more answers (maybe), and more questions
March 28th, 2009 by hello| this post has no bearing at all on our preference for IVF or adoption - we have not made that decision yet. at this point, i don’t think we have a strong preference for one over the other. this post only addresses our decision about whether or not we have the option of another round of IVF. |
a few posts ago i mentioned NK cells. we went forward with the test for this and it came back positive. however, that may or may not mean anything. the research on NK cell activity is very new and very full of holes. it strongly indicates that NK cells may be the cause of repeated early miscarriages (pre-heartbeat), which is what i seem to be stuck with. however, there is also research (just as full of holes) that pokes holes in the already holey miscarriage research. in short, there’s nothing very solid - just some rather convincing theories.
| NK Cell Assay the NK cell activity assay involves watching how quickly the NK cells in my blood kill off foreign cells. the results are based on the kill rate within a set time period. the normal kill rate is less than 10%; my NK cells killed 15.6%. for the second part of the test, they treat some of my blood with IVIg and some with Intralipid (a synthetic brand-name substitute for IVIg), then add the foreign cells. thankfully, at this point, i only killed off a little over 8%, so that treatment got me down to normal. |
let me back up. it is known (as much as anything is known, anyhow) that autoimmune disorders can cause infertility, because (grossly oversimplified) the immune systems of women with autoimmune disorders tend to be overreactive to everything, including pregnancy. there are very interesting statistics floating around about this, such as the extremely high percentage of women who start showing clinical symptoms of autoimmune disorders around 40 years of age who also just happen to have had lots of trouble getting pregnant or sustaining pregnancy, or were never able to get pregnant at all.
now, normally, someone trying to conceive AND testing positive for an autoimmune disorder and/or showing symptoms (not always the same thing - i test positive but have almost no symptoms) would be given prednisone or heparin before the transfer and throughout the pregnancy to keep the immune system at bay. this is routine, and works. BUT… not with NK cells. elevated NK cell activity has to be treated with IVIg (intravenous immunoglobulin [wiki]) infusions. i would have to have one infusion a week before they transfer the embryo, and another infusion a week after the transfer. i could potentially have to have them every three weeks for the next 5 months from then. each infusion is somewhere around $7,500, and there is little chance that insurance will cover it. we don’t have an exact price yet, and there is a very slim chance that some of them at least would be covered, but i’m not getting my hopes up. that said, the side effects are very rare, although some of them are pretty scary, but they are well within what i consider acceptable risk.
something else we found interesting is that the doctor was very careful to be sure that we understood that as far as he is concerned, there is no proof that this works. on the other hand, he was also very adamant that if we try again, we should do this. when ed asked him if he’d change his approach if we did this and it worked, he said no, because the research is not conclusive enough. so, he feels that this is a hail mary, but he feels that we should try it.
we’re in the frustrating position of having four embryos ready to use, and knowing that there’s very little chance that i’ll be able to maintain a pregnancy with any of them.
we could opt to try it again with prednisone, since that might be enough to do the trick, but we’d always know that we’d taken the easy way out, and we’d have no one to blame but ourselves if it didn’t work. or we could drop another $25,000 trying the IVIg infusion, then lose the pregnancy for some other random, perfectly normal reason. the transfer itself is about $3,000, so i suppose we could argue that we could do two transfers (two embryos each) for about $6,000 and know that we’d used up the embryos, and assume that the research on NK cells is undependable. but then we’re just making excuses, and putting me through another two miscarriages just to use up embryos.
there is no good answer. if insurance will cover the infusions, we will absolutely try again with that protocol. if not, i don’t know what we’ll do.
