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Endometriosis, Unexplained Infertility and More Moderated by Walid Saleh, M.D.
Dr. Saleh is listed as a Top Obstetrician/Gynecologist by The Consumers' Research Council of America and recently received a 2010 Patient's Choice Award - given to less than 6% of doctors across the USA.

Dr. Salah is a long-time advisor to INCIID. He is also a proud supporter of the "From INCIID the Heart" scholarship program. Dr. Saleh and SIRM are generous donors to INCIID's mission and very popular with patients who are looking for individualized and compassionate patient care. Dr. Saleh answer's patient questions and provides information about Endometriosis. Dr. Saleh's professional member profile is located here. Visit the Sher Institutes for Reproductive Medicine (Dallas).

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  #1  
Old 03-02-2012, 09:59 AM
hopin4bfp hopin4bfp is offline
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Default What kind of immune testing should my RE do?

Hello Dr Saleh

Thank you so much for the time you spend on these forums educating us and providing the much needed answers to the women struggling with IF and pregnancy loss.

I am 30, diagnosed with mild-moderate endo 3 years back by a laproscopy when one chocolate cyst was removed. I also have hypothyroid and take 75 mg thyroxine daily.
MY AMH testing and HSG results came back normal and my RE put me on clomid 100 mg for this cycle which worked (1 dominant follicle) but conception did not occur. While researching online, I found heaps of info about endo and its relation to IF due to immune issues. I feel that should be the reason why I have not conceived even once after having unprotected sex for so long and having a very regular 28 day cycle for ever. I know m/c is so very sad for the mother but I feel strange that I never even had one positve preg even if it ended in M/C which makes me think is something really wrong with me?

I have asked my RE (a reputed facility in NY) to get some immune testing done before we proceed with another cycle of Clomid......or do I even need Clomid?? I am going to wait out this cycle n ttc naturally, doing OPKS and BBT charts and I have an appt with her on 13th Mar.

Can you please suggest what tests should I ask her to do (she has done the basic IVF profile as per their procedure) and if she is not convinced, can I switch my case to SIRM Manhattan mid cycle?? I have read about APA, ANA, ATA and written down detailed notes n took printouts to present my case to her

Many thanks in advance
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  #2  
Old 03-02-2012, 10:37 AM
WalidASalehMD WalidASalehMD is offline
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My pleasure. Please go to www.millenova.com and download their order form online. The main test to order is called NK assay test and runs approximately $300. This can be drawn at your local 1ary doctor or OB-GYN and the blood sent to Chicago. Please note that I have no financial affiliations to this lab. They are one of three reproductive immunology labs that do the appropriate testing. Unfortunately, contracted labs like LabCorp and Quest do not. If the test is +, then I recommend you get an opinion from our SIRM in NY. also see below:


ENDOMETRIOSIS AND IMMUNOLOGIC IMPLANTATION FAILURE.
Patients with endometriosis have immunologic abnormalities. The most significant of these involve the presence of harmful antibodies known as antiphospholipid antibodies (APA) which are in the bloodstream of about 66 percent of women with endometriosis. In about half such cases (i.e. about 1/3 of all cases of endometriosis…regardless of severity) the immunologic implantation is profoundly aggravated by the presence of activated (i.e “toxic”) Natural Killer cells (Nka) in the uterine lining (endometrium). These NKa attack the invading trophoblast cells (developing "root system" of the embryo/early conceptus) as soon as it tries to gain attachment to the uterine wall. In most cases, this results in death of the embryo even before the pregnancy is diagnosed and sometimes, in a chemical pregnancy or even an early miscarriage. . As such, many women with endometriosis, rather than being infertile, in the strict sense of the word, often actually experience repeated undetected “mini-miscarriages”. Treatment requires prior and specific identification of all 18 sub-types and their gammaglobulin isotypes. Unfortunately, only a handful of Laboratories in the United States are capable of adequately testing for APAs. But it probably not APAs that cause infertility in endometriosis patients. Rather it is the co-existence of toxic or activated NK cells (Nka) that attack the early embryo’s root system as soon as it tries to attach to the uterine wall that causes the problem. The presence of APAs probably represents a marker which identifies those endometriosis patients who have immunologic problems requiring immunotherapy Women with APA's experience improved IVF birth rates when mini-dose heparin is administered from the onset of ovarian stimulation with gonadotropins (Repronex, Gonal F, Bravelle or Follistim) until the 8th week of pregnancy.

Recently we discovered that heparin therapy alone, only benefits APA+ women who do not have positive blood tests for Nka while women who test positive for Nka require intravenous immunoglobulin (IVIG) or intralipid therapy.
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Old 03-02-2012, 11:43 AM
hopin4bfp hopin4bfp is offline
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Thanks a ton for your quick response, Dr Saleh!! I am going to get this test done asap. I dont think I will wait for my RE appt to ask them to order it if it can be ordered through any primary care physician or my Ob/Gyn. Can this be done on any day of my cycle?? Thanks for the posted info about mini-miscarriages that may be going on in cases with these immune disorders. You are a gem!
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Old 03-02-2012, 11:48 AM
WalidASalehMD WalidASalehMD is offline
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My pleasure. You can e-mail me the result of the NK assay and I will be happy to help. The NK assay can be done any day of the cycle. Usually best to do it M-Thu morning so Fedex can ship it same day to Chicago. If you call the lab, they will mail you a kit that would have everything your OB nurse needs to ship it. Best of luck.
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Old 04-11-2012, 03:12 PM
hopin4bfp hopin4bfp is offline
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Default Nk Assay test ordered

Hello Dr Saleh

I have recently sent my blood sample to MI Lab for the NK assay test as advised and I have requested them to email you the results for interpretation as you so generously offered.
I am going to email you the results myself in case I receive them directly and some other blood work reports so you could advise me further.

Many thanks in advance for your time.
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  #6  
Old 04-12-2012, 09:57 AM
WalidASalehMD WalidASalehMD is offline
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I did not get those. Yes, please let me know what the NK assay showed and I will gladly advise.
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