KerriA...answers

KerriA...answers

Violet
Violet

September 6th, 2012, 12:59 am #1

Hi there,
How are you doing? I am sorry I did not get back to you earlier.

I did intralipids and neupogen. We just met with the RI last week (Dr. Braverman in NY) and he is now recommending Lovenox and taking Beta HCG 2x per week (kind of like a continuing booster shot) during the 2ww and maybe continue it... This change is based on the results of immune testing after the cycle. My NK activity went from 24 to 9 using the neupogen/intralipids. Dr. Braverman thinks that seeing how low the NK cells went that this is not my big issue thus his other recommendations (I also have 7 HLA matches with DH and 1 Dq Alpha match.)

I think I told you that I am also in the middle of the ERA (Endometrial Receptivity Analysis). This is a test from Spain if you Google it. My RE wants to rule out any endometrial issue.

Please let me know if I can help in any other way. This is so hard, isn't it?

Take care of yourself.
Violet
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KerriA
KerriA

September 6th, 2012, 2:32 am #2

I'm doing okay - pretty amazing how we learn to compartmentalize to deal with everyday life.

I'm glad you have a plan for the next go around. I think the lovenox, especially, seems like a great addition. Have they considered adding oral steroids too? Do you know what level of NK cells they are looking for?

I meet with my RE again on Friday. I've been doing a lot of reading. I made a list of all I wanted tested. Some I have already been tested for but I'm going to have them retested just in case they have changed.

Here's what I came up with:
Anatomical issues: repeat hysteroscopy, high resolution ultrasound with doppler to check uterine blood flow, perhaps repeat the HSG (first HSG was clear and the one I had several months after the loss showed a blocked (spasmed) tube - I'm thinking maybe it could be inflamed or something)

Autoimmune/clotting issues: ANA (& all related autoantibodies - anti-Sm, etc), NK cells, Th1/Th2 ratios, protein c deficiency, protein s deficiency, antithrombin III deficiency, homocysteine levels, antiphospholipid antibodies, lupus anticoagulant (I have had factor leiden, prothrombin, and MTHFR genes tested before)

Infection issues: ureaplasma/mycoplasma, Group B strep, chlamydia, bacterial vaginosis

Endocrine issues: TSH, T3, T4, anti-thyroid antibodies

Biochemical issues: beta 3 integrin (E-tegrity test), Endometrial Receptivity test.

Do you have any other suggestions to this list?

thank you so much for thinking of me!
kerri


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Violet
Violet

September 6th, 2012, 3:36 pm #3

I think your list is very comprehensive. Great work.
A few things I can add because I know you want to spend all of your time testing...right?

A friend of mine saw a uterine specialist and he was able to find things that were not found by RE's office.

Have you had your Vit D checked and also also celiac?

Otherwise, I think you are incredibly thorough.

When I spoke to the RI, he thought that I would not need an oral steriod (you mean Dexamethazone or something like that, right?) as he thought the Beta HCG would cover that. I am not even sure that we are going to move forward with the Beta HCG. It is so random and we will not be able to test HCG level so will just see if we are pg on an ultrasound. I have to do some more reading about this.

He (RI) also said something that was confusing to me and I am wondering if you can help me understand with your immunology background. He said that since my NK activity went down to a 9 from a 24, we would not need to treat NKs as the activity went to the low end of what they want to see. I thought that since we used neupogen and intralipids to help bring this number down, we would have to use them again to keep the number down. He said NK activity is so variable and since my number went so low, he thinks that NK is not my issue. Any thoughts?

I understand about putting this in a compartment. I am getting better and better at it as it...which probably means I am becoming numb to all this craziness.
I hope you are hanging in there.
Violet
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KerriA
KerriA

September 7th, 2012, 11:18 pm #4

Hi Violet,

I have had my vitamin D checked before, and it was normal, but I thought vitamin D was more suggested for egg quality. Do you know what the benefit it is supposed to have for DE? (I'm kind of kicking myself because I also used to take some as a supplement, as suggested by a naturopath, and I recently gave a bunch of way - and that stuff is $$$$). I also had not considered celiac as I have had no symptoms of that, though I know several people who have gone gluten free and feel much better in general after converting. I don't know if I can give up my cookies though .

I don't know how much help I can be understanding the NK stuff. I read through a lot of that literature and find it very confusing. It seems like many look at different aspects or populations of NK's, and I'm having a hard time sorting that out. I was reading S.her's blog, which is pretty good. He talks about some of the immune stuff and seems to think that it is most important to look at NK activity - not only the numbers of NK's in the blood. That makes some sense to me, but, admittedly, even though I study immunology, the reproductive angle is all new to me, and clinical immunology is a lot messier than what we deal with in my lab! (those humans make for difficult experiments!)
If it were me and you didn't have any problems tolerating the intralipids and neupogen last time, I would want to keep that the same - just to make sure there was no contribution. If I come up with any more information on these, I'll let you know.

best,
kerri
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