17 July 2010
Finally, Maybe an Answer...
... or at least a clue. I'm actually happy to say that I'm NOT NORMAL! (Well, you knew that already, right? but....)
(i put a ton of links w/ lots of info in this post... just in case you wanted to know more)
I talked with the nurse at the clinic I am consulting with in Peoria, IL yesterday and she explained my initial results. I will have a phone consult on Monday with the RE there and have more to say, but for now, here's what I know:
I tested abnormally for 2 things:
1) I have high APAs (Antiphospholipid Antibodies). The theory is controversial in its effect on the implantation of an embryo into the uterus, but the hypothesis is that these elevated levels cause blood clotting of the placenta/uterine lining and thus hinders the embryo from nuzzling in, or, if it does, it doesn't last long because the clotting will eventually starve the blood supply and miscarriage will occur.
Many fertility clinics do not believe in this relationship, mostly because there has not been a large clinical study showing a conclusive relationship between high APAs and infertility. Additionally, there are many women out there who are fertile and do test high for APAs. So, its definitely not a causal relationship, but maybe just a flag for other things that are awry.
The clinic in Peoria, along with a few other renowned Reproductive Immunology clinics do believe (warning: this link is lengthy with a TON of info on implantation failure) that high APAs should be treated for. They do this by having me take daily sub-cutaneous injections of levonox (heparin, a blood thinner) after egg retrieval in an IVF cycle. The injections continue until 8-ish weeks of pregnancy if I become pregnant.
2) I also tested high for CD16/CD56 cells which are associated with Natural Killer cells (awesome name, huh??, oh and I told ya so!! ). The basic theory here is that my body responds inappropriately to certain events in the monthly hormone cycle causing an inhospitable environment for the embryo. There are a crap ton of articles on it, but they are pretty heavy on the science part, so I'll spare you the details.
And again because the large clinical studies on this haven't been done yet, many REs do not treat for this.
However, those who do treat for this overactivity in the immune system historically use IVIG (an immunosuppressant delivered intravenously). But because IVIG is a) a blood product and b) extremely expensive, other places have been using intralipid infusions instead. It has been shown in-vitro (i.e. in a lab) that they suppress NK (natural killer) cells the same way that IVIG does. Oh!! and I forgot to add, elevated or improperly functioning CD56 cells are associated with women who have or have had endometriosis.... hmmmmm..... another clue, right?
So, along w/ the heparin daily shots, I would have to go in 2x for these infusions. Once, about a week before egg retrieval and the second after a positive pregnancy test.
That's a crap ton of info, huh? But it definitely jives with what I feel is going on in my body. If you recall, with each of my 3 embryo transfers (2 fresh, 1 frozen), I had a feverish, achey reaction about a week after transfer. I just KNOW deep down that this is where the issue lies and its so nice to finally have some sort of test to at least give some credence to my theory.
The next questions are... 1) Can we target any of that w/ chinese medecine, 2) Are the western treatments successful enough to warrant me paying for one more IVF cycle or 3) Should we just move right to a surrogate... So much to process, especially for a Saturday morning...