Miscarriages, Immune Issues, IVIG, now Pregnant
I thought I would put in my two cents worth and hope it helps someone. I started trying to conceive in December 2011 and we were immediately successful. Miscarried at 8 weeks after a 12 hour flu, however. I was 37 at the time so we decided to seek an RE and get all the levels checked to be sure. Everything was fine. FSH 4. However, they gave me a scare about eggs aging blah blah blah and talked me into my first round of IVF. That failed. Despite perfect embryos. Again, flu-like symptoms around implantation time and then it was over. I hated my RE at Shady Grove so I switched to someone more open and who treated at me as a person not a dollar sign, like my old RE. I did another round of IVF. This time I got a BFP, then the flu, then it was over. its on the books as a chemical pregnancy. By this point I knew something was not right. I am super tuned into my body (can even tell you which ovary released the egg each month). I dove into medical journals and articles and read everything I could about fertility and infertility. I told my RE I wanted Immune testing before moving forward. This was January 2013. She said it would take about 4 months. I was willing to lose that time as my fertility insurance was running out and I didn’t want to waste another dime on IVF. Sure enough, I had high NK cells. A uterine biopsy also showed high NK cell activity in my uterus (painful, painful test - but worth it). While I would have just done the Immune treatment and not another IVF cycle and still probably gotten pregnant, IVIG is so expensive that I opted for my third round of IVF with IVIG treatment (to freeze eggs).
I did one IVIG treatment one week before Embryo transfer. After embryo transfer I started one daily baby aspirin, one Dexamethasone (to limit inflammation in the body which triggers NK cell activity), one Estradiol twice a day, and 22 vitamins from a list my RE gave me (20 of which I had already been taking since 2011). I am also on Progesterone inserts 3 times a day.
I am now pregnant and on my second month. I have done two IVIG treatments thus far and will continue those every two weeks until after the first trimester.
We need to remember ladies that WE are the experts of our bodies. If we are not aware of what our bodies are telling us, how can we expect someone else to be? Doctors work for US. And while we assume that they will know what is best for us, the truth is that IVF is a VERY lucrative business. They don’t tell you that the odds of successful IVF treatment go down after the 3rd failed IVF. They may tell you that at your age, you should consider donor egg - even if they have diagnosed you with “unexplained” infertility. Why? Because donor egg is lucrative. THERE IS NO SUCH THING AS UNEXPLAINED INFERTILITY GIRLS! So, do your research and be well informed of your options. Then ask questions or even demand that certain testing be done. Don’t just opt for another IVF failure without knowing that every possible issue that could keep you from getting pregnant is explored. Know your insurance coverage and make sure what can be covered under your regular plan is coded correctly so that if you have fertility coverage, immune testing doesn’t eat up that dollar amount.
Here is a link to a very good article that explains the whole immune issue and fertility/miscarriage. It helped me understand how/why my body was behaving badly. my husband and I did not get tested for the soluble HLA-G protein. That wasn’t important to us. We just wanted to take care of the issue. It didn’t matter to us which one of us had faulty “wiring”
Here is a little piece that helps understand how this works. Its from this article: Immunology may be key to pregnancy loss (updated) by Carolyn Coulam and Nancy Hemenway
Problems with embryo signaling:
Antigens on the surface of the invading embryo or secreted by the embryo must signal the maternal immune cells that it is “self” rather than “nonself” or foreign so that the mother wont mount an immune response to reject the embryo. Soluble HLA G is an antigen secreted by the embryo that signals the mother’s immune cells that it is “self” and should not be rejected. Abnormalities in HLA G signaling as a cause of recurrent pregnancy loss can be detected by looking at HLA G gene in the mother and the father or by measuring soluble HLA G protein in culture media of in vitro fertilized embryos. The most frequent HLA G gene mutation found in couples experiencing recurrent miscarriage is HLA G-725C/G.
Problems with Maternal Immune Response:
When the mother’s immune system cannot or does not respond appropriately to embryonic signals, pregnancy loss can occur. How can we tell if the maternal immune cells cannot respond appropriately? There are blood tests that can identify inappropriately functioning immune cells:
· NK cells can be tested with the Reproductive Immunophenotype (RIP) and the NK activation (NKa) assays.
· T cells can be assessed by measuring the activated RIP and regulatory T cells (CD4+25+). In addition T cell function has been associated with the presence of Anti-thyroid Antibodies as well as the presence of circulating embryotoxins in the Embryotoxicity Assay (ETA).
· B cells function is evaluated by their production of autoantibodies including antiphospholipid antibodies, antinuclear antibodies, antithyroid antibodies and lupus-like anticoagulant.
Hope this helps someone.