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I disagree with your RE's dismisal of the NK issue. Sounds like he's out of touch with current thinking. Some old school RE's have difficultly in accepting the role of the immune system in reproduction or the rule of autoimmune disorders in early miscarriage. Although at one time this subject was controversial, more and more evidence is accumulating to support identifying and treaing autoimmune disorders (See references below).
Progesterone is ineffective in treating elevated NK cells and NK cell actvation. I have no idea what your RE was thinking (or not thinking). The tried-and-true treatment for NK cell problems is intravenous immunoglobulins (IVIg). Although effective, IVIg is very expensive. Less expensive treatments such as Solu-Cortef (hydrocortisone) and Intralipid (a solution used to nurish patients who cannot eat) are now being tested. Both of these new treatments show promise.
Time for a second opinion. Arm yourself with as much information about the role of NK cells in implantation and them bring it up at the consult. A good place to start is the Repromedix and Millenova laboratories websites:
http://www.repromedix.com/fo
rpatients/ourtests_patients.html
http:
//www.millenova.com/test.asp
REFERENCE
S
(and there's lots more where these came from):
Endocr Rev. 2005 Feb;26(1):44-62.
[b]Natural killer cells in pregnancy and recurrent pregnancy loss: endocrine and immunologic perspectives.[/b]
Dosiou C, Giudice LC.
Endocr Rev. 2005 Feb;26(1):44-62.
The endocrine system and the immune system interact closely during implantation and maintenance of pregnancy. One of the most striking examples of this communication is at the level of the decidua (endometrium of pregnancy). Here, under the influence of sex steroids, there is a dramatic increase of a unique population of lymphocytes, the uterine natural killer (uNK) cells, in early pregnancy. These cells derive predominantly from a subset of peripheral blood NK cells, which under hormonal influence gets recruited to the uterus. In mice, uNK cells play an important role in the development of placental vasculature. The role of these cells in human pregnancy is still not definitively established; however, they are believed to promote placental and trophoblast growth and provide immunomodulation at the maternal-fetal interface. [b]In contrast to their presumptive role in the maintenance of a healthy pregnancy, uNK cells and peripheral NK cells are dysregulated in unexplained recurrent pregnancy loss.[/b] Herein, we review NK cell populations, their changes in number and function in altered endocrine environments during the menstrual cycle and pregnancy, the current data on their potential role in unexplained recurrent pregnancy loss, and mechanisms for potential therapies targeted to NK cell function for this enigmatic disorder.
[b]Diagnostic evaluation of women experiencing repeated in vitro fertilization failure.[/b]
Vaquero E, Lazzarin N, Caserta D, Valensise H, Baldi M, Moscarini M, Arduini D.
Eur J Obstet Gynecol Reprod Biol. 2006 Mar 1;125(1):79-84.
CONCLUSIONS: A better understanding of reproductive failure mechanisms should allow an effective diagnostic flow chart and a focused therapeutic option for patients experiencing repeated IVF failure. [b]With this objective in mind, our data provide two important results: thyroid abnormalities, aPL and increased NK levels are more prevalent in women experiencing IVF failure...[/b]
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