Should I try Emma, Alice and ERA tests?


Myself and my husband spent 2 years attempting to fall pregnant. We were referred to the local fertility clinic. I underwent all the recommended blood tests and and a hycosy. My husband had a semen sample taken. We were eventually diagnosed with unexplained infertility and listed for IVF. I was 33 and my husband was 35 at the time and we were aware of the success rates in this age bracket, but we were otherwise fit and healthy and therefore hopeful.

We amazingly fell pregnant with the first embryo implanted after a stimulated cycle. Our little girl was born 2½ years ago. A year and a half later we were planning to return to try and conceive again as we had four frozen embryos. Not long before we were due to restart I collapsed with a ruptured eptopic pregnancy, which had been naturally conceived. I had a tube removed and took a good few months to recover. We had our first FET 4 months afterwards. It was unsuccessful. We had a further unsuccessful attempt. Both natural cycles as my cycles are relatively regular and I ovulate.

My consultant is now recommending we undergo the Emma, Alice and ERA tests to try and improve the chances for our remaining two FET. I’m unsure whether to take the tests as I’m aware that the evidence base isn’t such that it is currently recommended by the HFEA or NICE. It’s expensive and I wonder whether we’re better saving our money and spending it on further cycles if required. I’m also wondering whether any further investigations should be undertaken before we proceed with further FETs. My consultant didn’t feel that anything further was required however, or anything could be found that would alter the treatment plan. I’ve requested that the next cycle is medicated as I wonder whether that may have a better outcome. So essentially we’re unsure how to proceed and if there’s anything we might be missing or should investigate before we do another FET?

Thank you sincerely for offering your time in this way,

Dear K,

The failure in your case is likely to be simply due to standard probability. Sadly most IVF cycles fail, just as most natural intercourse does not necessary produce a baby in totally healthy couples.

Claims are made for these tests on the basis of various naturally carried micro-organisms (bacteria and so on) you carry in your body. They test what we call the microbiome and each of us will have a different microbiome depending on which bacteria we carry assc a result of a whole range of environmental and genetic issues. They are currently of great interest as it is surmised that some people with an “unsuitable” microbiome, whilst they are entirely healthy, are more prone to miscarriage, pregnancy loss and infertility. Much research is still needed.

The Alice, ERA and Emma tests have not as far as I am aware been subjected to properly conducted randomised trials in a carefully controlled number of patients. Until they are, there seems little justification for their use commercially before experimental proof has supported a clear improvement in the chances of successful pregnancy with live birth being the only outcome that you wish to achieve. If you were a member of my family I would advise you not to pay for such treatment. If however, this treatment was offered as a research trial and at no cost to you such tests might be justified but even then I would expect the doctor who are experimenting with this to pay you a fee for being a volunteer. After all you go through considerable stress and inconvenience for such treatment. This is standard good practice for all clinical experimentation. Added to this, I would expect you to be asked to sign written informed consent after the clinic can demonstrate to you that they have received ethical approval from a proper regulatory body.

I hope this is helpful,
Robert Winston

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