too soon for consultation?

megduff22

0 Posts
Reply too soon for consultation? Posted on: Dec 12, 2011 at 7:59pm
Dr. Braverman,

I am 35 years old; my husband is 37. We have been TTC for approximately three years with no success. I have a bicornuate uterus and when undergoing laproscopic/hysteroscopic surgery in January 2011 to shave down my septum, my RE discovered early stage endometreosis. Because of the endo and a slight male factor, we proceeded straight to IVF in August 2011. I responded well to the stims and was able to recruit 16 eggs, 9 of which were fertilized through ICSI. At day three, we transferred one embryo and froze six more. That cycle ended in a chemical; the day of beta, my hcG was 13 and my estradiol was 4. We just finished a FET cycle where we transferred two day-three embryos. Because of the low estradiol the first time around, I was on estrace and was monitored closely. The cycle ended with a negative beta.

I have a family history of autoimmune disorders (a maternal aunt with Guillame Barre, a cousin on my mother's side with MS, multiple cousins on my mother's side with various thyroid disorders, etc.) and my husband had severe ulcertive collitis (he has had his colon removed). With the two IVF failures and the family history of autoimmune disorders, I asked my RE to run some immunologic testing. He ordered the following: LAC, Anti-B2 glycoprotein I (igG and IgM antibodies), anti-thyroid antibodies, antithyroglobulin AB, antithyroid peroxidase AB, ACA, and ANA.

My question is whether I should wait to see what the results of the bloodwork is before arranging a formal consultation with you, or whether I should jump in for more testing right now? Does it sound like an immunologic issue to you, and either way, what additional testing do you think is necessary? We are 100% out of pocket for all ART so I don't want to be overly aggressive if it's not warranted. At the same time, I don't want to go through additional FETS and use up all of our remaining embryos if I could be diagnosed and treated for whatever is causing the implantation failure.

I'd really appreciate any help you might be able to offer!

Megan

Dr. Braverman

2004 Posts
Re: too soon for consultation? Posted on: Dec 13, 2011 at 3:06am
regardless of what the results are for the antibody screens that are being run , you require a full cellular immune profile. You have a very significant history (both self and family) and most likely have an immune component to your failures. The endometriosis alone usually has an activated NK cell component and the family history of autoimmune may show itself with regulatory dysfunction making it difficult for the embryo to generate immune tolerance. Please call me and i will be happy to get this testing started and outline a plan for you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.