After our 4th loss I took some down time but deep inside I've been yearning to find answers. So after searching for some answers I was strongly urged by more then a few women to seek out another doctors help who would work with my Reproductive Endocrinologist. I have to admit I was hesitant at first and I still don't know where I mustered the guts to call but I did. I called this other doctor. He is a Reproductive Immunologist. Which is a bit different then an RE in that they focus heavily on auto immune problems. The doctor I sought out practices in NY, NY. His name is Dr. Braverman. We have a free 10 minute phone consult with him come December 12th and I'm nervous. We're just going to chat with him and do a brief patient history. Then we'll have to at least go down once to see him. ( I have never been to the "Big Apple" before so why not ;) ) The most amazing thing is that when I spoke with my RE's office they were completely for working with this RE and have done so in the past with other patients. Knowing that your RE's office can do this to me says a lot about their Character and what they stand for. Some offices get their ego's hurt if you seek out another professionals advice or even a second opinion. Mine was completely for it and encouraged it. So here I am filled with a little bit more of hope knowing that these two offices will do whatever is in their power to help us have a viable pregnancy carried to term.
I have been doing a little bit of reading on Immune issues. I'll share with you bits and pieces of what I read. Most of what I'll share will be off of the FAQ section of the Fertility Friend Forum section for women with Immune system infertility. I've also been doing some reading up on my PCOS. Ever opportuanity I have to learn something about it is one step forward. I went back into my blood tests and I found that my AMH levels were very high into PCOS range, which I never really connected the dots to. I'm still on metformin and probably will be for the rest of my life. I recently purchased a book called the PCOS Workbook. I'm just getting into it but will let you know how I found it. So far I find it to be very interactive (if you like this kind of stuff (writing things down) then this may be for you).
Here is a basic overview that some of you may find interesting about immune system infertility. I never knew that there could be something more to this. Nor that there was more medicine that could possibly help us. Knowing there may be more answers to me at least gives me that hope I need right now. Even if something is wrong with me I'd rather hear it so we can be proactive and 'fix' it.
(Please note with anything medical that I post here it does not mean it's written by a medical professional. Please always consult your doctor and never self diagnose/ treat. It could do you more harm then good)
Do I have immune system problems?
(http://www.fertilityfriend.com/Circles/viewtopic.php?t=2569485&start=0)
It is hard to know whether one has immune system problems. Sometimes there are obvious signs like repeated miscarriages or failed transfers of good embryos on IVFs. Lot of times it is just the intuition that there is something wrong in that area. Things to consider are family history of autoimmune problems, miscarriages that happen earlier and earlier or few miscarriages followed by no implantation at all as well as having no positive pregnancy tests at any point. Any of those can be due to immune system issues. The immune system issues can either prevent implantation altogether or cause repeated pregnancy loss. Immune system issues can also cause ectopics as the embryos have an easier time implanting in the tubes where the inflammation and/or high NK cell activity are not present.
There are two types of immune system issues: autoimmune and alloimmune issues. Autoimmune issues are common when either the woman or her family has other autoimmune issues. Other autoimmune illnesses are for example
- endometriosis,
- adenomyosis,
- thyroid problems,
- celiac disease,
- eczemas
- allergies,
- asthma,
- autism etc. (see a list here). Alloimmune problems mean that there is a close match with the partner and body rejects the embryo for this reason.
Here is a break down of reasons for repeated pregnancy losses:
- Infection 1%
- Anatomy abnormal 5-10%
- Progesterone level low 20%
- Chromosome abnormal
- Primary miscarrier (no live births) 7%
- Secondary miscarrier (one or more live births) 50%- Immune mechanisms 50%
- Unknown 15%
Which tests do I need?
To test immune system issues, a good set to start with is most importantly the NK cell assay which shows how active the NK cells are in destroying the trophoblast (early placenta) and preventing implantation/causing miscarriages as well as underlying inflammation markers such as Th1/Th2 and Tnf-alpha along with some other inflammation markers of the list (below under tests). The inflammation markers are important because inflammation either causes NK cells to become activated, or NK cell activity causes an increase in inflammation. Therefore, even if the NK cell assay is normal, if there is underlying inflammation, implantation can be prevented when in the presence of an embryo, the immune system flairs up.
For the alloimmune issues, one needs to tests a full HLA-panel as well as DQ-alpha matches.
An additional issue is blood clotting problems. These are tested for under the RPL (repeated loss panel). RPL issues usually only come into play with 2nd trimester losses. So if someone does not get pregnant at all or has early losses, most likely auto- or alloimmune problems are to blame.
How are immune system issues treated?
Typical treatment consists of intralipid infusions for the elevated NK cells, prednisone and lovenox for the inflammation and NK cells (as well as for better egg quality, inflammation can cause poor egg quality) and Neupogen (with Dr. Braverman and Kwak-Kim at least) for the alloimmune matches.
The RPL problems are treated with heparin and baby aspirin typically.
Other things one can do at home are to start an anti-inflammatory diet, i.e. stop eating gluten, dairy and sugar which cause the immune system to flair up. Start anti-inflammatory supplements such as high doses of fish oil (6 capsules per day). Dr. Braverman recommends Maxi-Flavone. Limit exercise during treatment cycles (exercise causes and inflammatory state in the body). Though exercise outside of treatment cycles as over long term, exercise reduces inflammation. Use any relaxation methods. Eat/take antioxidants which reduce radical oxygen species (ROS). ROS are created by inflammation and cause destruction in the body.
No comments:
Post a Comment