RE just made DE recommendation

iVillage Member
Registered: 11-29-2005
RE just made DE recommendation
13
Wed, 06-13-2007 - 8:53pm

I have been lurking here for couple of days reading the posts trying to get an idea for what it's like to go DE. I have to say it all sounds positive and offers hope, of course with a few hurdles...

I spent a lot of time on the RPL (recurrent pg loss) board until about 3 weeks ago. Last week my RE suggested DE after my 5th m/c. Getting pg is not my problem (it appears to the only thing I can do) I just can't seem to stay that way. All my losses have been before 8 weeks and this last one was after we saw the heartbeat. All in all, the last 19 months have been trying and emotionally draining.

So based upon my hx and this latest loss, he told me DE at the age of 29. I have PCOS and Factor V. Recently I went to SIRM site and posted a question to Dr. Sher, I am not sure how familiar you are with all this so I am sorry if this is getting way to long but...

He suggested I get tested to allo/auto immune issues are well as NK/NKa. I was wondering if any of you went this route before decding upon DE. It seems like most people are faced w/ a translocation issue but was wondering if anyone might be able to offer insight. Wishing you all luck ~Amy

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iVillage Member
Registered: 01-06-2007
Mon, 06-18-2007 - 8:51pm
Hi Amy,
My story is a little different but I too have been dealing with SIRM and Dr. Sher. I have allo immune disorder and we just recently found out through immunology blood tests. I never had miscarriage (so to speak or that I was aware of). I had 2 separate tubal preganancies that subsequently ended in surgery to have tubes removed. We thought that was our only problem and when we started the IVF process learned this disheartening news. We too were told we could use donor sperm/egg/embryo as long as the DQ Alpha was not the same as DH & I. Apparently that is what causes the allo immune disorder but is common in only less than 10% of population. IVIG was also suggested to us but Dh & I both do NOT want to do that. I hope this info helps and if you would like to email me directly please feel free. I would be happy to offer anything I can. Best wishes to you in your journey.
Vicki
iVillage Member
Registered: 02-20-2007
Wed, 06-20-2007 - 12:45pm

I also have a mild form of PCOS, part of the reason we're doing DE.

As far as immunity issues, I just had an anti-phospholipid blood panel done. I get the results back on Friday. I don't know if I have those issues or not. I've had one chemical pregnancy.

I haven't heard of Factor V, what is that?

iVillage Member
Registered: 11-29-2005
Wed, 06-20-2007 - 4:10pm

Vicki,

Thanks for posting back and sharing your story. How was it that you found out that there was DQ problem, was it through a blood test? I have read info about it but am not quite sure I understand it. Is that the DNA between you and your dh is to close? I hope that your journey goes more easily from this point on! Thanks, Amy

iVillage Member
Registered: 11-29-2005
Wed, 06-20-2007 - 4:15pm

Tessmckenzie,

Factor V is a clotting disorder that is usually passed down from a parent, I don't know which one of my parents may have had it. They say it's only in small portion of the population but has only come to light over the past 12 years or so (not very long ago in the world of research). It's treated with Lovenox, a blood thinner during pg. Do you mind if I ask if your pcos is treated w/ metformin? I hope that your panel comes back okay! GL, Amy

iVillage Member
Registered: 02-20-2007
Wed, 06-20-2007 - 5:43pm

Thanks for the info, how would I get tested for Factor V?? Is it a blood test?

I do have a mild form of PCOS, but it was diagnosed by a naturopath; the RE didn't seem to feel that I have it. However, every month I had cysts on both ovaries, and elevated E2 levels. I did a lot of research myself and found out that someone can have a mild form of PCOS, without having full blown PCOS. Also, every time I took ovulation predictor tests, it always said I was ovulating, no matter what time of month it was. (My ovaries suck, I have given up on them).
The only thing that helped clear up the cysts was a liver cleanse (dandelion and milk thistle). After the month where I did the liver cleanse, I was able to do my first, and only, IVF cycle using my own eggs. However, the results were not great, so I decided to do DE instead.
I get my test results on Friday for anti-phospholipid, I'm very nervous about it!!

iVillage Member
Registered: 01-06-2007
Wed, 06-20-2007 - 7:29pm

Hi Amy,
We found out through the blood test. They are tests on our immunology. Below is something I found throiugh a web search regarding this subject. The 1st & 2nd paragraph is what was explained to us about allo-immune disorders. The rest fo the article touches on other causes of recurrent pregnancy loss. Hope this info is helpful and good luck to you!

Thanks Vicki

The implanting conceptus (the embryo, the placenta, and the fetus) is immunologically foreign to the mother and it is indeed surprising that all pregnancies are not summarily rejected. In fact, the ability of the mother to successfully host a pregnancy is entirely dependent upon a complex interaction of sophisticated immunologic adjustments that are designed to prevent immunologic rejection of the conceptus.

