Let’s Do This One More Time

So I sat, peeing on yet another pregnancy stick, watching for that second line to appear, and giving yet another disappointed sigh when once again, only one line showed.

Doing the same thing over and over, expecting a different result. I was officially going insane.

This was a great embryo. I was on Lovenox. I was on plenty of progesterone. I made sure my stupid feet were always stupid warm. I ate all the food I thought Gully would like. Everything I did was what I did with Olivia and it worked with her.

So why wasn’t it working this time? Why did my body once again have to fail my baby?

This last cycle was a doozy, you guys. I’ve never experienced anything like it, and I just really want to say goodbye to it. I took test after test, the results never changing, yet I needed them to change. I needed there to be another line. I needed it to be positive because we finally came across a treatment plan that worked and I got Olivia so why the hell wasn’t this working too??????

It’s maddening to think about, and this is why I’m so grateful to have an RE who is willing to switch up the plan. I’m so thankful we aren’t doing the whole Well-let’s-just-try-it-again-thing. We have a new plan in place for this last cycle. I had never even heard of it before, but it’s definitely something I can get on board with.

First, we’re transferring our last two embryos at the same time. This will be our final cycle going back to Houston.

My doctor wants to try doing an endometrial receptivity array, or ERA.

ERA Testing

OK, so let’s talk about the “window of implantation.” There used to be an assumption that an embryo needed to implant during a specific time during a menstrual cycle, about 8-10 days after ovulation. IVF cycles are based around this specific window, because the embryo has to be at the right development when the uterus is prepared to accept it—the “window.” But, recently there’s been research saying hey, maybe this doesn’t work for all women. And this can be due to alterations in the “receptivity” of the uterus. If my body happens to be off in this window, the embryo and uterus aren’t in sync and this could be preventing my embryos from implanting.

According to this article, 20-25% of transfers are happening too early or too late in the cycle. Sometimes the timing of that window is missed completely.

So this test, this ERA, is done by getting a biopsy of my endometrium (the lining in my uterus) and then examining the genes, predicting my personal “window of opportunity.” The goal is to find that ideal day for a transfer, and like I said above, it may not be the typical 8-10 days after ovulation.

The test comes back showing if you’re receptive or non-receptive.

Progesterone helps the endometrium prepare for accepting a baby, and normally it’s started five days before a transfer, which is what I’ve always done. But depending on the results of the ERA, I could end up being pre- or post-receptive, meaning I’d start progesterone before or after I usually would. It could be that my window of implantation is different from the norm and my uterus isn’t actually prepared to accept an embryo.

It’s an interesting concept. With my first donor egg cycle with the twins, I had a chemical. Those babies tried to implant and just couldn’t. Olivia’s twin couldn’t. Gully couldn’t. Using Lovenox, Metanx and aspirin for my MTHFR mutation could have played a role in my success with Olivia. But maybe all those other failures had something to do with missing my window. I don’t know. But it’s worth looking into.

So a month before the transfer, probably January, I’ll start a mock cycle. I’ll start estrogen for about two weeks and then I’ll start progesterone (so now I get to do PIO injections just for fun!!!) and five days later, we’ll do the ERA. Depending on the results, that’s when we’ll start the PIO injections for the real cycle, the next month, mid-February or so.

My doctor said there’s been a lot of research into this ERA in the last 18 months and there’s been a lot of success.

Here’s an example. I was talking with a woman this weekend who is in an IVF group with me and she was undergoing this testing. She told me her doctor told her that out of the eight women they’ve adjusted progesterone for recently, 6 became pregnant and stayed pregnant.

The difference is she did PGS testing on her embryos, so hers are for sure genetically normal, and we don’t know about mine, since we never did that testing.

So… besides for the pain of the biopsy and the cost, there’s nothing to lose here. We may as well because I would always regret not trying and fighting for the best possible chance.

Endometrial Scratch

At the same time as this biopsy, we’re also going to do an endometrial scratch. It’s exactly what it sounds like. I guess it feels similar to doing an embryo transfer, where there’s a speculum inserted and a catheter is placed through my cervix into my uterus just as in a transfer. Then they use the catheter to scratch the lining of my uterus. The point of this is because scratching the lining causes a “repair reaction” in the body, much like getting a cut on your finger and your body goes to work healing the cut. Apparently, this reaction builds a new lining and this new lining is thought to be more receptive to an embryo and could have a better chance at implantation.

I’m hopeful for this next cycle. I’m cautiously optimistic that this could be another key in my failure to get pregnant. For now at least, I’m doing pretty well, as long as I don’t think too much about this last failed cycle. It’s just too depressing to think about.

The downside to this next treatment plan is he doesn’t want me on birth control, so now it’s going to be like it was with my transfer with Olivia and we won’t be able to make any travel plans until less than two weeks before the transfer. Meaning way more expensive flights and hotels. What can you do, I guess. But everything else will remain the same: all the meds I was on, I will continue to be on. He wants me to call with my December cycle and we can begin the timeline countdown.

So I guess it’s Here we go again.