If IVF with PGS still results in loss, is it likely an immune issue?

kinipela

4 Posts
Reply Posted on: Jun 10, 2012 at 4:45pm
Hi there,

I am 34 years old. We have a long history of repeat loss with one son born in 2007. Our RE strongly feels our issue is genetic in nature even though we have normal chromosomes, though do have a history of chromosome issues in the family (brother was severely disabled due to de novo chromosome event. Father has pericentric inverstion which I did not inherit).

Due to this belief, we moved forward with IVF with PGS in March. We had 11 blasts sent for testing and only 4 came back normal. And they were all boys! We thought this was for sure our issue.

Transfered one expanding blast last week. Got a BFP at 5dp5dt, but it's a chemical (beta was only 24 at 10dp5dt).

RE said let's try one more time and if that one doesn't work, then we should re-think care plan for tries with #3 and #4. He strongly believes my body just holds on to everything, viable or not. Doesn't want to assume immune issue just because first try didn't work, given that I have already had basic RPL workup and given our history.

Just wondering if that seems reasonable.

Here is my detailed history:

Blood Type B negative; Husband is O positive
Rhogam shots after each loss.
M/C #1 @ 6 weeks -- January 2007 (low betas, chemical)
DS born December, 2007 -- natural conception. Uncomplicated pregnancy. Carried to term. DS also has B negative blood.
M/C #2 @ 5 weeks, June 2009 (low betas, chemical)
M/C #3 @ 5 weeks, September 2009 (low betas, chemical). Had basic RPL testing -- all normal
M/C #4 @ 6 weeks, February 2010 (chemical)
More RPL testing: DH had 36% DNA fragmentation, I had 66% NK cell activity (but this was regular blood test NK cell…not uNK)
TTC hiatus for 3 months while DH went on antioxidant therapy; DH retests: DNA Fragmentation reduced to 10%
October 2010: NK cells now normal – low end of normal!
M/C #5 @ 11 weeks: November 2010: Saw HB at 7 and 8 weeks; NT scan at 12 weeks reveals baby died at 11 weeks. D&C Feb 23rd 2011
July 2011: Genetic results back: 46 XX -- Normal girl but high chance of maternal contamination and degradation of sample due to being in freezer for months. Omphalocele was noted on u/s. Told "something was wrong"
M/C #6: HCG 16 dpo: 77 HCG 19 dpo: 454. Blighted ovum 13/09/2011.
Decided to move forward with IVF with PGS testing through Natera. March 1 2012: 23 eggs retrieved, 19 mature, 15 fertilized with ICSI. 11 made it to day five and were sent for testing; 4 came back normal XY (all boys and all 4BB quality). The rest all had multiple chromosome issues despite high quality looking blasts.
Issues with the aneuploidy ones were both of maternal and paternal origin.
FET May 29. Transferred on expanding 4BB blast. BFP 5dp5dt but HCG only 24 at 10dp5dt. Chemical pregnancy.

Thank you!!

Dr. Braverman

1999 Posts
RE: If IVF with PGS still results in loss, is it likely an immune issue? Posted on: Jun 10, 2012 at 6:43pm
I am very sorry for all your losses. Even with the translocation history , you MUST have an immune workup once you have failed transfer of normal PGD embryos.
Not sure what you mean by 66% NKactivity I would have to see that I have never seen one that high before doesnt sound right.

I would be happy to help you complete your workup and then try and get this right for you.

call my office and schedule a telephone or SKYPE consultation and I would be happy to guide you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

kinipela

4 Posts
Reply RE: If IVF with PGS still results in loss, is it likely an immune issue? Posted on: Jun 10, 2012 at 8:41pm
Thanks for your quick reply.

Re: NK Cells, not sure how much stock I should take in these numbers since this was not specific to uNK but the original report said:

Natural Killer Cells CD3-/CD16+/CD56+: 0.66
Reference range: 0.14-0.54 x10E9/L

They said this suggested autoimmune activity, even though all of my autoimmune/alloimmune panels came back within normal range.

And then when I re-tested one year later, they were now below the reference range at 0.13!

I'm in Toronto, Canada -- how does it work in terms of a consultation and moving forward with you if I am already working with a local RE (and my PGS normal embryos are frozen with him) in case he is not receptive to pursuing these tests/writing prescriptions for subsequent treatments?

Dr. Braverman

1999 Posts
RE: If IVF with PGS still results in loss, is it likely an immune issue? Posted on: Jun 11, 2012 at 6:20am
Its best to call and schedule a SKYPE or telephone consultation and we can get the testing we need done where you live and then I can answer the question about whether you need treatment for your remaining normal PGD embryos, but I would not transfer them with out the correct information. It is not unusual to see variations in single cells such as the 56/16 NK cell .
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.