Results of LAT and NK Cells Post LIT

Here are the results of my LAT and NK Cells after 2 LIT sessions using 2 donors each.

LAT after 2 LIT sessions using 2 donors

My LAT has improved! Thank God! :) From 10% and 5%, it has gone up to 76% and 41% with reaction code of 6 (strong positive) and 4 (positive reaction).    

NK Cells test results after 2 LIT sessions using 2 donors

As for my NK Cells, it is now within normal range.  Cut-off is 12.  From 14.39, it is down to 10.61.  Finally!

Though results are quite good, my immunologist still suggested that we go for another set of LIT using 2 donors to further increase my LAT score and also to lower my NK cells.  This we have done last September 4, 2012.  Hopefully, with this LIT session, my LAT will go as high as 100% and my NK cells will also decrease.  All of these we are doing in preparation for the IVF.  

Hope it works...

Consultation With My Immunologist

I went to Dr. Lara Theresa Alentajan-Aleta, my immunologist at the Don Santiago Bldg. across PGH in Taft Avenue last July 10, 2012.  I presented to her the results of all the blood tests I’ve done and here was her interpretation.

My LAT was back to negative. 

My KCT was high.

My NK Cells was also high.  (Though it was within normal range, according to Dr. Aleta, the cut-off should be 12.  Mine was 14.39.)

So, my options are the following:

1. LIT – Lymphocyte Immunotherapy Treatment (solution for Category 1 and 5 problem)

2. IVIG – Intravenous Immunoglobulin (solution for Category 1 and 5 problem)

3. Intralipids infusion (solution for Category 5 problem)

4. Take aspirin 80mg once a day (solution for Category 2 problem)

I told Dra. Aleta that we are planning to have IVF in Taiwan by September 2012.  So, we are doing this in preparation for the IVF.  

According to her, we can either have IVIG before going to Taiwan or have LIT. 

IVIG is more expensive and it will only stay in my body for a month.  LIT, on the other hand is cheaper (but will need at least 4 sessions or more depending on my body) but once my LAT is up, it could stay in my body for 6 months.  If within 6 months, I don’t get pregnant, I have to have booster shots to maintain the LAT. This, I wasn’t able to do before, that is why my LAT returned to 10% and 5%, which is considered a negative reaction.  So, it is very important to remember this: Booster shots within 6 months if you don’t get pregnant to maintain positive LAT.  If not, you’ll have to do it all over again, just like me.

So, Dra. Aleta and I agreed that we will have LIT since I still have time to do it before going to Taiwan.  So our schedule is this:

July 17 – LIT using 2 donors

July 31 – LIT using 2 donors

August 14 – blood test

Then we will decide from there if I need additional LIT and if I still need to have intralipids infusion.

Another thing I asked Dr. Aleta is how can I increase my LAT naturally.  Her answer: Avoid xenoestrogens.  Avoid processed and canned foods.  Avoid using styro and plastics.  Do not use fabric softeners.  Stop using make-up and lotions that contain paraben.  Avoid eating meat.  It is ok to eat fish, vegetables, fruits, seafood, organic eggs and free range chicken.

She asked me if I am taking any vitamins and I said I was taking Usana Essentials, Calcium, Biomega and Proflavanol.  She asked me to continue taking the vitamins and on top of this, she prescribed Glutathione 500mg, 1 capsule daily.  The brand she prescribed was Cosmo Skin which can be bought at Watson’s for Php45 per capsule or Php1350 per bottle of 30 capsules. 

That's it for my consultation with Dra. Aleta.  

I'll be posting my LIT session soon.

Have a great day ahead!

NK Cells Test Result

Here's the result of my NK Cells Test.

This is not the same as the one I had 3 years ago wherein the blood sample was sent to a laboratory in Chicago (Rosalind Franklin University).  This NK Cells test was done here in the Philippines (St. Luke's Medical Center).

Natural killer cells (NK cells) are important.  They make up 50% of all white blood cells and are needed to control rapidly dividing cells like cancer.  The theory is that some women produce too many natural killer cells which will aggressively attack any cells that grow and divide, offering protection against cancer but making pregnancy impossible.

