After three failed medicated cycles with letrozole earlier this year, my husband and I decided to move forward with transferring one of our healthy frozen embryos. But before doing that, our clinic recommended an IVF mock cycle with ERA, ALICE, and EMMA testing.
ERA stands for endometrial receptivity analysis. It’s meant to detect the ideal window of implantation, which helps plan the timing of a frozen embryo transfer. The ALICE and EMMA tests check for harmful and beneficial bacteria, respectively, in the endometrium that could impact implantation success.
Usually, these tests are done for people who have experienced recurrent implantation failure. There’s also some controversy around whether an ERA is useful or not. But because I’ve never been pregnant before, doing a mock cycle to run these tests seemed like a good idea — and again, was recommended by my clinic.
I knew for my mental health’s sake that I wanted to go into our frozen embryo transfer (FET) cycle knowing we’d checked for any potential implantation issues beforehand. I knew I’d feel devastated if we had a failed transfer and then did this testing, only to find out I had chronic endometritis or something else wrong that could have been treated.
So because I’m a person who likes to know what to expect going into things, I’m sharing what my IVF mock cycle was like. I’ll tell you the medication protocol I did, the timeline of everything, and what the biopsy felt like. I’ll also let you know whether or not I thought it was worth it.
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Medication Protocol for My IVF Mock Cycle
Because I have endometriosis, my clinic wants to keep my estrogen levels down. So I did not do a medicated cycle. Instead, I did what’s called a modified natural cycle, which means that I took minimal hormones and relied more on my body’s natural hormone production and cycle timing.
Here’s a list of all the medications I needed to take during my cycle, as advised by my clinic:
- Progesterone suppositories (no PIO shots!)
- Pregynl trigger shot
- Letrozole
- Aspirin
- Prenatal
- Medrol (steroid pack)
- Synthroid (Thyroid support)
I also took a probiotic every day and continued taking DHA fish oil and COQ-10, as this is a part of my normal every day supplement routine. If you’re curious, I have been taking Omnibiotic probiotics (alternating between the AB-10 and Stress Release formulas) for several years now — and same with Nordic Naturals DHA fish oil). And I use Kirkland’s COQ-10 (sold at Costco as well) because it’s an affordable option.
The only three medications on this list that I took every day during my IVF mock cycle were aspirin, a prenatal, and Synthroid. Everything else I took at specific points in my cycle, which I’ll detail more in the timeline section below.
And because I wanted to keep things pretty similar to what they’d be like during an actual FET cycle, I went back to my once weekly acupuncture appointments. I haven’t posted much about this yet, but I did acupuncture for about 3-4 months before my egg retrieval and felt it had a positive effect on my results. So I definitely wanted to start it back up to prep for a transfer.
Mock Cycle Timeline
While this timeline might vary depending on the clinic, when you begin your cycle, and other personal details, here’s what my timeline looked like:
- Cycle day (CD) 1: First day of full-flow period. I called the clinic to schedule my baseline appointment.
- CD 3: Baseline appointment. I got bloodwork and an ultrasound to check the thickness of my lining and measure any resting follicles. Then I scheduled a follow up appointment in another week and began taking daily low-dose (81 mg) aspirin and letrozole.
- CD 3-7: Take letrozole.
- CD 10: Follow up bloodwork and ultrasound. They looked for my uterine lining to be at least 7mm and a mature follicle to move ahead with trigger shot. I had both so was given the OK to administer my trigger shot that evening.
- CD 12: I began taking progesterone suppositories, starting in the evening. My clinic gave me a specific time to take my first dose — don’t miss this! I also began my Medrol (steroid) pack on this day.
- CD 13-16: I took progesterone suppositories in the AM and PM. Then I continued taking Medrol according to prescription instructions.
- CD 17: Biopsy day! In a FET cycle, this would be the day that the transfer happens, but in this mock trial, my biopsy was performed instead. I had one more dose of Medrol to take this day, but otherwise, I was allowed to stop the aspirin and the progesterone suppositories.
- Remainder of cycle: I relaxed and waited for my next period to begin! Mine began about a week after stopping progesterone (so I had a shorter cycle).
I got my biopsy results within two weeks — I want to say it was around 10 or 11 days after my biopsy. Speaking of, let’s talk about the biopsy briefly.
The ERA ALICE/EMMA Biopsy
You may have scrolled right to this part if you’re wondering if the biopsy hurt. I’m going to be brief and honest here (because I think talking too much about it may not be the most helpful if you’re nervous).
Did it hurt? Yes. If you’ve had a fallopian tube study (called an HSG), it feels very similar to that, in my opinion.
Was it quick? Also, yes. For me, the painful part lasted maybe twenty seconds. That’s it.
Did I survive? Sure did! I had mild cramping for maybe an hour afterward. I fell asleep once I got home (thanks, Valium), and by the time I woke up three hours later (thanks again, Valium), I felt back to normal.
I opted to take the Valium at my clinic because I thought it would help during those twenty seconds of the biopsy. But honestly, I was already pretty calm in the waiting room beforehand, and I don’t feel like any helpful difference it made was worth it for those twenty painful seconds — it just made me feel sleepier and more emotional.
If I had to do this again, I wouldn’t take the Valium. Overall, it made me feel excessively sleepy and weepy for several hours when the biopsy itself was less than a minute. This isn’t everyone’s experience, though, so do what’s best for you!
