[agate]

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

 

[wishingandhoping]

Hello

Please can you help me understand my immunes? It is so confusing, I have tried looking at it myself but I just can't grasp it.

Can I PM you my results?

 

[agate]

ok... but if you are happy to post them as a new thread, then if you have any follow up queries I can keep all your info together... otherwise once, I've dealt with a pm I have to delete it and can't keep a copy of my reply or my box would be full

best wishes

A x

 

[wishingandhoping]

I am more than happy, i have nothing to hide! Let me know if I have missed anything out!

Which numbers do I tell you? Tnf-a 11.5, ifn-g 14.8.
Histone antibodies - positive, thyr.perox.abs - 7. ANA - negative.
Dna double stranded.abs- 7
Cardiolipin ab igg - 3.9, cardiolipin ab igm - 8.8
Nk assay:
50:1 - 13.3
25:1 - 8.7
12.5:1 - 6.4
Igg conc 12.5 50:1 - 4.6
25:1 - 4.5
50:1 - 7.3
Icg 6.25 25:1 - 6.2
Then at the bottom it says: note >10% reduction in killing at each effector/target ratio
Underneath that it has 85.3

Thank you for the very quick response! x

 

[agate]

Tnf-a 11.5, ifn-g 14.8.  I assume those are ratios against IL10?  If so those are quite low
Histone antibodies - positive - not sure why that is positive if ANA is negative, but any abnormality on these tests should be checked with your gp,
thyr.perox.abs - 7 - I presume thats a negative
ANA - negative. 
Dna double stranded.abs- 7 I presume thats a negative?
Cardiolipin ab igg - 3.9, cardiolipin ab igm - 8.8 - I presume those are also negative?
Nk assay:
50:1 - 13.3 - the killing power of your NKs is normal
25:1 - 8.7
12.5:1 - 6.4
Igg conc 12.5 50:1 - 4.6  - the killing power of your NKs did reduce when ivig was added to the test tube but its probably irrelevant as it was already normal.
25:1 - 4.5
50:1 - 7.3
Icg 6.25 25:1 - 6.2

there is normally an analysis of your CD3, CD19, CD56 and CD19+5+?

 

[wishingandhoping]

Tnf-a 11.5, ifn-g 14.8. I assume those are ratios against IL10? If so those are quite low - they are against IL10 could this be an issue?
Histone antibodies - positive - not sure why that is positive if ANA is negative, but any abnormality on these tests should be checked with your gp, would the clinic have mentioned to me if there was an issue?
thyr.perox.abs - 7 - I presume thats a negative
ANA - negative.
Dna double stranded.abs- 7 I presume thats a negative?
Cardiolipin ab igg - 3.9, cardiolipin ab igm - 8.8 - I presume those are also negative?
Nk assay:
50:1 - 13.3 - the killing power of your NKs is normal
25:1 - 8.7
12.5:1 - 6.4
Igg conc 12.5 50:1 - 4.6 - the killing power of your NKs did reduce when ivig was added to the test tube but its probably irrelevant as it was already normal.
25:1 - 4.5
50:1 - 7.3
Icg 6.25 25:1 - 6.2

there is normally an analysis of your CD3, CD19, CD56 and CD19+5+?

This is all the information I have - although I have noticed that there are figures next to all of them in brackets showing the references of the ratio.

On memory they said that I had low figures and I may need a drip. Does this sound right? I have my second immunes test on Monday. It will be interesting to compare.

 

[wishingandhoping]

Hello again!
I spoke to ARGC and that said that my CD19 is 16 which is slightly raised so may have ivig depending on my next immunes test which is on Monday. Thanks for your help, really appreciate it x 

 

[agate]

yes... that does make sense - you have quite low inflammatory:anti-inflammatory cytokine ratios - you do need some level of inflammation to get implantation - so I guess they need to avoid giving you immunosuppressive meds like steroids, but think that a drip (ivig?) might help balance your immunes bring the ratios into the normal range. 

there are natural remedies that are supposed to be immuno-balancing too - omega3 fish oils (under supplements) , cordyceps (under mycology) that you might want to consider too.

I assume your clinic would have mentioned if you need to follow up with your gp to check on the positive antihistone result but its probably best to double check.

Ah.. then it does look as though they haven't given you the rest of the analysis
CD3, CD19, CD56 and CD19+5+

best wishes

A x

 

[wishingandhoping]

Hello

I am not sure which fish oil to go for, the Nutrasea comes in different flavours how exciting! My DH wants me to ask the clinic before I purchase anything but I have read the information and it's very interesting.

 

[agate]

I used to get nutrasea... I think I had the apple flavoured ones.

 

[Aspi]

HI Ladies

I pushed my consultant for the tests after a failed ICSI cycle - They came back and low and behold I have Autoimmune issues (they dont know what) and antibodies - I have been told to take DHEA and that I would be placed on steroids during the next cycle and that they expected to get more eggs than they did as my oestrogen was high.

Do you have any advise I should ask him for to get a clearer picture? I did not know DHEA was not licensed and he made out it was a supplement!! Actually a hormone which could make more testosterone and possibly aggravate fibroids.

