To give your embryo transfer the best chances of success, we generally recommend a mock cycle. The Mock Cycle is a 3-week process designed to prepare you for the actual embryo transfer. Here’s a breakdown of the steps involved and what you can expect at each stage.

About Mock Cycle

What’s a mock cycle?

A mock cycle is like a practice run for your embryo transfer. It involves taking medication as if you were preparing for a transfer. This way, we can troubleshoot any potential issues ahead of time to avoid complications on the actual transfer day.

Additionally, this “practice” cycle is also used for implantation testing. Since your embryos are so precious to us, we leave no stone unturned before the transfer to give you the best chance at success.

If you are planning for a mock cycle or implantation testing, consider budgeting $2,900 plus medication costs.

What’s implantation testing?

Implantation testing involves inserting a catheter into your cervix to withdraw cells from your uterine lining, known as an “endometrial biopsy.” This test helps us assess the condition of your uterine lining to identify any issues that could affect implantation. The results of the biopsy tests can take 1-2 weeks.

Here are the endometrial biopsy tests we perform:

ReceptivaDx

The ReceptivaDx test checks for inflammation of the uterine lining and signs of endometriosis, a common cause of infertility. Watch Dr. Aimee’s interview with the founder of ReceptivaDx to learn more.

ERA (Endometrial Receptivity Analysis)

The ERA test tells us the optimal timing for embryo implantation based on progesterone levels.

EMMA + ALICE

The EMMA (Endometrial Microbiome Metagenomic Analysis) test analyzes the endometrial microbiome to help identify abnormalities associated with a poor reproductive prognosis. It provides information on the balance of healthy bacteria, which is associated with higher pregnancy rates.

The ALICE (Analysis of Infectious Chronic Endometritis) test detects pathogenic bacteria, which causes chronic Endometritis. It’s important to treat with an antibiotic because pathogenic bacteria is associated with implantation failure and recurrent miscarriage.

EndomeTRIO

The EndomeTRIO includes the ERA, EMMA, and ALICE for a complete endometrial analysis. Listen to Dr. Aimee’s interview with an EndomeTRIO expert to learn more.

Preparing For a Mock Cycle

There are just two steps you need to take before you start your mock cycle.

Order Your Medications

Dr. Aimee will provide a list of meds to order. Typically, these include:

• Birth Control Pills (Juleber)
• Letrozole (Femara®) 2.5mg, 20 tabs (4 tabs for 5 nights). Dose of letrozole is individualized.
• Progesterone 100mg capsules #90
• Ovidrel 250 mcg/0.5 mL syringe #1
• Tylenol #3 (w/ Codeine) tablet, Quantity of #10 
• Valium (Diazepam) 5 mg tablet, Quantity of #10

We recommend Alto Pharmacy if you’re in their courier delivery zone. Other specialty pharmacies that ship nationwide are MDR, Freedom Fertility, and VFP.

Tell Us When Your Period Starts

Your Mock Cycle start date depends on your period start date. As soon as your period begins, email Dr. Aimee with the subject line, “Mock Cycle: My period started today!”

If you don’t hear back within two hours, call our office at (925) 277-0600 to schedule your Pre-Mock baseline appointment. If it’s after hours, call us the next morning.

Baseline Appointment

Welcome to the start of your Mock Cycle. Today is your Baseline Appointment, which is scheduled when your period starts.

What to expect at your Baseline Appointment

• Ultrasound and Blood Work. You’ll visit our San Ramon office for an ultrasound to check the readiness of lining and follicles. We’ll also draw blood to measure Estradiol (E2), Progesterone (P4), and Luteinizing Hormone (LH) for baseline hormone levels.

• Mock Cycle Calendar. Dr. Aimee will review your calendar with you, which outlines the key dates of your Mock Cycle. These dates can change based on your follicle check results, so keep your schedule flexible around these dates.

Sample Calendar:

Note: This is a sample timeline and may vary based on individual treatment plans and monitoring results.

• Mock Cycle Payment. The total fee for the Mock Cycle is due today, the day you start medication. Here are our general Mock Cycle fees, but refer to the invoice from our Financial Assistant for comprehensive pricing.

• Start Medication. In the evening of your baseline appointment, you’ll begin taking Femara tablets for the next few days.

• Monitor Ovulation. For the next 7 days, monitor your ovulation. If you reach peak ovulation before 7 days, email Dr. Aimee with the subject line, “Mock Cycle: I’ve ovulated”.

Lining Check Appointment

About 10 days after the Baseline Appointment, you’ll return to our office for a follicle check and further medication instructions.

• Ultrasound and Blood Work: You’ll return to our office for an ultrasound to check the readiness of your lining and follicles. We’ll also do blood work to measure Estradiol (E2), Progesterone (P4), and Luteinizing Hormone (LH).

• ReceptivaDX Form: A Medical Assistant will ask you to fill out the ReceptivaDX Test Requisition Form. Your credit card will be charged for the ReceiptivaDX test by the testing company, Cicero Diagnostics.

• Mock Cycle Medicable Table: Based on the results of the ultrasound, Dr. Aimee will determine your medication dosages and set a date for the biopsy.

• Possible Trigger Shot: It’s very likely that in the evening, you’ll take your trigger shot. Dr. Aimee will confirm this with you. You’ll also follow the rest of the meds protocol for the next 7 days.

Sample Medication Table:

Note: This is a sample medication table and may vary based on individual treatment plans and monitoring results.

Biopsy Day

On the day of your biopsy, it’s important to be well-prepared to ensure everything goes smoothly and as comfortable as possible!

Follow these instructions to help you get ready:

1. 2 Hours Before Your Appointment: Drink three 8-ounces glasses of water to have a full bladder.
2. 30 Minutes Before Your Appointment: Take one Valium and one Tylenol #3. If you don’t have a driver and stronger pain meds aren’t required, you can opt for Motrin 600 mg.
3. Before you Arrive: Eat a meal and hydrate well. A full stomach helps ease discomfort.

The biopsy procedure is relatively quick, but we’re not going to sugarcoat it — it’s more than just a little pinch. It’s 5 seconds of pain, it’ll go from 0 to possibly 8 in less than 5 seconds, but it’ll quickly go right back down to 0 within 10 minutes or less. Afterward, you should start feeling back to normal and resume your usual activities.

Biopsy Test Results

The results from Receptiva, EMMA + ALICE, and ERA can take 1-2 weeks. Once we receive them, we’ll email them to you. After we get all your results back, Dr. Aimee will discuss the results with you and outline the next steps in your treatment plan.

Please bookmark this resource ????

It’s packed with information! Our goal is to ensure you’re never left wondering about the next step in your treatment process. Many patients find it helpful to bookmark this page so they can follow along and be well-prepared. As I always say, “The more you know, the better it will go.”

As you reach the end of this resource, remember my team and I are here for you every step of the way!

If you have any specific questions not covered in this guide, please reach out to me or my nursing team at draimee@draimee.org and nurses@draimee.org.

Thank you for trusting me with your family-building journey. I look forward to working with you!

Warmly,

Dr. Aimee