I also took Tylenol beforehand to help with post-biopsy cramping.
Was an IVF Mock Cycle Worth it?
For the sheer peace of mind the test would bring me, the ERA mock cycle with ALICE and EMMA testing was worth it. My results came back normal, and my lining was receptive at the time of biopsy. I felt like I could go into a FET knowing we’d done everything we could to prepare and that we’d investigated any uterine environment factors that might’ve been causing my inability to get pregnant.
The peace of mind this test gave me was everything.
If you also have unexplained infertility, I’m sure the what-ifs can drive you crazy at times. What If I have something wrong with XYZ? What if we’re missing something? What if we should have done that? What if, what if, what if!
I didn’t want to go into our first embryo transfer with all those what-ifs clouding my ability to stay calm and positive. So I did the mock trial and all the testing.
But besides peace of mind, I’m also glad I did it because it was basically a practice run of the real thing. I’m someone who gets anxious about taking new medications (or a higher dose of a medication), especially so when it’s an injection. This practice run allowed me to get all the newness anxiety out of my system and take notes so that when it comes to the real thing, I know exactly what to expect.
Thanks to the mock cycle, now I know that the Pregnyl injection was more painful than the Lupron trigger was for my egg retrieval, and it left a bruise. So for the actual cycle, I’ll put some lidocaine cream at the injection site beforehand. But I also know that I experienced no side effects from the hormones.
Plus, I learned that the aspirin made me bleed a little longer after my bloodwork, so I don’t need to be alarmed when that happens. (I have pretty bad blood phobia!) And that double dose of progesterone? Very constipating. Stool softeners were and will continue to be my friend. Along with lots of water, fiber, walking, and MiraLax, if in a pinch.
So for me, this mock cycle testing was worth it.
I think there are a lot of factors that go into this decision though, and I shouldn’t be the person to sway you into doing this or not. I always recommend you discuss your situation with your provider and ask for their opinion. Here are some questions we thought about while considering our plan that might be helpful if you’re on the fence about this:
- How many embryos do you have? Are they genetically healthy (euploid)?
- Will this testing cycle cause excess financial strain?
- Have you ever been pregnant before?
- Have you had recurrent miscarriages or implantation failure?
- Would this testing cycle bring you peace of mind if you are struggling mentally and emotionally?
- Would you regret it if you didn’t do this before a transfer? Or would you feel comfortable jumping into a transfer and seeing if it works?
- How would a mock cycle affect (i.e. delay) your timeline, and is that delay something you could work with around your schedules?
My First-Hand Tips for a Mock Cycle
I did not have to do the dreaded progesterone in oil shots, which I know is something most people hate about an embryo transfer cycle. So while I don’t have tips on how to survive those shots, I do have some tips to help other areas of an IVF mock cycle go more smoothly.
- Keep a medication checklist somewhere central: My clinic gave me a medications list organized by day, so I pinned that on my fridge and used it as a checklist. I chose my fridge so that my husband can see it, too, and because we’re in the kitchen so much, we saw it often. That way, if I didn’t check something off, my husband could check in and make sure I didn’t forget to take anything. If your clinic doesn’t make a medications list, I recommend you make one for yourself!
- Set timers and alarms for medications: I also made alarms on my phone to remind me to take certain medications. This was specifically helpful when I began to take Medrol. The first day required taking six — yes, SIX — doses, divided over the day. Then five the next day, four the next, and so on. I had so many alarms set up on my phone, but it was worth it. I didn’t miss a dose. Also, the timing of the trigger shot and the first progesterone dose are SUPER IMPORTANT. Set an alarm. Maybe two!
- Once you begin taking progesterone, prioritize fiber and up your water intake. Progesterone can be horribly constipating. Or, at least it is for me. If needed, take a stool softener like Colace once per day. If the constipation goes on longer than a day or two, take Miralax. Trust me, do not let it go more than two days before you start taking stool softeners or laxatives to help. I learned that lesson the hard way after my egg retrieval. Magnesium can also help get things moving. I prefer taking magnesium glycinate or rubbing a soothing magnesium cream on my stomach.
- While waiting in the exam room for your biopsy, take deep belly breaths. Try to breathe into the lowest parts of your belly, feeling your whole abdomen expand with your breath. Exhale slowly and steadily, making it longer than your inhale. This helps relax your pelvic floor. While it won’t make the biopsy painless, tense pelvic floor muscles can make it hurt more than it needs to. Deep belly breathing can also activate the vagus nerve, which can further calm the body.
- Be careful about reading too many first-hand accounts of what the biopsy specifically is like beforehand. This might seem contradictory when I’m writing a blog about my experience, but I purposefully did not include in-depth details about my biopsy itself. There’s a difference between knowing what to expect from the ERA mock cycle as a whole so you feel prepared and freaking yourself out from reading too many negative experiences. I chose to read a few articles (and maybe part of a Reddit thread) before I cut myself off and stopped reading about it. Mentally, I felt better going into it not having recently read any biopsy horror stories and putting trust in the fact that I would be OK and get through the brief discomfort.
Ultimately, choosing to do an IVF mock cycle with or without ALICE and EMMA testing is your decision. Weigh the pros and cons with your partner, read the research, ask for your doctor’s opinion, and go with whatever feels right for you — not because I did it or someone else didn’t.
Until next time,
Laurie