Any advise on how to pin this down more would be grateful!

ARGC are they really good? thinking of changing to them .........

and CARE nottingham?

 

[suzymc]

Hi Agate
Quick question. Do you know if HFEA has updated it's report since 2010 on reproductive immunology? i remain a sceptic but if there are new results into if treatment of immune issues does infact make a difference then i may reconsider.
Many thanks
Suzy

 

[agate]

no - i don't think hfea have published anything more on the topic - obviously, in journals such as the journal of reproductive immunology there is new research published all the time.

 

[suzymc]

ok, thanks. i'll have a bit of a 'google'

 

[DaisyBunny]

Hi Agate. I hope you're well. I was wondering if you could help me with my level 1 immunes results. I basically asked my doctor for all the tests on your FAQs (which they agreed to) but when my GP e-mailed e the results there was a note at the top stating that some of the thrombophillia screens hadn't been indicated due to lack of clinical details to support the request (!) Anyway here is what I have got; I have been on thyroid meds - 75g for 3 months as my initial TSH was 3.01. My doctor wants me to continue with the meds and they'll test again in a few months time. What tests are missing and I'll try and get them done privately.  Is there anything apart from the TSH that stands out to you? Thank you for your help.

Full blood count (424..)
Total white blood count (XaIdY) 6.9 10^9/L (3.8 - 11)
Red blood cell count (426..) 4.35 10^12/L (3.9 - 5)
Haemoglobin concentration (Xa96v) 12.9 g/dL (11.5 - 16.5)
Haematocrit (X76tb) 0.39  (0.37 - 0.47)
Mean cell volume (42A..) 90.0 fL (77 - 95)
Mean cell haemoglobin level (XE2pb) 29.7 pg (27 - 32)
Mean cell haemoglobin concentration (429..) 33.0 g/dL (31 - 35.5)
Platelet count - observation (42P..) 239.0 10^9/L (150 - 400)
Differential white blood cell count (42I..)
Neutrophil count (42J..) 4.4 10^9/L (1.8 - 7.5)
Lymphocyte count (42M..) 2.0 10^9/L (1.5 - 4)
Monocyte count - observation (42N..) 0.2 10^9/L (0.2 - 0.
Eosinophil count - observation (42K..) 0.1 10^9/L (0.04 - 0.5)
Basophil count (42L..) 0.1 10^9/L (0 - 0.2)

Code Result
Serum total bilirubin level (XaERu) 7 umol/L (5 - 20)
Serum alanine aminotransferase level (XaLJx) 18.0 iu/L (10 - 40)
Serum alkaline phosphatase level (XE2px) 39.0 iu/L (25 - 115)
Serum gamma-glutamyl transferase level (XaES3) 12.0 iu/L (0 - 30) -  Total Protein and Globulins are no longer part of
  the LFT profile.
  If needed please contact the laboratory to discuss
Serum albumin level (XE2eA) 40.0 g/L (35 - 4
Blood glucose level (X772z)
Fasting blood glucose level (XE2mq) 5.2 mmol/L (3 - 6) -  A FASTING venous plasma glucose of 7 mmol/L or
  greater is diagnostic of Diabetes Mellitus (WHO).
  FASTING venous plasma glucose values of 6.1 mmol/L
  or greater, but less than 7 mmol/L
  represents impaired fasting glucose (WHO).
Immunoglobulin level (XE2wI)
Serum immunoglobulin A1 level (XaIZd) 1.8 g/L (0.7 - 4.4)


Code Normality Result
Serum TSH level (XaELV) Below range 0.33 miu/L (0.35 - 5.5)
Serum free triiodothyronine level (XaERq) 5.4 pmol/L (3.5 - 6.5)
Serum free T4 level (XaERr) 15.2 pmol/L (11.5 - 22.7)
Thyroid peroxidase antibody level (XaDvU) 34.0 iu/mL (0 - 60)

 

[agate]

I think you'd probably want vit D25OH, antinuclear antibodies and thrombophilia screen including antiphospholipid antibodies.

you are right, only the TSH stands out and your doc's advice seems sensible so long as you don't feel hyperthyroid because you FT4 isn't all that high although your TSH is heading for too low.

 

[Aspi]

I got told that there was no worldwide medical research that had been done - maybe just one paper written but no formalised research as of yet, I volunteered to be a guinea pig! ;-). It seems to make sense and how come those clinics that do take it into consideration have seemingly stronger results?
I just wonder why there has been no proper research? x

 

[agate]

there are a lot of studies, but all very small.

basic answer is because full scale research studies cost money and tend only to be done where there is a patentable drug.  the drugs used in immune fertility are out of patent - so there isn't any money to be made by the drugs companies, so no funding.

its also seen as high risk work because its done on nearly pg/pg women.

and, its a particularly hard area to do studies in because we all have slightly different problems - so that makes coming up with appropriate test groups and control groups quite hard.

 

[Aspi]

Very interesting thanks Agate! x

 

[Aspi]

p.s. your "mine of useless information", is bloody invaluable! thankyou xxx