Treatment possibilities for elevated NK cells include LIT, intravenous immunoglobulins (IVIG), steroids, rheumatoid arthritis drugs and or the latest one is the intralipid infusions.  The natural solution for this is to take fish oil, specifically EPA, to decrease NK killer cell activities.

Here in my recent test, my NK cells are within the normal range.  However, I still have to show this to my immunologist for proper interpretation as I do not know what those other items meant.... some are below the normal range, yet some are over.  

I'll update you after the consultation with my immunologist.  

Blood Test at Manila Endocrine Laboratory

I just had my blood tests done here at Manila Endocrine Laboratory this morning. It's been more than a year since I last checked my LAT, APAS and NK Cells.  Since we're planning to go through IVF, we decided to have these rechecked again and see if there are still problems...  At least, we can still work up on the problems before going to Taiwan for the IVF.  Though our doctor in Taiwan do not believe that my immunological problems are the cause of my infertility, we chose to work up on this side as well.  Better safe than sorry.  This is because I have heard some people who have gone through IVF without fixing their immunological problems first, and they got negative results in the end... 

This is the gate of Manila Endocrine Laboratory.

  

Took this picture while inside the car because it was raining this morning when we went there.

Go straight inside and you'll see this clinic.

This is the blood extraction area.

The tourniquet (tight band) has been placed around my upper arm... and now the medical technician is looking for the vein...

After putting alcohol on the skin over the chosen vein, the needle connected to a syringe was then inserted into  my vein. Ouchy!!!

Extracting bbloooooddd....

After extracting the required amount of blood, the needle was removed.  The small wound was pressed on with cotton for a few minutes to stop bleeding and prevent bruising.  My blood was then placed in these vials. (Only 4 vials in front)

Cost of the tests:
Lymphocytes Antibody Test (LAT) - Php3,500
APAS Test - Php5,000
Primary Immuno Deficiency Panel 1 (for NK Cells) - Php5,800

Total: 14,300

Only a few laboratories do these testings and prices vary.  LAT and APAS tests can be done in PGH-Medical Research Laboratory (Contact Number 5548400 Loc. 3232) every Monday to Friday, 8-10am. Results are released every Friday. Prices are Php3,500 and Php6,410 respectively.

For the Primary Immuno Deficiency Panel 1, you can also have it tested at St. Luke's Global (Contact No. 7897700), 2nd floor pathology for Php5292.  Actually, even if you have it checked at the Manila Endocrine Lab, they will send it to St. Luke's Global for the testing because they are only the ones who can do this kind of testing here in the Philippines.  APAS and LAT testings can also be done in St. Lukes, but are more expensive.

Results:

The results of my APAS tests will be sent to me via email tonight. As for the LAT and NK cells, most probably I will get them on Saturday.  

They run the LAT testings every Friday morning and results are out in the afternoon or by Saturday mornings. So if you want to get your results asap, it would be better to have your blood extracted by Thursday of the week.

For the NK cells test, it usually takes about 2-3 days for the results to come out if you do it in St. Luke's.  So here in Manila Endocrine Lab, results are expected around 3-4 days since they have to bring the blood to  St. Lukes.

Note:  Fasting of 4-6 hours is needed if you are going to do the APAS test.

How to go to Manila Endocrine Laboratory:

That's all for today.  I will update you again of the results as soon as I get them. Till then...

My Infertility Case Exposed

My husband and I were married on May 1, 2005… that was 6 years ago.  We were not in a hurry to have a baby then as we were still enjoying our lives as a couple.   I was just only 24 years old then.  Most of my friends were not even married yet.  I have a regular 28-day cycle.  So I thought everything was normal and getting pregnant will come naturally.  There were no pressure, no rush, no worries… we were just enjoying and taking our time…  Little did we know that getting pregnant isn’t as easy as it seems to be for others…

See  An Infertility Specialist After a Year:

After a year, that was when we started getting a little worried.  Is there something wrong with us?  Do we have any infertility problem?  Why am I not getting pregnant yet?  I think it is time to see a fertility doctor…

True enough… once you have been trying to conceive for more than a year without success, it is time to make an appointment with a fertility specialist for evaluation.  Infertility is defined as the inability of a couple to successfully get pregnant after a year of unprotected, well-timed intercourse. 

