[Tama]

Hello ladies,

Saw Dr G three weeks ago and then went back for full immune testing. Had all but the karyotype and hidden C (still waiting for af to do this test!) tests back. These are the results, I'm hoping one of you lovely ladies will be able to tell me what this means and what, if anything, Dr G will do about them. I'm waiting for the karyotype test to come back before seeing Dr G.

DH and I are due to start our next IVF in the New Year Hoping we have time to address things before then, if needed!

Factor II Mutation-Prothrombin Factor II G20210A mutation: Negative
Factor V (Leiden) Factor V G1691A mutation: Negative
MTHFR - gene mutation: MTHFR C677T mutation: Negative

DQ Alpha Genotype (DH): 0102, 0201 {1.2, 2.1}
DQ Alpha Genotype (me): 0102, 0505 {1.2, 4.1}

Leukocyte Antibody Detection:
Flowcytometry: Negative
[T-cells] IgM+: 1.4%
[T-cells] IgG+: 1.0%
[B-cells] IgM+: 32.4%
[B-cells] IgG+: 33.0%

TH1:TH2 intracellular cytokine ratios:
TNF-a:IL-10 (CD3+CD4+): 34.8%
IFN-g: IL-10 (CD3+CD4+): 10.7%

NK Assay (% Killed) Panel:

50:1: 38.6%
25:1: 28.3%
12.5:1: 13.7%
IgG conc 12.5 50:1: 8.1%
IgG conc 12.5 25:1: 6.5%
IgG conc 6.25 50:1: 15.5%
IgG conc 6.25 25:1: 10.8%
% CD3: 76.8%
% CD19: 1.3%
% CD56: 19.0%
% of CD19/cells CD5+: 23.1%

NK assay w/Intralipid:
50:1 w/Intralipid 1.5 mg/ml: 7.3%
25:1: w/Intralipid 1.5 mg/ml: 2.6%

I would be so very grateful if anyone is able to shed some light on these results for me. I of course will be going back to see Dr G but as I will have to wait another week or so it would be so nice to just understand what these results me for myself and dh.

Thanks inadvance.

Tama

 

[agate]

Factor II Mutation-Prothrombin Factor II G20210A mutation: Negative
Factor V (Leiden) Factor V G1691A mutation: Negative
MTHFR – gene mutation: MTHFR C677T mutation: Negative - all good

DQ Alpha Genotype (DH): 0102, 0201 {1.2, 2.1}
DQ Alpha Genotype (me): 0102, 0505 {1.2, 4.1} - 25% dqa match - look under D for dqa on the faq

Leukocyte Antibody Detection:
Flowcytometry: Negative
[T-cells] IgM+: 1.4%
[T-cells] IgG+: 1.0%
[B-cells] IgM+: 32.4%
[B-cells] IgG+: 33.0% - you'd like this to be higher, ideally, look under L for LAD and LIT in the faq

TH1:TH2 intracellular cytokine ratios:
TNF-a:IL-10 (CD3+CD4+): 34.8% - a bit high - dr g will probably suggest 2 shots of humira then a retest - look under C for cytokine ratio in the faq and under H for humira and S for supplements
IFN-g: IL-10 (CD3+CD4+): 10.7%

NK Assay (% Killed) Panel:

50:1: 38.6% - this is pretty high - look under N for nka
25:1: 28.3%
12.5:1: 13.7%
IgG conc 12.5 50:1: 8.1% - it comes down nicely with ivig though
IgG conc 12.5 25:1: 6.5%
IgG conc 6.25 50:1: 15.5%
IgG conc 6.25 25:1: 10.8%
% CD3: 76.8%
% CD19: 1.3%
% CD56: 19.0% - also high - so dr g will probably suggest prednisolone 25mg as well as ivig/ils
% of CD19/cells CD5+: 23.1% - also high - dr g will suggest extra progesterone

NK assay w/Intralipid:
50:1 w/Intralipid 1.5 mg/ml: 7.3% - comes down nicely with ILs so it looks like you might get away with ils instead of ivig - look under I
25:1: w/Intralipid 1.5 mg/ml: 2.6%

hope this helps but the faq will explain more

 

[Tama]

Agate,

Thank you so much for coming back to me on all my results - very helpful 

I will cross reference the points you made with the FAQ's.

Thanks again 

Tama

 

[Tama]

Agate,

Thank you again for all the information you provided.

