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Discussion Starter · #1 ·
Would someone kindly tell me which I actually need of the following? (it is a bit of a maze to me right now!)

Lister
NK CD 69 costing 182
NK cytotoxicity costing 412
NK assay (69 plus cytotoxicity) 530
Anti card a/b costing 77
APS screen costing 231


ARGC - total is 780
Cytokines - i presume this is NK cells? does anyone know for sure?
Thyroid panel - already done
insulin - done
cardiolipins
DNA double strand

The thing is I'm already at Lister so I prefer to stay there than get involved with yet another hospital but if they don't do the most important stuff, I will go over to ARGC.

thanks
 

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Hello again  :)

I have had both at argc and Lister and only tested my NK CD69 at the Lister, which they said is all you need, if they are high, then you can go on to test the NK cytotoxicity. The Lister tend to think this is the only important one you need to test for, whereas the argc test for everything at each cycle to cover all eventualities. I think really the problem is if you need humira before you start as it takes a few months to get into your system. Good luck!

xxx
 

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Discussion Starter · #3 ·
Sorry - humira is the treatment for what exactly? 

i am reasonably up on all the other stuff but all these CD whatevers have really confused me - so similar and yet different functions. Dr Beer's book is heavy going and I feel I have read it but not totally absorbed it.
 

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Anna

ds DNA is just one form of anti-nuclear antibody - you may have had this checked already as part of an ANA test at the Lister. Cant help on the NK stuff.

Betty
 

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Anna,

This explanation on Alan Beer's website may help you with more information about cytokines.

http://repro-med.net/tests/th1th2.php

Humira is a drug developed for people with rhematoid arthritis which is an autoimmune disease characterised by over production of TNf-a cytokines (form of NK Cells related specifically to CD 56).

Therefore if you are shown to have a high cytokine level (TNf-a TH1 TH2 helper cells imbalance) you may be offered Humira by a clinic like ARGC or Dr. Beer's clinic.

Again, sometimes steroids are used if people do not want to go down the Humira route. I had a just over borderline cytokine result and Alan Beer recommended Humira for me. I did not take it but instead had an IVIG infusion a couple of months before my embryo donation cycle plus steroids and other meds. appropriate to my diagnosis. Still do not know how much influence the IVIG had. Certainly my only live birth was from the addition of prednisolone even though I also have clotting issues and had used clexane on previous miscarried pregnancies.

I would just like to ask why you are not have more extensive implantation failure testing that the ones you have listed? For example, not sure whether you have a partner, but had his sperm been properly tested including dna fragmentation? Have you both been karyotyped (if you are using own eggs)?

Have you had a full uterine investigation? e.g. hysteroscopy etc. There are also further relevant tests including antinuclear antibodies, MTHFR, Factor V Leiden, Protein C deficiency, Protein S, Prothrombin Gene mutation and other clotting issues... What about lupus anticoagulant etc? Antithyroid antibodies etc etc.

Sorry to go on, but I would advise extensive testing, much of which your GP can do. This means you could stay at the Lister and request more of the basics through them or through a sympathetic GP.

Your decision to go to the ARGC could also be based on their success rates for your age and diagnosis and perhaps you could do a comparison between the two based on these criteria. Certainly I really rate the Lister though and Dr. Thum especially is well up on immune testing. However, your list of tests between the two is completely different and that is confusing I admit....

Regarding the testing of cytokines - really the gold standard for NK Cells/cytokines and specialist immune testing is the Chicago lab. that ARGC (and Dr. Beer use). However, it depends on whether you will take Humira or IVIG if you are found to have issues? Worth considering?

The other standard medication for most testable issues would be clexane, aspirin, steroids, high dose folic acid and high dose B6 and B12. You could certainly self medicate the folic and B vits anyway (relevant mainly to MTHFR). You may also want to investigate fish oils as they have been shown to have immune ameliorating properties.

Not sure of your personal circumstances etc.

I know how hard it is to negotiate all of these issues.... wishing you the very best.

Daisy
x

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Discussion Starter · #6 ·
hi Betty and Daisy and thank you for the info.

