Endometrial Receptivity Analysis (ERA) is a test that measures whether the uterus is ready to accept the embryo, leading to further implantation. There is an implantation window during which time, if the embryo comes, it gets implanted. However, as a student of statistics, I am not surprised to know that there is a bell curve, with 84% women falling in the +5 days region. The rest 16% have their own window of implantation. I am not a person who really fits in the box, I knew that already. So it is a surprise that I don't fall under the 84%? I need two more days of progesterone, because my implantation window is shifted by 2 days.
As for my last transfer, the embryo was sent on day 5, my uterus was not ready to take it. Hence, it was rejected. Generally, if the embryos are healthy and the uterus and uterine lining don't have any problem, but still the embryo fails to implant, this test is done. It is a pretty new test, so this isn't yet done for everyone. But who knows, maybe in a few years this will be part of the test panel they anyway do before IVF.
For the ERA, what happens is a mock-cycle. I am so tempted to call it a dry-run, going by my software lingo. Anyway, the thing is, they do an estrogen and progesterone injection phase just like an embryo transfer, but instead of a real embryo transfer, on day 5 AND day 7 they did uterine lining biopsies. I was taken to the operation room and the doctor did something which felt like a pap smear. Ok, a little more invasive than that, because they actually had to snip off a part of the uterine lining and send that to the pathology lab. A same process was done on day 7. Both those samples were tested for receptivity.
The results showed that day 5 was not-yet-receptive. Generally that would indicate that day 6 would be receptive, but I am glad they took _two_ samples. Because it was the day 7 one which actually was receptive.
The doctors are happy, and as an engineer, I am happy too, because the "bug" has been found. Does it mean this is it? Well, no. A thousand things can go wrong. Once the embryo is in the uterus, Nature has her own whims too. We still can't control those. But this is one big step in identifying what may have gone wrong.
Yes, this is one more cycle of shots, painful shots. It also means delaying everything for two more months. One month for the hormones from the last IVF cycle to wash away, and one more month after the dry-run for the hormones of _that_ cycle to wash off. It also means more visits to the doctor, more blood tests, ultrasounds. I had to do two more water ultrasounds. They generally do one, but in the first one they saw a tiny bump in the lining (<1mm, but still) and the doctor wanted to make sure that won't get in the way of the embryo. So once I removed my Nuvaring for that month, and the withdrawal bleeding stopped, I went for _another_ water ultrasound. Luckily that bump had gone away. The nurse told me this uterus ultrasound picture is so perfect that it should be featured in text books. My God! PS: The water ultrasounds are painful too. They inflate the uterus like a water balloon and then use ultrasound to see around. Also, it leaves me very bloated and tender for the next two days. So tender around my tail area that I can't sit properly.
As I lay on the table wrapped with paper from waist down, I stared at the lamp and thought - why exactly am I doing this? But then I told myself, it is easy to give up, but when have I been known to do the easy thing?
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