Guidance (Pg./Loss Ment)
About a year ago I had some testing done at Millenova labs in order to gain some perspective after my loss in 7/2007. I have had two pg. to term 2x. After my second injectible cycle in 2007, I got pg. although never developed h/bs. I never had the testing done at the time of the d&e because the doctor said it's most likely chromosonal given my age which was 40 at the time. I totally understand the stats on women over 40 conceiving and the likelihood of abnormal eggs and the increased m/c rate and that even low fsh isn't an indicator of success. However, I can't even get there again since the loss.
The results of the immune testing showed big red flags on the RIP with CD16+CD56+ at 21.9%. Every other value was well within normal range. The thyroid panels were also totally normally and no ab. ANA was negative. The nka result was 22.4% and with both suppression of IVIG and Intralipid was 12.5. The Ebryotoxicity Assay was absent. The APA Millenova panel also showed borderline for the ACA and I think phosphatidine. There were some red flags with SSA and SSB so of course I had all the tests re-ran by a rhematologist that my internist insisted I see. It was determined I don't have shogrens or lupus. You might ask me why haven't I addressed the nk issue. Where I am from the immune theory isn't looked as an "answer" to IF. I have seen two local RE's that discounted it so it's been hard to seek proper tx. and get someone on board.
I also tested + to C677T and PAI-1 with one copy of each and no one really seems to think it's a big deal (hematologist) and was told baby aspirin and extra folate should handle that. In addition I had these genetic factors prior and never had events during my prior pg. The one thing that concerned the rhematologist was moderately elevated ACA at 27 on the IgM and 5 on the IgG. Again no one really thinks it's a huge impediment but to be safe with a BFP I could go on lovenox. There is some theory that the hematologist told me they are finding some connection with Hep C and ACA and I had Hep C in 1984. I didn't have ACA in 1998 when I was initially tested. At present, I don't have chronic Hep C nor have I ever and have consistently tested negative with the PCR test several times as well as had normal liver function tests.
This was basically my last covered cycle and I did the lovenox post ovulation just to see if it made a difference. Of course it didn't and it's another bust. Every single cycle I do whether injectibles or natural I always get this cramping between 6-11 dpo and no one can tell me if it is normal. Sometimes it's actually quite painful. I know the nk activity can cause implantation failure. Would that be something I would feel or know is happening?
There is another RE that I briefly consulted with 2 months ago re: IVIG but they aren't offering intralipids which is by far more reasonble. I am going to have a consult with him as they now have a local sattelite ofice but that doesn't solve my problem of intralipid accessibility.
I guess my questions are what do you suggest based on the testing I already had that could be done differently that might increase chances? Should I repeat the nka and the RIP to see if it is worse or better? I'm coming to the end of the road and before I totally quit I want to make sure I have done all that I could to address the immune issues.
I appreciate your response. Thank you.
Yes, the best thing to do at this time is to repeat the RIP and NKa to make sure these elevations are persistent rather than transient. Dr. Coulam
You are welcome. Dr. Coulam