General autoimmune testing advice
11 Replies
Frisbee Girl - December 21

Hello! I have a general question on autoimmune testing, or the testing the Dr. Alan Beers does, if you have any opinion on it at all:

Is it worth going through autoimmune testing if your fertilized eggs actually implanted and progressed with good HcG levels? I guess I'm asking if the autoimmunity would have kicked in earlier, like during the implantation process, and would have either produced a BFN or a chemical pregnancy... thus rendering any testing done after a BPF and GOOD HcG levels useless. Can the autoimmunity kick in after the sac has started to grow normally?

Thank you for any opinion at all you might have on this subject.

 

B. Jacobs, M. D. - December 21

In all probability, your loss was caused by a chromosome problem with the pregnancy. It is actually rather common. If there really is an autoimmune problem for pregnancy loss, it is far mopre likely to be related to phospholipid antibodies. I do test my patients with recurrent pregnancy loss, but have the studies done by Dr. Kuteah, in Memphis. Dr. Beers'work is rather controversial.
Good luck.

 

Frisbee Girl - December 21

Thank you, Dr. So... to be clear... if I had a first beta of 409, then 48 hour later 817, then 48 hours later 1720... the fact that I miscarried at 5 weeks still could be chromosonal?

 

B. Jacobs, M. D. - December 21

Absolutely.

 

Frisbee Girl - December 21

Good to know. And.... the chances that it's an auto-immune thing or Natural Killer cells is low, correct? Or... out of the question, even? (I'm just trying to weigh all the costs.... this auto-immune testing is aboutg $3000 out of pocket at the very least, and that's BEFORE the treatment, which I understand can run in the 10s of thousands.... but I cannot get a straight answer from anyone who actually does the testing, because they WANT you to test for all (and therefore make them $$$). I appreciate your honesty. Thank you!

 

B. Jacobs, M. D. - December 22

The data about natural killer cells as a problem are somewhat in doubt. The natural killer cells found in the blood are different from the ones found in the uterus. It is questionable if measuring those in the blood can tell you anything about what is happening in the uterus. Although there is a possibility that your problem is related to uterine natural killer cells, it is not probable. Also, the prposed treatment if IVIG is unproven, and not without risk. I do not advise any auto immune work up unless a couple has had 3 or more losses, and, then, I look for phopholipid antibodies. Those are documented to increase risk.
Good luck.

 

Frisbee Girl - December 22

You are a blessing. This is our 4th IVF try -- eggs were of 23 year old, sperm of 40 year old -- we got 12 highest grade blasts out of it, and keep transferring two only to get a miscarriage at around 5 weeks. The first betas are always so nice and high and they double perfectly, but I bleed them out at 5 weeeks or so. We've had 3 losses so far, and are into our fourth. This time my first HcG is 371 (nice!) and we'll go back on Christmas Eve to see if they have quadrupled. I just don't want to keep running through all our frozen embryos only to find out after we've ran through 12 that I had something in me that was killing them all along. I have been diagnosed with Factor V Leiden, so I am currently on 40 mg of Lovenox daily. What would the treatment for phopholipid antibodies be?

 

B. Jacobs, M. D. - December 22

You are already on the appropriate treatment - Lovenox. Adding aspirin may be of some benefit.
Good luck.

 

basket - December 24

I had the immunotesting done and my husband and I both showed positive for I believe it was the monocytes so I was started on Heparin 2 days before our ET and have continued on it and I am supposed to keep on it throughout my pregnancy if I am BFP on 12/26. Is this what your routine would be? They say that this could be the reason I have not been able to get pregnant.

Thanks!!

 

B. Jacobs, M. D. - December 24

The evidence related to phopholipid antibodies and impaired reproduction is not related to failed conception or implantatin, but recurrent pregnancy loss. We do use low mo;ecular weight Heparin (Lovenox) from either date of anticipated conception or date of transfer throughout the pregnancy.
Good luck.

 

basket - December 24

Would the phospholipid antibodies be what we were positive for then? If we are not BFP this time will I still have to keep taking the Heparin shots as long as we are still trying to become pregnant?
Thanks!

 

B. Jacobs, M. D. - December 24

I do not know what tests weere run on your blood. Testing fo natural killer cells is not testing for phospholipid antibodies. I cannot advise you to stop taking yourHeparin. I do not have all the data, and I have not evaluated you. Giving medical advice to somone who is not your patient is risky to both parties.
Good luck.

 

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