day when the uterus is/should be receptive. If you catch the beginning and the WOI is not narrow, you can assume you determined the date when you should transfer a blast. Otherwise, I don't understand how you synch optimally.

Furthermore, if you transfer Day 2 or Day 3 embryos, you cannot know when they will become blasts inside the uterus. My embryos are slow-growers, so they might become blasts on Day 6. In this case, they would actually be in synch with the endometrium if I do not delay the transfer by 1 day, as advised by the ERA test. So in certain cases, could the ERA advice be harmful???

Anyway, I am still trying to figure it out....
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Joined: January 27th, 2015, 5:04 pm

April 6th, 2018, 2:04 pm #4

I finally got my ERA test result from March 1. The endometrium came back as "pre-receptive", with the following comment:

"Recommendation: Blastocyst/s transfer at P+6 (145 ± 3 hours with progesterone administration)*
* This recommendation is only applicable to the same type of cycle treatment as the one used for this endometrial biopsy and if the endogenous progesterone measured prior to the first progesterone intake is
<1ng/ml.
An 89% of women with similar endometrial profiles reached receptivity with 1 more day of progesterone administration (confidence interval of95% [86%-91%]), so in these cases new endometrial biopsy is not needed. Therefore, blastocyst/s transfer is recommended at P+6 (145 ± 3 hours with progesterone administration).
For a day-3 embryo(s), the transfer should be performed two days earlier than indicated in recommendation for blastocyst transfer above."

General comments on "pre-receptive" endometrium: "This gene expression profile is concordant with an endometrium at a pre-receptive stage. It may be due to the displacement of the
window of implantation, and to confirm a second biopsy on the recommended day could be required."

My understanding is that if the endometrium appears "pre-receptive" and they don't indicate when they expect it to be receptive, then you should deduce it is "non-receptive". Luckily not my case.

My local RE believes that another ERA test to test "receptive" is not needed, and I should just delay transfer by 1 day.

I am inclined to do as suggested, but I am still considering all options, and had the following questions:

1. What happens if you transfer Day 3, but the embryo actually becomes a blast on Day 6? Could it then be too late, and you might enter post-receptive state if your window of implantation is narrow?
My RE said that the normal window of implantation is 48 hrs, and a narrow window of implantation happens only if the uterus has anomalies, which would not be my case (I saw such cases on forums).

At this moment, I am still not clear about the timing of implantation, e.g. on wikipedia I saw that the embryo could wait till Day 8 or Day 9 to implant, so then why would you put a blast right when the endometrium starts being receptive? But maybe I need to understand more. In a different place I read that unlike Day 3 embryos, blasts are very sensitive to the window of implantation, and should be transferred right in the window.

2. I still don't have a proof that my endometrium will actually ever be receptive (89% is not 100%), so I wonder if it is worth having a 2nd test.

3. According to info I found, the dose of progesterone administered when doing the test does not matter, only thing that matters is the timing when P4 is started. However, the estradiol dose does matter (changes the window of implantation), and my RE actually keeps making variations from one cycle from another, so I wonder if there is an impact on the window of implantation.

4. My lining is only 6 mm, so even with a receptive endometrium, is this a problem?? A receptive endometrium sure helps, but how could thickness influence implantation otherwise? I read that thickness could affect placentation (don't understand how), and I read a theory that a thin lining would bring the embryo closer to thicker blood vessels, and too much oxygenation could affect the embryo.

I did try G-CSF this cycle with no results - actually the endometrium receded a bit after the wash. So G-CSF does not work for me.

I am reluctant to using again Tamoxifen - I am sure I would gain 1 extra millimeter at least, but I am afraid of possible negative effects on the faetus.

My local RE pretty much thinks that I should transfer with 6mm. It is true that with Estrofem + Lenzetto I gained 0.5 to 1mm compared to previous cycles, when I was using cyclo-progynova (valerate estradiol). Also, I took a very high estradiol dose, which might have mattered. This RE does not believe in taking estradiol for a long time, and I am very happy I don't have to do this anymore like in previous years - I feel it was useless.

Right now, I am contemplating a new hysteroscopy next cycle, and then a transfer in May. But I am not decided yet. Anyway, I will also contact NH after a bit, and see what they suggest. I see they have now stem cell treatment for thin endometrium, but who knows the cost, and if it is effective.

This is a link to a presentation of the ERA test, which I found useful:https://youtu.be/wcLC2VNy7EA

As a side-note, I have again 2 small subserous fundic fibroids (how on Earth???). But the RE said they don't affect the cavity at all.
Hi Alma! Thanks for explaining things to me..They make more sense now.
Your questions are all great questions and I think it is worth researching this a bit more before you transfer. How about discussing your concerns with Dr Zhang and also another RE who has great experience in the ERA test?
By the way Dr Y doesn't think much of this test however there are other REs who are big on it...Maybe on some facebook groups you would find experiences from people who had it done..( let me know if you want me to add you)

I also wish I had answers to give you but this is all very new to me..

Please keep us posted of what you decide to do. May is so close. Will you transfer?
And i am sorry you have two more fibroids. I have 6 in total-well used to-I am pretty sure I have more now.

Wishing you wholeheartedly the best of luck Alma in your next steps!! You will be in my thoughts and prayers.
xx
Joy
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