I've had a full work up in terms of HSG, hycosy, hormone profile, AMH inc,  and 2 IVF cycles with 100% fertilisation and 40% blast produced.  Sperm vg (fragmentation I'd have to check but i assume ok owing to fert rates?). Chromosomes for both ok.

Nothing, not even a chem pg. Drs say age related, poor quality eggs(39) but Im not so sure. Its an easy diagnosis and one  which leads to many IVF attempts and payments to them to find any good eggs!

I've had all the clotting done not via GP unfort. and it's fine save factor 8c which is low and needs to be repeated.

Hence my focus on immunes now and my desire to get them all done properly for my peace of mind really.


thanks again for the replies, xxx


 

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Hi Anna,

Sadly the fact that your DH's sperm fertilises your eggs doesn't necessarily mean there aren't issues at the dna level.  Obviously, your age may be a significant factor of course (and potentially DH's age..).  Also the quality of your clinic and their expertise is also a factor.

Not sure which clotting tests you have actually had?  Have you had MTHFR for example?  Plus all the other relevant tests - not sure you have....?   What about lupus anticoagulant, antinuclear antibodies for example - both very important tests?

An area I don't know much about is to check uterine issues - perhaps an hysteroscopy would be better indicated over hycosy in order to really examine your uterus??  Just a thought.

Also, have you and DH been checked for bacterial infection?  Important ones are chlamydia, ureaplasma and mycoplasma which can prevent implantation and cause miscarriage if left untreated.  It is a fairly simple swab test...

Sadly, even though you produce embryos which were successfully taken to blast (which is great), it does not mean they were chromosomally normal...  as you know.  However, other issues may be at work and it is certainly worth trying as many avenues of investigation as poss.  I can see why you want to have a belt and braces approach with the immune testing.  I also agree that it is easy to put everything down to a woman's age and although this is a significant factor it is not the whole story.

Finally, not sure whether you had your E2 tested in conjunction with your FSH as just doing FSH is pretty meaningless without an E2 comparison (high E2 will falsely suppress FSH making it seem lower than it really is).  Also, as you know,  FSH/AMH tell you pretty much nothing about the quality of your eggs more how you may respond to FSH stimulating meds. in an ivf cycle...

Sadly, maybe it is just bad luck - it is so hard to say.... not sure how many cycles and where you have done them... 

Sending best wishes and best of luck,

Daisy
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Discussion Starter · #8 ·
hi Daisy,m thanks very much for writign all that out; it's much apreciated.

to answer your (very good) points,

1. yes E2 is generally at high end of normal ranges, so deemed not to be suppressing FSH (around 6,7)

2. yes i think i "get" AMH now, but only because, after I had a poor AMH result, I panicked and read the literature on the internet on it in great obsessive depth.  In case anyone else is interested, AMH levels are predictive of response to IVF stimms as opposed to indicative of quality per se. QED they predict IVF success (because if you have few eggs, your success is reduced, obviously, taking 0 as an obvious example)

3. uterine stuff - yes i am thinking of hyster in addition to hycosy.

4. throm panel - I am normal for APTT, antithrombin III, protein C, APCR, protein S clotting, prothombin time, fibrinogen, homocysteine (normal up to 15 though less than 10 desirable. I am 9.31 umol/L!!), negative for MTHR c677T mutation , normal FBC, anticard IgG normal (3.6GpLu/ml) and IgM normal (2.8MpLu/ml), negative for prothobin factor II, negatvie for factor V leiden.

only things that jump out are:

1. factor VIIIc - low at 0.22 when it should be 0.5 to 1.49. (asked haetomologoist friend who said too low not really relevant) need to get repeat test.

2. age - cannot do anything

3. posterior cervix - unusually so but apparnetly not deemed an issue

4. possible NK immune issues tb invetsiagted.

5. sperm dna frag issues - will invetsigate

So, there it is. All very unsatisfactory really. Tens of thousands spent and no sensible answers. what other "product" could get away with it I wonder?

love and good luck to all this wet saturday,

anna xx
 

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humira is the treatment for TNF - A (tumour necrosis factor alpha)
 
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