The science of making babies started back in the 1930s, and the first reproductive endocrinology practice was founded in 1939 at Johns Hopkins. While the field continues to advance, many individuals find themselves without answers or new technologies to help them conceive.
When I first started working in the field of reproductive endocrinology and infertility back in 2013, PGS testing was relatively new, and not many patients went with this option when pursuing IVF. By the time I left the clinic in 2016, ERA cycles were coming out. Since then, PGS, ERA cycles, mini IVF and egg freezing are all becoming more mainstream as the field dives deeper into the research and looks to push the boundaries. However, I find myself asking, why are so many people still left without a baby?
Fast forward to 2021, and I, like so many of my past patients, find myself on the long journey to motherhood via IVF. It seems I’ve turned over almost every rock and completed every available test. As a women's health nurse, I want everyone to know the most up-to-date tests and methods available to couples trying to conceive via IVF. While I wish the field would make even more advances, here are the few that you might want to consider:
ERA Test
The endometrial receptivity array, also known as an ERA cycle, started in the last 10 years and continues to gain popularity at fertility clinics in the U.S. An ERA cycle mimics your normal frozen embryo transfer protocol, but instead of transferring an embryo on day 5 of progesterone exposure, your physician will take a small biopsy of your uterus and send it to a lab for analysis.
We use ERA cycles to find the window of time that an individual is most receptive to an embryo transfer. Over time we have learned that the environment of the uterus plays a critical role in embryo implantation and live birth rates.
If you have had failed embryo implantation with transfers, or miscarriage after a frozen or fresh embryo transfer, talk with your care team about an ERA cycle to determine your window of receptivity and when you should start progesterone prior to a transfer.
Emma Test & Alice Test
These two tests are very new to the market and are not offered at all clinics. The Emma and Alice tests look for two things within the uterus: infection and bacteria.
The Emma test looks at the microbiome environment of the endometrium (the lining of the uterus where the embryo implants). Our uterus needs good bacteria, probiotics, in order to maintain a healthy pregnancy. With the Emma test, we can determine if an individual needs to supplement with vaginal probiotics to support a healthy uterine microbiome.
The Alice test looks for an infection called endometritis. This infection of the uterine lining can cause failed implantation and miscarriages. Fortunately, this infection is relatively easily treated with a course or two of antibiotics.
If you have had failed embryo implantation with transfers, or miscarriage after a frozen or fresh embryo transfer, talk with your care team about the Emma and Alice tests.
The Receptiva Test
This test has been around longer than Emma and Alice but is not widely used by all practices in the REI field. The Receptiva test is similar to the ERA, Emma, and Alice tests in that it involves a mock frozen embryo transfer cycle with a biopsy at the end. However, this test is looking for markers of endometriosis. BCL6 is thought to be a marker in women with endometriosis and this is one of the markers that the Receptiva looks for with a biopsy analysis. Endometriosis causes inflammation in the body that leads to failed implantation and recurrent pregnancy loss.
There is not yet enough clinical evidence or literature to know how valuable the Receptiva test is for infertility patients. However, it still holds value for many couples suffering from failed implantation and recurrent pregnancy loss. If you suspect endometriosis, ask your doctor if you should do the Receptiva test. If your results come back positive, your doctor may suggest lupron suppression or you may need a laparoscopy.
PRP and Ozone Sauna Therapy
Platelet rich plasma or PRP, consists of injections into the ovaries to stimulate them. Clinics also use PRP for endometrial lining growth and receptivity.
Ozone Sauna Therapy targets egg health and the uterine lining through a sauna using Ozone air. A tube is inserted into the vagina where the Ozone air flows through and into the body. Ozone is believed to improve egg quality by decreasing inflammation and can be beneficial for women with endometriosis or low embryo yield.
While both of these offer exciting new treatments, we do not yet have a large body of evidence to clearly state their benefits on female fertility.
Conclusion
In the end, most of these new treatments bring additional costs to an already expensive process. For some, the costs don’t stand in the way of wanting to turn over every rock. For others, the cost is prohibitive, blocking them from getting a full picture of their infertility. Either way, add these tests and treatments to your question list for your next consult with your fertility doctor. They might just give you the answers you’ve been looking for.
Suzie Welsh, RN, MSN, is a fertility/IVF nurse and founder of Binto, a women’s health company. She’s also an infertility warrior, just like the rest of you!