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Immune issues - start here guide to this section!

166K views 554 replies 107 participants last post by  Slamps 
#1 ·
This section of the board relates to some of the less commonly investigated reasons for infertility, for example:

immune issues e.g., elevated Natural Killer Cells and TNFalpha ratios, and the infections that may trigger them
clotting issues e.g., MTHFR, Factor V Leiden, Antiphospholipid antibodies
thyroid problems (which are frequently an immune issue) e.g., Hashimoto's, underactive thyroid

It may also be relevant to ladies who want to explore immune aspects of other fertility diagnoses, e.g.,

endometriosis - which according to immune specialist doctors is frequently associated with immune issues
unexplained - which according to immune specialist doctors may be due to undiagnosed immune, clotting, hormonal or physical issues.

Possibly the best place to start is with the FAQ thread

You may want to start with Deciding to See an Immune Specialist
and possibly read the sections under Why in the W part of the FAQ.

We have chat threads on this section for supporting ladies who are having general immunology fertility treatment, and for specific treatments like LIT and Humira and for specific conditions like Underactive Thyroid.

Additionally, you may want to look at the threads on other sections of the board for clinics you may be considering for immune treatment/testing e.g., Care Nottingham on this section of the board, Fertility & Gynaecology Academy on this section of the board, ARGC on this section of the board and the Lister on this section of the board.

Some immune tests and treatments are contraversial as they can be expensive and there is limited scientific evidence of a high enough standard to satisfy many mainstream fertility doctors. You may want to read the HFEA's statement here:

http://www.hfea.gov.uk/fertility-treatment-options-reproductive-immunology.html#7

This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites
 
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#77 ·
Thanks very much for your quick reply Agathe. This is helpful.
I do not have coeliac or Crohn disease, just a severe inflammation (close to hyper-permeability or leaky gut but not right there). The doctor has prescribed vitamins, and I have been taking them since about two months now.
Is aspirin included in the blood thinners?

 
#79 ·
I tested positive for chlamydia without any PID symptoms. The Greek test was done at the same cycle as I had the NHS swab for Chlamydia, which came back negative.

I'm interested in the immunes as I tend to get a sore throat every month. However, its 12 dpo, quite late for implantation and I can generally start to feel cramps and yucky as though my period is on her way. As this is generally every month could it still be due to implantation?

Agate, do you know what immune tests can be done on NHS? Thanks
 
#81 ·
Hi Agate

Could you help me please - I am not sure whether I need to do anything more about this or not!

My anticardiolipins have come back high from the gp twice - just had second result after positive pregnancy test last week.  My gp said she is happy to look in to it further but I have had most other tests done already at the GP - I had a thrombophilia screen that was normal this included factor V, lupus and a few other things I also had normal autoimmune which included antinuclear, anti smooth muscle abs, anti parietal, anti mitochondrial, anti lkm - all of which means nothing to me!  I haven't had further immune tests done - Penny prescribed Clexane, aspirin, pred, intalipids and neupogen anyway due to history.  Are there any other tests you would recommend - I am going to a clinic on Monday for intralipids that do MTHFR tests so was wondering about this after reading your FAQ but already take b complex 50 and will take 5mg folc acid until week 12 - do you think it would be worth doing his test - or have any other thoughts?

Thank you very much
Bex x
 
#83 ·
Agate - thank you I will do!

I think the first time it was 30 and this time 22 but am out at the moment and don't have info to hand! Is that very high?  I am on 40 clex.

Thank you
Bex x
 
#84 ·
that doesn't sound v high to me but there are different scales so you need to see it compared to the normal range for your lab.  suggest you check the paperwork and send all the details to penny when you get home in case she wants you layer on another 20mg shot with your 40mg per day, but I am hoping its not much above normal and isn't needed.
 
#85 ·
Thanks very much Agate - will check it out - so you wouldn't worry about getting MTHFR or any other tests?

Thank you
Bex x
 
#87 ·
Hi Agate that's great - thank you very much for your reply.  I just looked it up and the range for the lab is less than 13 so 22 and 30 seems quite high to me but maybe it isnt - I am a but clueless wuth these things what do you think?

Thanks again - really appreciated
Bex x
 
#89 ·
it doesn't seem really high but my gut feeling is that its better to be safe and ask your doc to put your clexane up asap - usually it would be something like taking your 40mg as normal and adding another shot at the opposite end of the day of 20mg or maybe even 40mg.
 
#93 ·
Sorry to here that poppyseed you have been through so much.
I dont really have any answers, do your clinic think its immune related or an embroy genetic issue?

