Good morning! and a little recap of reproductive immunology….

17 09 2012


I hope you had a lovely weekend.. I did.  I’ve been doing all my injections and so on, morning and night, and went in for an ultrasound and bloodwork this morning.  The tech wouldn’t say anything about my endometrial lining, but I have a few good follicles in the 10mm range on both ovaries from what my eyes could pick out, and I feel like that’s an okay response for 4 days of stims.  I was primarily worried that I would have enormous follicles already and that they’d be overripe (or whatever!?) when it came time for ER.  This is the worrisome thing with traveling for IVF– especially because, due to a major work project, I cannot change my schedule and leave earlier than Friday.

I started stims on Thursday, and had 3 nightly shots of 600 units Gonal F… then Sunday shifted to 450 Gonal F plus one vial of Menopur (because you do need some LH to mature the eggs, but Luveris is in short supply.)  I believe that is the equivalent of 525 units FSH and however many of LH… and I’m doing IM injections of estrogen every 3rd day or so… but I digress.

I am also doing lovenox 40 mg (1 syringe) every morning, and 25 units ganirelix (half syringe) every morning.. and then I’m also taking 10 mg prednisone twice a day, and baby aspirin once a day.  That’s what I consider the “immune” portion of my meds.  There’s also the egg quality side of things– all those vitamins, supplements, the metformin even though I don’t have PCOS, the melatonin and myoinositol, etc.

One nice thing about this weekend was, we got a good amount of rain.  It’s been a dry summer (though not as bad as last summer!) so it was refreshing to have a steady gentle shower for a few hours each day.  It also got me out of doing some gardening and yardwork.  Instead I folded laundry, packed most of my suitcase for NYC, and I must be nesting, because I also did some generic organization-type stuff in my bathroom, closet, dresser etc.

A gal on the forum I participate in the most (FertilityFriend) posted this link to an excellent introduction to immune infertility issues– so if you are new to the “trying to get pregnant” game, or if you’re an old hand (excuse the expression) — if you have miscarried, failed IVFs, or just plain never gotten a positive… give it a read.  Here are some reasons you might be at risk for just one flavor of immunological infertility, NK cells in your uterine tissue:

1. Women with a known autoimmune disorder such as fibromyalgia, lupus, rheumatoid arthritis, Crohn’s Disease, thyroiditis, chronic fatigue syndrome, Raynaud’s disease, mixed connective tissue disorder and ulcerative colitis;
2. Women with a history of dysplasia of the cervix, carcinoma in situ of the cervix or papilloma virus infections (HPV);
3. Infertile women with endometriosis prior to their first assisted reproductive technology (ART) or IVF cycle;
4. Women with recurrent spontaneous abortions who lose their pregnancies earlier and earlier or who have secondary infertility;
5. Women with two IVF failures;
6. Women with repeated implantation failures;
7. Women who experience flu-like or allergy-like symptoms with implantation, transfer or implantation failure;
8. Women who experience stabbing pelvic pains or intense cramping with inseminations or embryo transfers;
9. Women who experience strange symptoms in abdomen, pelvis and legs of cramping, jitteriness, jerking or strange travelling sensations in the skin post intrauterine insemination or post transfer.

Most REs (reproductive endocrinologists aka fertility specialists) are clueless about reproductive immunology.  They like to blame failed IVFs on “egg quality” or “unexplained infertility.”  Sorry, if you’re under 36 or so, it ain’t egg quality in most cases.  You must educate yourself and sometimes your doctor– you must push to get the care you deserve, whether from the RE in your city or by consultation with a doctor in another location.  Anyway– off my soapbox, here’s the article.
[Note: I don’t subscribe to self-treatment for immune conditions, so I’m not a proponent of the TCM/Chinese mushroom therapy described at the end of the article.  I think  the rest of the article is a good solid description of reproductive immunology though.]

For what it’s worth, we have Category 1 and Category 5 problems.  My husband and I have a partial DQ Alpha match, but Dr. Braverman doesn’t think it will be a problem (only 4 matches.)  But I have super aggressive NK cells, lots of inflammation, high tnf-alpha and ifn-gamma, and a whacked-out Th1:Th2 ratio.  In other words, I’m glad we found Braverman.  I just hope my eggs come through and do their part.



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