It is but normal to feel uneasy, and worried of what you will find out through the series of fertility tests you are about to undergo.  Just think of it this way, if you find out what is wrong with you, you can do something about it.  

Fertility Testings for Men

So, we went to a fertility specialist and had our initial fertility tests with her.  She requested for a semen analysis from my husband.  This is usually requested to rule out the problem from the husband.  Results showed that his sperm count (the number of sperm per millimeter) was sufficient but the morphology (the percentage of abnormal sperm) was high.  So the diagnosis was Teratozoospermia or high levels of abnormal sperm.  But normally, OBs do not worry too much on this.  As one of my OBs told us, “As long as there are sperms available, there is no problem.  We only need ONE” 

Being a paranoid, I persuaded my husband to see a urologist, a doctor who has specialized knowledge and skill regarding problems of the male and female urinary tract and the male reproductive organs.  Further blood tests and ultrasound were requested.  It came out that he has varicocele.  This condition is similar to varicose veins but involves enlarged veins around the testes which can inhibit sperm production and affects the quantity and quality of sperm produced.  Varicocele can overheat the testes, thus causing problems with fertility.  However, treating this problem by surgery was not recommended to us by the urologist.  According to him, the surgery will not increase our chances of conception significantly.  He advised us to just proceed with artificial insemination instead.     

Fertility Testings for Women

Now, it is my turn.  There are far more fertility tests to be done for women than men.  Oh, life is really like that… So, here are what I have done so far.  I divided it into four groups so that it would be easier for you to understand it.

1.     Hormone testing – Blood tests are usually done on Day 2 or 3 of your cycle to check for hormonal imbalances or disorders that might be preventing pregnancy.  I was asked to check for the following:

a.      FSH (Follicle-Stimulating Hormone) – this hormone stimulates the growth and development of the follicles on the ovary during the follicular phase or first half of the menstrual cycle; high FSH level show fewer eggs left and poor egg quality; mine is normal

b.    LH (Luteinising hormone) – released by the pituitary gland to stimulate ovulation; mine is low; if you have high LH, you may have PCOS or polycystic ovary syndrome.

c.     Prolactin – this hormone is released by the pituitary gland and high levels can stop ovulation and menstruation; mine is a little bit high probably because of stress

d.    TSH (Thyroid hormones) – responsible for controlling thyroid function; mine is also normal

2.   Monitored Cycle –  This is done monthly to know your fertility status and know what plan of action to take next; Depending on your OB, you are usually asked to go to the clinic on the Day 2 or 3 of your cycle for check up.  Then ultrasound follicle monitoring on Day 6-8 to check if there is an egg and also to check the endometrial lining.  Abnormalities such as polyps and myoma can also be seen during this time.  Another ultrasound for follicle monitoring on Day 10-14 to check on the size of the ovarian follicles, and check on the thickness of the lining of the uterus to help predict the time ovulation. Then, you’ll be given a “schedule” as to when you are to have intercourse.  This is called timed intercourse.  Some OBs also give fertility drugs like Clomiphene Citrate or Femara.  This is for ovulation induction and is taken for 5 days starting from Day 2.  

Through the monitoring done by transvaginal ultrasound, I found out that I do ovulate and I have endometrial polyps and myoma.  Most of the time, OBs will not ask you to have the polyps and myoma removed at once because there are many people who also have those but get pregnant also.  In my case, I had my polyps removed last December 2010.  OB did not remove the myoma or uterine fibroid because according to her, in my case it is not the culprit to my infertility.

3. Tubal and uterine investigations to see if there are any structural (anatomical) problems of the reproductive system that causes infertility; usually done on the first part of menstrual cycle to ensure you are not pregnant

a.     Hysterosalpingogram (HSG) – This is a test where a dye is passed through the fallopian tubes to check for blockages that could be stopping the egg or sperm progressing.  This is done in a hospital, but out-patient.  I had mine done in Chinese General Hospital last 2006.  A small catheter is inserted into the cervix through which liquid dye is injected.  X-rays are taken as the dye passes through to see if there are any obstructions.  I felt heavy cramping during and for several hours following this procedure.  But this just means that my fallopian tubes are not blocked.  According to the technician, no pain, no gain.  Expect vaginal discharge as the dye is expelled from the uterus so do bring a pad or panty liner with you.  After the procedure, the OB gave me antibiotics to take to guard against possible infection.  Result: No blockages in the fallopian tube and I have a normal uterus.      