I saw Dr G yesterday for my follow up and he has suggested the following immune tx alongside my next IVF;

• Extra progesterone (pessaries and injections)

• Clexane

• IL's x 2 to start with

• Humira x 2 shots (had TB blood test done yesterday so am waiting for results before invertergoogling the best place to buy Humira)
• LIT

He didn't suggest prednisolone and I forgot to ask, doh! So will need to check on this when I call for results of TB test. He also said I would need some AB as I had an infection which showed on from the swab - streptococcus (spelling!?) but didn't give me a prescription for this and with everything else dh and I walked out without asking about it, double doh!

Anyway we had a long chat about LIT and I've done some more reading on this. Both myself and dh are not sure about having this done for a few reasons.

A) My results seem to indicate that IL's could help without the need for LIT
B) Just not sure about the whole LIT process
C) There is a chance that without LIT we may need more IL's, however as LIT costs £1,500 and IL's is about £285 if we need more IL's we could have 6 for the price of one LIT

My head is spinning from everything and would really just like the voice of reason. I am sure that Dr G recommends everything possible to give you the best chance of success, however, I just feel that LIT maybe isn't right for us. Maybe I am answering my own question or maybe I just can't see enough evidence that LIT is worth the £1,500 price tag

If money was no object I think maybe I'd think again about having it done but dh and I don't have a magic money tree and need to spend the money we do have saved in the best way possible.

So this rather long waffle boils down to money and evidence.

Do you think if we have all the other immune tx excluding LIT that based on my results that we are doing the best we can with the funds we have available?

Thank you so much

Tama x

 

[agate]

on the plus side: your LAD is borderline rather than really low and you don't have a history of repeat mc according to your signature

on the minus side: your nka is pretty high and this might result from your dqa match - so i can see why dr g is saying you should have everything possible right from the start - and he believes lit can make a big difference - other docs don't e.g., dr s at sirm - he would try you on ils every 2-4 weeks instead - he doesn't like lit (or humira) - but he seems to be pretty pessimistic about nka elevation in the presence of a dqa match - he said recently that a partial match reduces your chances by 50% (a total match by 95%)- he is quick to suggest surrogacy.

i think you have to go with your instincts, but i do think the match may raise the stakes making it worth having lit from the outset - with your already borderline numbers i think you'd get away with having one course of it and then it would be ticked off - one alternative is to try without it and then go back to it if it doesn't work but there is a risk that your nks are even higher by then - personally, i see paternal lit as lower down the 'risk scale' than humira - which you seem to be prepared to try - to me if you are ready to go for humira - you are ready for lit - they are both at the far end of the scale - but i see paternal lit as less risky - you are only been exposed to your dh's bugs - and you are doing thast already during ttc.

i don't think you can look at the cost of lit compared to  6 x ils - the stress of going through a 'touch and go pregnancy' where you might be rescommended to have both ivig and ils together to try and save baby would easily wipe out the cost difference -  personally i'd have the lit upfront - (i'd feel differently if you didn't have a dqa match with the high nka)- but i am a 'baby at all costs' person - you have to go with what feels right to you.

 

[Tama]

Agate thanks once again for coming back to me so quickly 

No I've not had repeat m/c's so as you say this is on the plus side along with borderline LAD. Dr G did say that the DQA match wasn't a problem as we only share one and he wasn't worried about this.

I can see what you are saying about the humira and if we are willing to go this route why not do the LIT too. I guess it boils down to trying to get the most out of immune tx that we can for the money we have available.

I really do not know what to do for the best or how to find another £1500 on top of the other money we need for the immune tx.  What ever I do I guess I will always think 'what if' and part of me just doesn't believe I will get a bfp.

Thank you so much for taking the time to come back to me, you're a star. 

Tama

 

[Alex42]

HI ladies can someone pls help understand these results?

NK assay (%killed) Panel

50:1 result 18.6 (limits 10-40)
25:1 result 12.2 (limits 5-30)
12:5:1 result 9.4 (limits 3-20)
IgG con 12.5 50:1 result 9.8
IgG con 12.5 25:1 result 8.9
IgG con 6.25 50:1 result 12.8
IgG con 6.25 25:1 result 11.2

%CD3 result 83.5 (limits 60-85)
%CD19 result 9.5 (limits 2-12)
%CD19+cells, CD5+ result 5.3 (limits 5-10)

TNF-a:IL-10 (CD3+CD4+) result 27.2 (limits (13.2-30.6)
TNF-g:IL-10 (CD3+CD4+) result 7.7 (limits (5.8-20.5)

Thank you so much!!! Alex

 

[agate]

alex: your cytokines are normal (in the FAQ under C for cytokines)
your NKa is high but seems to respond well to IVIG - look under N in the FAQ

 

[Alex42]

Thanks Agate!! How can you find the time to answer all our questions...

Alex