Saturday, May 22, 2010

Immunology????

If anyone is reading...what do you all think about the conflicting opinions for immunology- specifically NK cells? SIRM, my previous RE (Dr Zouves), the popular Beer Clinic and other clinic believes in NK cells. Dr Schoolcraft says it is "hocus pocus". I am not sure what to do about my cycle with CCRM. Should I just trust Dr Sch and erase it from my mind?

Here's my history with immunology- my first two failed cycles I was not tested for any immunology or clotting issues and both cycles failed. (but we also had low fert rates and slow growing embryos) At the second clinic, for our third IVF, my RE did extensive immune testing, that's what he is known for. I was treated for a slight elevation in NKcells but our embryos also were much better quality. We did get a BFP and had a successful outcome. I was only treated for NKs with one infusion IVIG, my NK cells were monitored after positive pregnancy and were within normal limits.

For our frozen transfer a couple years later we did a natural FET...which is supposed to be much easier on the immune system than a fresh cycle and I did not have any immune treatment. 4 were transferred, but only two that were growing well. We got a positive beta and it doubled, NKs were checked at that time and were normal. There was no heartbeat at our first u/s despite doubling betas. My RE thought it was probably a chromosomal loss not immune. But d&c results showed 46XY. At that point, the NKs were retested and were elevated. Did the NKs attack my baby? Is this why we lost it?

For our next fresh cycle we wanted to be proactive about the NK cells and were treated for them as a preventative measure. We did get a positive beta and I had intralipid inufusions every 3 weeks. But we lost the baby at 8wks. I freaked out and thought it was an immune cause and went to the Alan E Beer Clinic for a further immunology work-up. The d&c ended up showing that the loss was chromosomal (monosomy X).

The work-up at the Beer Clinic showed I had other clotting issues (but I had been treated with lovenox anyway since my third cycle), it also showed I have low levels of blocking antibodies so I did an IVIG infusion to bring up these levels before another fresh cycle. This fresh cycle ended in a negative despite the immunology treatment of 2 IVIG infusions. I don't think this recent failure was due to immunology...our embryos were slow growing and not the best quality. Although, we spent a lot of extra money, I am glad I did rule out an immune cause by doing the treatment.

I am not sure what to do about our upcoming cycle at CCRM. If we happen to get some CCS normals, I just don't want to take any chances. I may just have my NKcells treated as a preventative measure just in case through the Beer Clinic. I just keep thinking back to my first miscarriage.... but who knows if the NKs were really the cause of the loss. CCRM has better success rates than Zouves and SIRM and doesn't treat killer cells. I don't know what to do. Anyone else dealing with a similar dilemma or had this decision to make at CCRM? I sort of wish I never knew about the immune issues.
I don't know what to do????

3 comments:

  1. I think it would be wise for you to do the immune treatment. NK cells are not "hocus pocus". Time and again I have seen people successfully treated for this with steroids and/or intralipids.As you have had success with immune treatment previously, I really don't think it would be worth the risk of not doing the treatment, seeing that you are going all the way with CCRM and CGH. I hope this helps. Good luck with your decision.

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  2. I don't think I know enough to say NK cells are not a big deal. I have never been tested for it and I always wonder if mine are elevated. During an immunological checkup, my prev RE found out that both my antithryroid antibodies are elevated. He was concerned abt this and I have since started synthyroid to supplement my thyroid. Dr Sch. thinks that the elevated antibodies don't really matter as in they don't affect the IVF outcomes. But I beg to differ. Over the years I have had 4 IVFs, each with decreasing egg quality while my antithyroid levels have been increasing steadily. I want to believe there is a connection there. And I am not going to stop taking my synthyroid during my upcoming CCRM cycle.
    Well... all that doesn't help you in any way, But just wanted to tell you that it is up to you to control your cycle in such a way that you will not regret it. So if you think IVIG will help, and Dr Sch doesn't think it helps or hurts, then I'd say go for it.

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  3. Thanks for your reponses. You guys are right that I should just treat it to be safe. It won't hurt anything and I don't want any regrets... especially this being our last shot.

    Andie- I agree, I have seen people successfully treated with immune treatment after previous failures.

    Lifeinchronicles- That's interesting about antithyroid antibodies and egg quality. I have high antithyroid antibodies too. I wonder if this is why I strugggle with egg quality. hmmm?

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