Disclaimer: this post is not meant to be medical advice and it shouldn’t be construed as such.
Last Thursday, I had a baseline ultrasound to see if I could start the progesterone for the ReceptivaDx and ERA tests. When nurse practitioner asked me how I was doing, I said, “No offense, but I’m a bit sick and tired of this place…” The last time she’d seen me was after the news of my chemical pregnancy. She nodded and said, “We hear that a lot.”
She called a few hours later to let me know that my progesterone levels were good, and gave me the all-clear to start PIO.
With these tests, whatever hormone environment will be for the embryo transfer has to be the same for these tests, otherwise the results won’t be accurate. So, in my case, because I will be doing an FET with injectable estrogen and PIO, I had to take injectable estrogen and PIO for the biopsies.
Tuesday morning (after 5 days of PIO), I wrapped up a phone call with a new client, popped a Valium, and hopped in my fabulous MIL’s car. (DH had a work engagement in Riverside County, a 90-minute drive away, so couldn’t take me.)
MIL and I arrived at the clinic. My RE’s assistant led me to the Biopsy Room and I signed the consent forms. I double-checked the vials were labelled correctly and waited for the Valium to kick in.
I’ll stop beating around the bush (pun intended). Having a foot-long cotton bud-like thing threaded through your cervix and scrape your uterine lining hurts about as much as you’d think. First there was stinging as the catheter was inserted, followed by a cramping sensation. It made me cry out, but my RE, Dr. F, was very quick and got enough tissue for two biopsies: one ReceptivaDx, one ERA test (Day 5).
I returned on Thursday (I drove myself, so didn’t take anything by ibuprofen) to do a second ERA test (Day 7). My cervix was a bit disgruntled about being poked again, so this time the threading hurt more than the sampling. I felt a bit sore on and off for the rest of the day, but it wasn’t too bad.
About the ReceptivaDx Test
ReceptivaDx (formerly eTegrity) looks for two proteins that women with endometriosis and/or repeat implantation failure (me = yes on both counts) may lack.
According to its brochure, it looks for Beta 3 Integrin, which is thought to be essential for embryo implantation, and a newer biomarker, BCL6, which can be helpful in diagnosing endometriosis, which can make you resistant to progesterone.
My RE pushed for this test because she first heard of the famous Dr. Schoolcraft of CCRM using it and having success with women with unexplained infertility. She has also recently had 10 consecutive successful cases of women who, like me, weren’t getting pregnant, and who are all now pregnant.
Worth noting that Dr. T, the RE I had a second opinion consultation with, looked at the list of publications where ReceptivaDx studies had been published, and wasn’t impressed by them.
Cost: $690, plus RE’s fee (which I’m hoping my insurance will cover)
Results: take about a week
Next steps: if you lack either or both BCL6 or Beta 3 Integrin, the treatment is two months of Lupron.
Yeah, you read that right.
TWO MONTHS OF LUPRON.
The mere thought of being on that drug for two months is enough to turn my hair white overnight… But, goddamn it, I’ll do it if I have to.
About the ERA Test
The Endometrial Receptivity Array (ERA) test processes 236 genes to determine a person’s unique window of implantation.
Its brochure says the test may be useful for patients who have experienced repeat implantation failure with good quality embryos (at least three failures in women less than 37, and two or more in women over 37).
Dr. T prefers this test, but my RE, Dr. F, wouldn’t have done it had I not pushed for it. And I pushed for it because historically, getting pregnant hasn’t been my problem (even with my own shitty eggs) and I’ve had three failed FETs with PGS-tested embryos. Plus, I’ve read a number of success stories online from DEIVF parents who had success after doing this test. Also, V was a day-6 transfer, FET1 was a day-7, and FETs 2 and 3 were day-5’s. This makes me think that I need to be transferring on day 6, and the ERA test should confirm.
Cost: $600 (first biopsy) and $250 (second biopsy *if in the same cycle*), plus RE’s fee to take the sample. Biopsy fees can be higher if performed by an Ob/Gyn or a clinic that doesn’t already have a relationship with Igenomix.
Results: take about two weeks
Typically, you only do one ERA biopsy in a given cycle, but I decided to do two to save time and, possibly, money. If the first biopsy comes back as “pre-receptive” then a follow-up biopsy is recommended. I’m wagering that day 5’s biopsy will come back as pre-receptive and day 7’s will come back as post-receptive, thereby confirming (by process of elimination) that day 6 is the optimal day for me to do an embryo transfer. By doing both tests in the same cycle, I don’t have to wait to do a follow-up biopsy the following menstrual cycle, which saves time. And if I’m right, that I’d need the day 7 test results to confirm my day 6 theory, then I’ve saved $350 by doing two tests in the same cycle.
Other Differences Between ReceptivaDx and ERA
Dr. F recommended the ReceptivaDx test; Dr. T recommended the ERA test. Once Dr. F said we could do both tests in the same cycle, DH and I looked at each other and decided we were going to throw the kitchen sink at this next fourth FET, it couldn’t hurt to do both. (Except financially. And possibly me. Ouch.)
Also worth nothing that my Dr. F says that the Igenomix, developers of the ERA test, spend a lot more money on marketing than ReceptivaDx. I will say this, as a graphic designer: The Igenomix brochures are a lot better designed, have photos, and are printed on heavier cardstock (more expensive paper).
Our Next Steps
I’ll start birth control pills when my period arrives. (My last PIO injection was the eve of the second, day 7 ERA biopsy, so I should get my period over the weekend or early next week.) The birth control keeps me in a holding pattern until we know what the results are. Once we have the results from both tests, we’ll meet with my RE to discuss the protocol.
Have you done either test? If you could only pick one, which would you choose? Or would you do both tests like me?
Hello, did the Lupron & Receptiva test work?
*crossing fingers* for useful test results! (Oddly, I’m not sure what’s a better scenario – that they find something wrong so you at least know how to treat it or that everything is ok.)
Also, I’m sure the nurses here that a lot. I feel bad for them sometimes – they’re seeing us at our worst for the most part.