The placenta and the fetus carry imprints of the father's immunologic make-up, which differ substantially from that of the mother. These imprints are referred to as HLA antigens. This immunologic difference between the conceptus and the mother causes the mother to produce blocking antibodies against the HLA antigens. The blocking antibodies produce a protective barrier around the fetus which is designed to quarantine the baby from rejection by the mother's immune system, thereby transforming the uterus into a "privileged site" for implantation. The production of such blocking antibodies is referred to as an allo-immune response. In some cases, where the father and mother share some of the same HLA antigens, blocking antibodies fail to develop and the required allo-immune response does not take place, thereby exposing the conceptus to a rejection process. Many repeated miscarriages and/or late pregnancy losses are believed to occur in such circumstances. Damage caused to the placenta as a result of such immunologic rejection, often causes the body to produce antibodies to phospholipids (a component of its own cells). The production of these so-called auto-antibodies or more specifically, antiphospholipid antibodies, are part of a process referred to as an autoimmune response. The antiphospholipid antibodies combine with phospholipids and severely damage placental cells, often resulting in early miscarriages or later pregnancy losses.

A similar autoimmune response is also known to occur in association with a variety of disease states where antibodies are formed to the body's own tissues. Examples include conditions such as Rheumatoid Arthritis, Hashimoto's Thyroiditis, Lupus Erythematosus, Myasthenia Gravis, etc. Not surprisingly, these are all diseases associated with a high incidence of repeated miscarriages or late pregnancy losses.

We recently demonstrated that many women with organic pelvic disease (e.g., chronic pelvic inflammatory disease, endometriosis, and pelvic adhesions) also produce antiphospholipid antibodies and that such women find great difficulty in achieving pregnancy. In such cases, these antiphospholipid antibodies often destroy the root system of the very early placenta even before there is any indication that implantation has occurred. Such women are often erroneously labeled as being infertile when in fact they are simply rejecting their pregnancies so early (through an autoimmune process) even before it can be diagnosed.

In other words, reproductive failure associated with a failed allo-immunity as well as autoimmunity are ultimately most commonly a result of placental damage due to the influence of antiphospholipid antibodies.

In the past, the traditional approach to treating failed allo-immunity resulting in recurrent pregnancy loss, was to induce production of blocking antibodies by the immunization of the woman with her husband's (or donor's) white blood cells. As mentioned above, these blocking antibodies would quarantine the baby from the mother's immune system and thereby prevent the production of antiphospholipid antibodies. This treatment was often unsuccessful in spite of best efforts.

We recently demonstrated that the administration of mini-dose Heparin with aspirin (H/A), prior to initiating pregnancy through in vitro fertilization and embryo transfer counteracts the effects of antiphospholipid antibodies in most patients with autoimmune problems, resulting in a much higher success rate than that which could be achieved in the absence of such treatment (see Human Reproduction, December 1994). However, we have identified a number of situations where in spite of H/A treatment, a successful pregnancy does not occur. Accordingly, while H/A treatment in such autoimmune states is a treatment of choice, it is not a panacea. Patients with positive APA (phosphoethanolamine and phosphoserine) and patients with positive thyroid antibodies, need to do a test of the cellular side of the immune system called the natural killer assay (NKA). If the NKA is abnormal, then Enbrel or IVIG or both may be necessary for optimal implantation.

iVillage Member
Registered: 11-29-2005
Thu, 06-21-2007 - 3:19pm

I think the Factor V should show up in the anti-phospholipid panel, that's the clotting panel right??? I think it is... I am doing a lower GI cleanse right now. I to have kinda given up on my ovaries. Never had high E2's but high LH and the false opk's... classic pcos'er ovaries/body except w/o out a lot of extra weight, although I do have some fluff ;)

Let me know how your panel goes and try distracting yourself with something funny, that always helped me! Hugs ~Amy

iVillage Member
Registered: 11-29-2005
Thu, 06-21-2007 - 3:25pm
Wow :) A lot of info but helpful for my understanding, thanks so much I appreciate it! Hugs and luck ~Amy
iVillage Member
Registered: 01-06-2007
Thu, 06-21-2007 - 4:05pm

Anytime!! GL & best wishes!

Vicki

iVillage Member
Registered: 11-29-2005
Thu, 06-21-2007 - 6:12pm

lol... I lied, I have more questions :)

Did any of your insurance cover the testing or is it considered to experimental? And with allo-immune issues, or DQ issues, does it mean that you only have to have one donated portion, sperm/ egg/ or both? And if you don't mind me asking, if it's one or the other, how did you decide? Thanks, Amy

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