X
 
#94 ·
hi poppyseed:  i'm sorry for your miscarriages.  you might want to look at the miscarriage section of faq.

early miscarriages can be difficult to tackle because its hard to know the reason, but common reasons are:
- hormonal e.g. low progesterone
- infection e.g. chlamydia, mycoplasma causing hostile uterus and/or poor sperm quality
- genetic e.g. a permanent problem with your or your partner's karyotype, or a variable problem with the egg or sperm quality
-anatomical e.g. a septum or fibroid in the uterus
-bloodflow e.g. due to scar tissue in the uterus, or a thrombophilia
- immune e.g. raised NK cells or inflammatory cytokines causing problems with egg quality or hostile uterus

basically, the approach most good doctors will use is to prioritise those according to your history and investigate them to see if they can cross any off... then try to treat you according to what they find.
 
#95 ·
Hi Agate,

Could I please pick your brain?

I read somewhere that chocolate was a no no with immune issues and have not had any for months!!!!
I have raised helper cell ratio and slightly raised killer cells, should I say away from
Chocolate, or have I made that up?

Hope your well

 
#96 ·
I THINK chocolate is a mixed bag because you are talking about a product made of
sugar (mainly glucose, some lactose if its milk)
fats (mainly saturates)
milk proteins (if its milk)
cocoa solids

the sugars and saturated fats probably aren't helpful to anyone.
the cocoa solids will contain very variable mixes of flavinoids depending what brand you buy (the cheaper brands tend to have very little cocoa in anyway, and the 'premium milk' brands will tend to have the cocoa doctored to remove the bittterest flavinoids, but anyway....

studies showed that some of the flavinoids boosted immunity and some suppressed it, so its probably russian roulette depending which brand you happen to buy?
 
#97 ·
Dear Agate

I have woken  to my sixth BFN this morning. I was hoping to talk to you about what to do next as I've had a lot of immune testing done already, but not sure what board is best to chat with you on. Please point me in the right direction.
Thank you so much
 
#99 ·
Dear Agate

I wondered if I could seek your advice, as I feel very lost.

2009 ICSI - admitted 2wks in hospital OHSS
BFP - 2010 First FET (have our son)
Since then

Four FET's same batch as BFP all BFN's
Fresh Cycle - BFN bled early before OTD
Two subsequent FET's both BFN

I have had various immune tests done, including; vit D, Thrombophilia screening, anticardiolipin antibodies, lupus anticoagulant, natural killer cell, coeliac antibodies, and anti thyroid bodies. My NK cells were border line, my thyroid TSH high, but I have got this now down to 1.6. On my last cycle FET I was taking 10mg Prednisolone. The last two FET's I have had an endometrial scratch done.

Our embryos are always very good (told top grade) and have achieved  good fertilisation rates. But still not working.

Do I:

1.) Continue Russian roulette with our two remaining frosties ?
2.) Have  fresh cycle with PGS which has been suggested?
3.) Try a local clinic which is round the corner outside London but doesn't specialise?

I feel our chance to give our son a sibling is slipping away completely. Do you have any suggestions??

Your trouble and time in replying would be very much appreciated.

 
#100 ·
what was the lining like?  what prep protocol did you use in the last few times?  how old are you?  is there signficant male factor?  are the embryos blastocyst?  what luteal support did you use?  do you have pcos?  has your weight/diet changed much since when you got pg last?
 
#101 ·
Hi Agate

Thank you so much for your reply.

My first FET which was successful with my son in 2010, my lining was very thin, for which I had extra support for (patches, in addition to progynova and cyclogest). In fact on this cycle I fell pregnant with twins, but one twin was very poorly and died at 14wks. Since then all subsequent linings have been very good. The last lining was triple layers and 10.4mm at scan prior to ET.

I have also had a hysteroscopy in June 2013, just to be on the safe side and my uterine cavity all looked entirely normal.

In the FET's cylces I'm on progynova 6mg daily. This last cycle the cyclogest was upped to 3x day but previous it has been 2xday. I was on cyclogest 3xday with my son. For the 2nd fresh cycle due to OHSS on the first, I was on the short protocol and I didn't suffer any OHSS symptoms, for which I was so relieved.

I am now 37.
My DH has poor sperm count and mobility.
The embryo that was successful with our son was a day 3, we choose on a subsequent cycle to also put back another day 3, but the remaining 7 have all been blasts.

Don't have PCOS

Weight 57kg. Not changed much at all if any since pregnancy. Weight very stable. BMI last checked at 21.

Many thanks
 
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