Fa fa fa FA fa fa fa fa FA feck.
I talked to Dr O about my immune tests last week. He was due to call on Thursday, so as usual my phone had a fun time accompanying me on exciting day trips to the shower and toilet and other exotic destinations. In the event, I didn’t get a call until around 6pm on Friday, by which time the mobile and I were getting a tad irritated with each other.
Anyway, I was a little complacent, it seems, re test results in my previous post.
The Auto-Antibody Profile tests were all negative, which is “reassuring” apparently.
However, the levels of my natural killer cells, which Dr O said can impede implantation, were high, at 23% of the total (I think he said 13-15% is normal). Plus CD56, a specific type of NKC that affects implantation, was high as well, at 17% (usually up to 12% is fine). Is this why I rarely get sick, I wonder? (I’m deliberately not googling anything about this stuff.) Lots of these aggressive cells are not great for the early part of pregnancy. The solution to this problem is intralipids, administered in a drip a week before frozen embryo transfer, a week after and then once more if I am pregnant. This used to cost around €1,500-€2,000 a go at the clinic, Jee-ay-sus, but is now (a mere) €260 a shot – three doses in total if the transfer works. I would also be on: i) a low-dose steroid; and ii) Clexane blood thinner from about two weeks before the transfer (ie once we start to build up the uterine wall with Estrofem); and iii) aspirin if pregnant. I think he said those three would continue until I was 12 weeks.
In addition, my CD4:CD8 ratio was elevated (again, I’m not looking this up, so I don’t really know what these cells are), which indicates I may be producing high levels of inflammatory substances. This also reduces implantation potential, as the body relies on an anti-inflammatory environment when embryos are trying to implant; we will need to check my cytokine ratios in a CKR test. I had a flu jab on Friday, so I’ll need to wait a couple of weeks before taking that test (another €350, lawks) and then another two weeks for the results to come in before I can talk to O again. If the CKR test is positive, ie the ratio of my inflammatory cytokines really is elevated, they will put me on a pure form of Omega 3 (sounds a bit shady to me, for some reason) for four to eight weeks, which will delay the cycle but be worthwhile, according to O, who said my embryos are good, so we need to concentrate on implantation issues. We could be looking at a three-month delay, I guess, to sort that one out.
And I was worried about the Metformin… On which topic, I don’t have PCOS but I have quite a high ovarian reserve and my ovaries respond in a similar way to those of women with PCOS, which might (hmmm…) imply that I have a degree of insulin resistance. Insulin is not very good for implantation either (jeez!), so we would want to reduce it before the start of my treatment.
I should start the Metformin before my FET cycle begins and gradually build it up (as it can make you feel quite sick). He recommends starting off with one 500mg tablet at dinner time, perhaps also with yoghurt or probiotics; then increasing to two tablets, the other with breakfast, for a week; and then adding another tablet at lunch for a week (a total of 1,500mg a day). At that stage, we would reduce to two tablets but increase the dose, to 850mg twice a day. If I did get pregnant, I would continue on Metformin for 12 weeks.
There was an awful lot of information flying down a slightly dodgy mobile phone connection but I think the above is more or less on the button.
So, we’re looking potentially at:
- Metformin from around about now. O sent a prescription after our last talk in early October but I haven’t started it yet, as I wanted to talk to him about it first. Plus, I don’t know now when my FET cycle will start and I’d rather not be on it for several months longer than I need to
- Some form of mega-Omega 3 for four to eight weeks before transfer begins (if the CKR test is positive)
- Intralipids x 2 shortly pre- and post-transfer, and once more if pregnant
- Low-dose steroid and Clexane starting a couple of weeks pre-transfer and continuing for the first 12 weeks
- Aspirin post-transfer and for the first 12 weeks
- Plus the usual FET cycle meds of contraceptive pill, nasal spray, Estrofem and progesterone. And the folic acid I realise I forgot to take today
Quite a lot to process. My hope last Christmas that I’d have a baby, or at least a bump, this Christmas is dashed for sure. Hopefully though, all of the above will mean we don’t waste any more of those tiny little embryos.