Monday, March 26, 2012

Immune Results and Consult

So we had our consult with RE #4 over a week ago.  With all the flurry with the new baby coming, I haven't had a chance to post.

I was a little angry that RE #4 asked us to come in and the first thing she said was that she didn't have all the results back yet.  WTF? Seriously...weird but anyway.  I guess she wanted to get a feel to which way we were leaning because if we wanted to be very thorough, she'd have to order more tests anyways. Who knew?

I am posting my results to help others like me:

Thrombophilia Panel:
1.) Factor V: normal
2.) MTHFR C677T Mutation Detection: Heterozygous mutated
3.) Prothrombin Gene Analysis: Normal
4.) PAI-1 4G/5G Gene Polymorphism: Homozygous mutated
5.) Factor XIII V34L: Normal
6.) MTHFR A1298C Gene Polymorphism: Heterozygous mutated

T-Regulatory cells:  1.2 (normal)

NK Assay (% Killed)
NK cells (50:1 = 18.3) (25:1 = 15.4) (12.5:1 = 13.1)
CD3: 85
CD19: 5.9
CD56: 4.1
DC19,CD5: 27.1
Anit-DNA Histones: all negative
Anti-phospholipid antibodies: negative
LAD: negative
TH1:TH2: 25.9 (tnf) and 12.6 (ifn)
T-reg: 1.2

So at this initial meeting she wanted to get a feel for where she should turn next. She said NK weren't elevated.  To me, they seem a little high but for the Beer Center, they're fine - anything under 20% is OK, but other reproductive immunologists want the NK cells lower <15%.  Anyway, she disregarded that and moved on to the LAD negative result.  This means that I don't have enough of these antibodies in my blood and the therapy used is no longer legal in the US. We would have to go to Mexico and we're not willing to go that far just yet. She said she didn't think the LAD negative result was all that troubling because my T-reg cells were normal.  Also good news was that my APAs were not elevated.  Given that we weren't prepared to do the LIT therapy in Mexico, she said she didn't think I needed any other immune related testing - apparently those 18 vials were just the tip of the iceberg.

There were a few red flags on the thrombophilia panel though. I am compound heterozygous for MTHFR which means I will need to add Folgard to my protocol - this is basically extra folic acid, b6 and b12 vitamins because my body doesn't process these things well enough. She also suggested baby aspirin - there were enough red flags on the thrombophilia panel that she requested I do more blood work to see if I also needed to add Lovenox to my protocol. 

So in the end, she concluded that she didn't think my issues were necessarily immune related. She did think the blood clotting could be an issue, but the major change we would need to make is to change the protocol and add ICSI which my other RE had already suggested.  She doesn't really see the need to do the endometrial biopsy either because my NK cells weren't elevated in her opinion.

I did do the additional blood work she requested that day (another 12 vials - sheesh) and I have the results of those back too, but I will post more on that tomorrow.  

So we walked out of there ready to move on to another IVF with the current clinic, hoping to get a RX for the Folgard and to get more guidance on if Lovenox is needed. 

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