b.    Hysteroscopy - a thin viewing tool called hysteroscope (a light and camera is hooked to it so that the doctor can see the endometrium on a video screen) is inserted via the cervix into the uterus to check for irregularities or scar tissues.  It is also used to remove fibroids or polyps.

c.  Laparoscopy –is a surgical procedure that involves insertion of a narrow telescope-like instrument through a small incision in the belly button. This allows visualization of the abdominal and pelvic organs including the area of the uterus, fallopian tubes and ovaries.  It also checks for scar tissues, endometriosis and fibroids.  Done under general anaesthesia.

I had hysteroscopy and laparoscopy done at the same time last December 2010 at the Philippine General Hospital to remove my endometrial polyps and also to check if I have endometriosis.  My OB found that I have some implants at the back of the uterus so these were cauterized. According to OB, it will be better to get pregnant within 6 months since there is a possibility that the implants might recur.

     

4.   Immunological testing – This is also done through blood tests to check for reproductive immunological factors.  This is normally done if you have a history of miscarriage, IUI and IVF failures, or an unexplained infertility like me.   The tests can be divided into 5 categories.  Below is a description of each category and its corresponding treatment.

 

Category 1 – Leukocyte Antibody Test (LAT) or Lack of Blocking Antibodies

Some women may fail to produce blocking antibodies to stop the immune system from attacking and rejecting the fetus.  The problem is when the woman shares the same antibodies with her partner; in other words the couple’s DNA is too similar.  Normally the father’s DNA in the embryo tells the mother’s body to set up a protective reaction around the baby.  But when this blocking effect does not happen, the baby is rejected.  Treatment for this is lymphocyte immunization therapy (LIT) in which the male partner or donor’s blood is injected into the woman.

Category 2 – Antiphospholipid antibodies (APAs)

Antiphospholipid antibodies are the most common kind of abnormal immune system problem.  APAs can prevent implantation thus preventing pregnancy in the first place.  Phospholipids are a sort of glue needed in early pregnancy.  Some women, however, produce APA blood-clotting antibodies which attack cells that build the placenta and increase the risk of miscarriage.  Anticoagulants like low-dose aspirin and heparin (a blood thinner) are often prescribed.

Category 3 – Antinuclear antibodies (ANAs)

Antinuclear antibodies are directed against structures within the cell nucleus and can attack the fertilized egg and the cells in the womb.  This can prevent implantation and increase the risk of miscarriage.  This is often treated with steroids like prednisone to suppress the inflammatory process.

Category 4 – Antisperm antibodies

Antisperm antibodies can cause agglutination or even prevent fertilization because they stop the sperm being able to penetrate through the cervical mucus.  It can be produced after an infection.  Treatment for this is usually steroids.

Category 5 – Elevated Natural Killer Cells (NK cells)

Natural killer cells are important.  They make up 50% of all white blood cells and are needed to control rapidly dividing cells like cancer.  The theory is that some women produce too many natural killer cells which will aggressively attack any cells that grow and divide, offering protection against cancer but making pregnancy impossible.  Treatment possibilities for high NK cells are LIT, intravenous immunoglobulins, steroids or rheumatoid arthritis drugs.  The natural solution for this is to take fish oil, specifically EPA, to decrease NK killer cell activities.    

Fertility Treatments

Unfortunately for us, I am positive for Category 1, 2, and 5.  We were advised to see an immunologist and had immunological work-up.  So far, from a LAT of 0%, I am now 100%.  That is after 9 LIT sessions, 4 with husband as donor and 5 from blood donors.  I take Aspirin every day for almost 2 years now.

I have experienced 3 failed IUI (artificial insemination).  2 consecutive IUI last 2007, without any immunological work-up.  And right now, after my LAT has increase last April 2011, we tried for another IUI this May 2011, but unfortunately it wasn’t successful.

Whew, so there goes my long story on my infertility case.  I tried to explain it as clear as possible so that you would better understand my condition.  Many people have been asking me about it, so here it is… If you have other questions, please feel free to ask me.  I’d be more than willing to share with you my experiences.   Happy reading!