Should I Do Further Immune Testing

Cocopops

0 Posts
Reply Should I Do Further Immune Testing Posted on: Jul 27, 2011 at 9:20pm
Hi Dr Braverman,

Firstly, thank you for being so generous with your time and for sharing your considerable experience. A friend on FertilityFriends.co.uk recommended your site and I've found it incredibly helpful.

My history in a nutshell:
Me 38; Partner 46
TTC 3 1/2 years
Comprehensive IF investigations for me & partner - all fine = unexplained infertility
1 natural PG 2 yrs ago = missed m/c at 8 weeks after seeing HB
Since then 3 failed IUI's; 1 IFV = BFP but sac, but no fetal pole or HB at 6 weeks
Karyotyping tests: all good
Recurrent miscarriage profile - everything fine except the following:

I have Factor V Leiden; Active Protein C resistance 0.57 (range 0.90 - 1.20); Protein C clotting Assay 0.38 (range 0.60 - 1.40). This will be treated with Clexane next cycle.
Question 1: Is Clexane enough for multiple clotting disorders? I'm not sure of the dose yet, but I will start during stimulation, pause for EC, then carry on.

But here's the main snag....

My IVF clinic says that my results don't point to an immune issue, but these worry me:

CD8 % 14.28 (normal range 15.89 - 40.37)
CD4/CD8 ratio 4.34 (normal range 0.54 - 2.97)
CD19 % 14.6 (normal range 4.16 - 26.11 BUT I've read it should be lower than 12)

Question 2: Do you think I should see an immune specialist and go for further tests (such as the Chicago tests) or am I fussing?

Just in case you need to contextualize things:

Haemotology: all withing normal range except MPV at 15.0 (normal range 7-13)
Clotting Screen: all withing normal range

LYMPHOCYTE IMMUNOPHENOTYPE WHITE CELL COUNT 5.40
Lymphocyte count 2.23
Lymphocyte % 41.3
CD3 % 76.3
CD3 (T Lymphocytes) 1.70
CD4 % 57.89
CD4 1.29
CD8% 14.28
CD8 0.32
CD4/CD3 % 57.30
CD4/CD3 (Helper T Lymphs) 1.28
CD8/CD3 % 13.20
CD8/CD3 (Cytotoxic T Lymph) 0.29
CD4/CD8 ratio 4.34
CD5 % 76.1
CD5 (Absolute value) 1.70
CD16 % 9.92
CD16 (Absolute value) 0.22
CD19 % 14.6
CD19 (absolute value) 0.33
CD56 % 8.86
CD56 (Absolute value) 0.20

Please let me know if you need anything else, such as the normal ranges given.

Best wishes,

Cocopops

Dr. Braverman

2016 Posts
Re: Should I Do Further Immune Testing Posted on: Jul 28, 2011 at 11:54am
Hello, Im very sorry about your losses. First , yes the clexane is good for multiple findings on thrombo but the levels must be followed to assure adequate dosing especially in light of multiple findings. As fo the immune panel, you must understand that there are so many subsets of each of the cell lines i.e. CD8 CD4 CD3 and 56 that just looking at the totals does not give you the information you need to decide on whether therre is a need for immune management.

I can order our complete reproductive immune profile for you as well as manage all other aspects of your immune treatments if you like. We can get your blood tests done where you are. Please feel free to call my office and schedule a consultation with me.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Cocopops

0 Posts
Reply Re: Should I Do Further Immune Testing Posted on: Jul 28, 2011 at 2:29pm
Thanks, Dr Braverman - I thought that might be the case. I've contacted your clinic via email for some info about phone consultations etc.

Thanks again, your help is appreciated.

Cocopops

Dr. Braverman

2016 Posts
Re: Should I Do Further Immune Testing Posted on: Jul 28, 2011 at 11:43pm
I look forward to speaking with you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.