IVF before Immune testing too risky if you're paying

[lorelei]

Yes. You could have developed an allergic reaction to your dh's sperm, or your cm could have turned "hostile" toward it - they can check that with a post-coital test. Also, many times a woman miscarries before the pregnancy becomes viable due to immune issues (before there is enough hcg in your system to get a + home hpt). The only way you would know is if you had a beta test show some hcg action.

[scubanut2004]

I totally agree with this!

After my second failed IVF, I insisted on getting further testing done. And guess what? Lo and behold, they found that I have MTHFR with the C677T Gene mutation as well as positive for APA.

So now at least we have some reason why the IVFs have not worked. Sure, there is also the fact that I'm 41 and considered to have "old eggs" but I wasn't satisfied with just that being the reason.

I now take a daily dose of baby aspirin and folgard (prescription strenght folic acid) and will be on these 2 pills every day for the rest of my life. And when I start back on the rollercoaster for IVF #3 next month, I will more than likely be on heparin (or lovenex) to combat the APA issue.

[SomedayMommy]

Wanted to add:

Certainly to to impune any of the posts that have been already made. They may certainly be something to be said for immune testing.

My RE is not a proponent of immune testing. He believes it is old news, and that no solid evidence has come out of years and years of testing. He showed me one study where the group of high NK cells patients had a much higher birth rate than did the group with no NK cells.

And as I said, please do not take my comments to be a flame to the OP. Perhaps there really is something to immune testing. Perhaps there's not. I just don't want someone to think that immune testing will give all the answers. SIRM will make you believe that immune testing is THE answer. Whereas other REs simply don't believe in it at all.

[Raven74]

Hi Somedaymommy,
Don't worry, I don't take your comments as a flame! I agree that immune testing is not THE answer; it's just another round of diagnostic tests which can help determine what is causing IF.

My RE is also not a proponent of immune testing. It took those three failed IVFs before she would order the tests. She also did not include testing for NK's; when I asked why, her office said she "did not believe in them." Perhaps she read the same study as your RE. I went ahead and had that test run as well. My NKs came back within normal range. Everyone has NKs; they are actually a good thing, as they protect the body from things like cancer. When NKs are elevated, that can be from a range of anagonists, from cancer to stress to infection to pregnancy. The issue would not be the presence of elevated NKs, but is whatever is causing them to spike. It also stands to reason that women with elevated NKs can achieve pregnancy if the NKs are not actively attacking the embryo or implantation. There is great deal of information and studies on NKs which have prevented implantation and caused miscarriage, and that have been successfully treated with IVIg, prednisone and/or dexamethisone during IVF to achieve pregnancy.

Though my NKs were well within normal range, my immune testing came up with blood-clotting disorders MTHFR and APA which could have been treated (had I known about these prior to the IVFs) with rx strength folic acid, heparin or lovenox, and prednisone. These extra measures could have prevented implantation failure.

The MTHFR is a genetic issue, but the APA is an acquired thrombophilia (blood-clotting disorder). The APA, being acquired, was being triggered by my own immune system. It's not a mistake; it's an immune defense against an attacker. I'm just now getting to the source of what was causing the APA, which was an underlying chronic infection. Our immune systems are there to protect us, and they do a great job, often too good a job. If you know what your own body is fighting against, you can begin to solve your own IF puzzle.

Again, my point below is that if you are paying out-of-pocket for IVF, it's a wise move to have all of your diagnostic information in front of you before shelling out tens of thousands of dollars.

[BeccaMichelle]

I posted right before my second IVF after I did the immune testing and found out I had APA also. I took heparin shots twice a day after ER until I was 12 weeks pg with my twin girls. That's right, the immune testing probably made them possible! We are now 24 weeks and doing great. It's definately worth testing for b/c it's simple to treat and get around something like Apa. My blood was most likely clotting and not allowing blood to get to the baby if any were trying to thrive. I never had a positive and I also have endo but I do believe the heparin helped. Good luck everyone! IF has so many causes and we have to research ourselves and be our own advocates for finding out what the reason is for our IF.

[cobluesky]

Becca, Congrats on your twins! I was wondering what immune tests you did before your IVF? Thanks!!

[BeccaMichelle]

Hi cobluesky! I went to a Sher Institute because I knew they did extensive immune testing. They did lots of bloodwork to check for Natural Killer Cells and MTHFR and blood clotting disorders such as the one I have Apa +. I had no Natural Killer Cells or MTHFR and had to go on heparin after the ER and til the 13th week of pregnancy. Then I just had to take a baby asprin until I had them and I'm still taking that. The twins were just born April 18th and we were 32 weeks pregnant so they are in the NICU but doing well and so darn cute. I also have endometriosis which was found through a laproscopy surgery. IVF gets around that in most cases. Thank God for IVF. I do think it's worth gettiing an immune workup, and maybe not a laproscopy because it won't improve your chances much to do a lap, if you are going to do IVF, that would get around endo. Lap is a surgery and not fun. If I had it to do over, I would just do IVF with no lap. But the immune testing found the blood clotting thing and we were able to treat that and I think that improved our chances. Good luck to you!

Here is the place I went to.

www.haveababy.com

I went to Sirm in St. Louis with Dr Ahlering, He is the best!!!! My hero!

[cobluesky]

Thank you so much for responding. I will definitely get some testing done as soon as possible since we are going to do the IVF in June. In June it will 2.5 years since we started trying (not one BFP yet) so I am finally ready to give IVF a whirl. My hopes are up and twins would just be a bonus.

It is wonderful to hear of your success and that your twins are doing well. We have a friend who delivered her daughter at 32 weeks, she is now three and is an absolutely adorable, healthy and precocious little girl. The first few months were a bit stressful for her parents but then she just seemed to catch right up and do beautifully.

Wishing you and your twins all good things in the year ahead!

Thanks again.

[TRK]

I have started the IVF process w/my transfer date set around 6/23 if all goes well, so I haven't started the stimulants at this point. Is it too late to ask for immune testing? If not, what specific tests do I ask for? APA?
Thanks

[IWantToBeAMommy]

What is MTHFR and APA?