Planning for ERA and FET
06/19/2023
I had been waiting for this day for the past 3 weeks; to discuss our next steps with our last frozen embryo. 3 weeks ago, after the news of our failed FET, I was pretty broken. The Dr. had shared with me on our call, when she delivered the bad news, that we may want to consider an ERA before our next embryo transfer. An ERA is an endometrial receptivity array. It is a test that claims to find the optimal time for an embryo to be transferred into a woman’s uterus in order for the embryo to implant, known as the “window of implantation.” It is typically meant for women who have had one or more failed embryo transfer cycles. The test can help determine the next window for implantation down to a 6 hour window therefore increasing the likelihood of implantation and pregnancy.
I had been feeling a little nervous today, as I awaited the call. Over the past several weeks since the failed transfer, I have slowly been putting myself back together and trying to focus more positively on our next transfer. I was eager to have the call so I knew the plan. Over the past 3 weeks as I considered the next steps and what might be best for our next embryo transfer, I was thinking a lot about the difference between the FET with Mila and the FET that had just failed. The clear differences were:
EMBRYO QUALITY
Mila was a day 5 ‘Good’ embryo - this means that the embryo transferred to get us pregnant had become a blastocyst (or ‘blast’) on day 5 after the introduction of the egg and the sperm. We had used a method called Intracytoplasmic Sperm Injection (aka ‘ICSI’) when creating our embryos. ICSI is a manual injection of the sperm into the egg, rather than simply introducing them in a petri dish. After genetic testing, it was scored as “Good” on their scale of Good/Fair/Poor.
Our most recent transfer was with a day 6 ‘Fair’ embryo - this means it took 6 days before it became a blast and after undergoing genetic testing, it was scored as a “Fair” embryo.
TRANSFER METHOD
During our embryo transfer with Mila back in 2020, we used a medicated cycle method of FET which was very controlled. It requires getting on birth control to manage your menstrual cycle as well as a schedule of drugs prior to the embryo transfer of birth control, lupron, estrogen and progesterone.
During our most recent embryo transfer, we did what is now considered “the standard protocol” of a natural cycle method. This requires monitoring your natural hormones and natural menstrual cycle to determine the ideal time for the transfer. This requires much less drugs.
PRE-TRANSFER CONDITIONS
Prior to our embryo transfer that became Mila, I had no “abnormalities” occur as we led up to the transfer.
With our most recent transfer, although my uterine lining and hormone levels were perfect, I did not ovulate at a time that would have normally been expected. I ovulated a few days later. And although all other factors were optimal and the ovulation didn’t actually “matter” (because you don’t want the ovulated egg anyway) - this was odd to me. Looking back at it now, it’s a little concerning to me. In addition, 2 menstrual cycles prior to the transfer, my normal 5 week long cycle was shockingly only 2 weeks long, leading me to have little confidence that my body can be trusted for a “natural” cycle to happen as many women’s would.
With all of this information in my mind, I had decided this would be an important topic of discussion with my Dr. Although there are higher occurrences of pre-eclampsia with women who use the medicated cycle, I felt I had enough reasons to opt in that direction so it was at the top of my list to discuss.
During our call today, we began with what may have happened with the recent transfer and why it didn’t work. My Dr. shared with me a few details.
A Day 6 Fair embryo has a 55% chance of leading to pregnancy - she see’s this as a good thing because it’s higher than 50% but for me that seems pretty low and scary.
We had also utilized something called an embryo-scope when creating our embryo’s. Essentially, once ICSI is performed, the embryologist can monitor the cell division of the embryo in an incubator 24/7 to make sure that it develops normally. When adding the embryo-scope to the process, you can add another 20% to the successful pregnancy stat, making ours more like 70-75% chance of success.
The embryologist said the embryo survived the freezing and thawing process so there was no concern about any degradation of the embryo.
The primary difference between the two embryo transfers I’ve had is that one was medicated and the other was natural so perhaps my uterine lining prefers the medicated protocol.
Bodies change as we get older and after pregnancy so my progesterone requirements may be different now.
With these details in mind, we discussed what we thought would be the best next steps and we agreed that going the medicated route would be best. This was for several reasons:
It worked the first time we did it.
My natural menstrual cycle is not the most dependable.
I had a very healthy pregnancy with Mila so the chances of pre-eclampsia do not outweigh the benefits a medicated cycle would have towards reaching a successful pregnancy.
Before undergoing this medicated FET cycle we also want to undergo the ERA to ensure we can time things more accurately. Our last remaining embryo is the same as the embryo we recently transferred. It is a Day 6 Fair embryo. You would think that the combination of a day 6 Fair embryo that had been monitored under an embryo-scope and has a 75% chance of success paired along with using the ERA to time the transfer perfectly would provide a 100% guarantee of success but unfortunately we have another issue at play. Embryo’s do not all “hatch” at the same time and this means even if we time the transfer perfectly, if the embryo doesn’t hatch when we expect it to, it won’t be able to implant into the uterus at that optimal moment.
In writing this post it actually got me thinking about something called “assisted hatching” where the embryologist uses a laser to thin the outside of the embryo and make it easier to hatch so I have messaged my doctor now to inquire about that one! I’ll keep you posted!
Now, before any of this can happen, my Dr. has requested another set of bloodwork and cultures to make sure I’m still in optimal shape. Thankfully, I have (mostly) maintained my diet, I haven’t had any alcohol, and I have been continuing the vitamins as advised so chances are, I’ll still be in a good place for starting the ERA cycle. I have already made an appointment to see my OB/Gyn tomorrow for the bloodwork and cultures and hope to have the results back within 2 weeks when my next cycle will begin. The Dr. has also already called in my birth control so I can get started on it as soon as that cycle begins.
Having this call today has certainly made me feel more hopeful and I do see this as being the right path for me. I’m finally getting that bit of excitement back in me and ready to take this ERA and FET head on! I’ll continue sharing updates here on my blog as well as on my Instagram @parentingsohardig.
Thank you to everyone who has been sending me so much love and support through all of this. I’ve also been surprised and delighted by the number of people who have felt comfortable in opening up to me and sharing what they’re going through right now as well. I truly enjoy connecting with people who are going through this struggle and being a safe place of empathy, support, guidance, and understanding for my fellow fertility fighters! If you’re going through your own fertility journey now and need someone to connect with, don’t hesitate to reach out. Most people have been DM’ing me on Instagram.
