Confused and need some help!

[Juliet'sMommy]

Okay girls, I find myself once again in need of your vast knowledge and expertise. Here's my history (I'll try to be brief):

Oct. 2001 - DD conceived naturally the first month we tried

July 2002 - post-partum hemorrhage approx. 10 days after vaginal delivery / aggressive D&C / surgeon ended up packing my uterus and sewing it shut for 6 weeks

Oct. 2003 - started trying for #2 / conceived naturally the first month we tried / blighted ovum / D&C @ 7.5 weeks

Dec. 2003 - Nov. 2004 - bms/clomid for 6 cycles/periods became very sporadic and irregular

Dec. 2004 - RE diagnosed uterine adhesions and performed lap/hysteroscopy in Jan 2005 = left tube remains blocked and 1/4 of my uterus is still covered in scar tissue

Feb. 2005-July 2005 - ovulatory monitoring, bms and one unsuccessful IUI

Sept. 2005 - 1st IVF = twins (one vanished and lost the other at 8 weeks) / diagnosed with elev. homocysteine and compound hetero MTHFR / began folgard

Jan. 2006 - conceived naturally, but lost the h/b at 10 weeks

At that time, I pushed my RE for Lovenox/heparin and BA (she had previously said it wasn't necessary) and we agreed to start it before ovulation or prior to FET.

In June, ovulatory monitoring revealed I was ovulating from my right side (the tube that is not blocked) and DH and decided to try one last time on our own before moving on to a FET. When I asked RE about starting heparin, she reneged and said we would start it with a positive pregnancy test. About three days before AF was due to arrive, I started getting faint + hpts. It didn't seem to matter which brand I used or what time of day I took the test but I'll admit, the line was very faint. However, it always turned + within the 10 minute time-frame and it was always dark enough that DH could see it. I waited a couple of days and took another test, but was disappointed when the line was barely visible. I attributed it to just being a different brand and scheduled a beta for the next day(14 dpo) which came back (-). AF started the next evening.

We then moved ahead with our 1st FET. (RE finally agreed to let me start taking heparin two days before my transfer, even though I begged her to let me start CD6.) Anyway, two weeks ago, on Tuesday, August 1, we transferred 2 5-day blasts. I had what I thought was a little implantation spotting on Thursday morning. On Saturday evening, I got two very, very faint + hpts. On Sunday, I think I got a little bug or something because I was nauseous, throwing up, achy and sick in bed all day, so I didn't test. But by Monday, the second line was still faint, but clearly visible. I took another test that evening with the same result. On Tuesday morning (yes, I'm addicted to hpts), neither my husband, nor I could see a second line. I was losing hope, but decided that since it wasn't my FMU and it was a different brand, I would test again that evening with FRED. Sure enough, the line was back (although still very faint), but nonetheless, it was clearly there. However, the test I took on Wed. morning came back (-) and on Thursday at 9dp5dt, my beta came back negative as well.

My question is, do you think there could possibly be something else going on here, or do you think this is just a case of bad luck? Or do you think I can possibly attribute it to not starting heparin soon enough? I'm just a bit concerned now because this has happened two cycles in a row where I get all kinds of + hpts, but by the day of my beta, the hpts are (-) and so is the blood test.

Please advise if you can and thanks in advance for your opinions/suggestions!

Anne

[Lauren2005]

You are a classic immune issues patient. Have you had FULL and COMPLETE immune testing done through Dr. Beer's office? Dr. Beer died in May but his practice continues under the guidance of Dr. Stricker. Everything you've described is entirely consistent with reproductive immunology problems. Nothing short of full testing and aggressive treatment is appropriate.

Kind wishes,
Lauren

P.S. http://www.repro-med.net

[Juliet'sMommy]

Lauren,
Thanks for the input! My RE has tested me for the following:

Homocysteine Level
Antithrombin III
Factor II (prothrombin) Activity
Activated Protein C Resistance
Prolactin
TSH with reflex T4
Insulin
Phospholid Antibody (APA) Panel
Lupus Anticoagulant

At the time of testing last November, everything came back normal except for my homocysteine level which came back at 11.5. As a result, my RE then tested me for MTHFR and found that I was compound heterozygous. Since then, I've been on Folgard twice/day and I'm now taking 1 baby aspirin/day. Within a month, my homocysteine level was back within the normal range.

So do you still think I need additional testing? My acupuncturist mentioned something last week about natural killer cells, but since my APA panel came back normal is it really a possibility that NK cells are the problem?

Thanks in advance for your help!
Anne

[jbourke]

Yes, you most definately can have elevated NK's without APA - LIKE ME! I agree with Lauren, get the full panel done then you will know what you are looking at. Those +++ turned --- are big sign of implantation, follwed by early m/c and best of luck.

[SgtMom]

Anne - I dont have any advice other that to say that I know I had implantation going on one cycle and the hpt was negative a few days later. I think you should trust your intuition that something is going on. I hope you get to the bottom of it soon. I was upset to read that this cycle was BFN for you in the end. I hope sweet J is doing well.

Take care,
Kate

[SgtMom]

Anne - I dont have any advice other that to say that I know I had implantation going on one cycle and the hpt was negative a few days later. I think you should trust your intuition that something is going on, and I hope you get to the bottom of it soon. I was upset to read that this cycle was BFN for you in the end. I hope sweet J is doing well.

Take care,
Kate

[Tabithalyn]

Anne, I too had very early prg. loss -you are driving yourself nuts with the HPT's what you really need(ed) is a Standing Requisition to go and get QUANTITATIVE Beta HcG drawn early!!

I did this and used to go in for blooddraw around CD26 or so of a 28-29 day cycle. I was getting low level betas ranging from 25, 18, 7 and 3! but then I would also always get my AF on time after testing for the beta levels. It sounds like you've at least identified that you are likely getting implantation failure type conceptions (you conceive but they just don't stick/implant properly).
Immune issues being so tricky, they can flare up and become a big problem only when you do conceive. I think at this point you can't think it is only the heparin that will solve the situation. IT sounds like yu may need to investigate other meds like prednisone and/or IVIg and potentially would require getting investigated for a DQ Alpha match test (to see if you and your husband have too similar white blood cell stuff going on).

I'm sorry to hear about the disappointments and hope that you can get a doc to at least do the NK cell testing and perhaps ANA testing and such but do remember you may not always show ++ on these and other antibody tests but you may actually still require the other treatment meds in order to stay prg.

A true RI doc would be best to help you get thru some diagnosis and treatment issues as they'd at least be familiar with what to look for and also get you on some extra meds.

Take care and best of luck -remember quantitative beta shows the actual level of Beta hcG -some labs consider anything under 5 to be a negative when if you had a 3 you actually have conceived but it is likely a chemical/early prg. loss. This is why I always got the blood drawn so I could tell exactly when I was conceiving -it turned out I was quite frequently as well...
hope it all gels together for you soon.
Ally