# Natural Killer Cells Testing



## Sueorr (Jun 28, 2012)

Hello,
I'm undergoing IVF at Guy's hospital in London. I have had 1 fresh transfer and 1 FET. Although my embryos are good quality they are just not implanting. 
I read about IID and NK cells online.
However, my consultant at Guy's said that they do not believe in it and will not test it at Guy's. However I want to get it tested just in case, and if anything, to save us heartache in another failed FET.

Has any of you ladies been in a similar situation? Can you pls suggest where could I get them tested? Can it be done via my GP?

Many thanks
Sue


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## Pudding34 (May 13, 2013)

Hi Sueorr

Sorry to hear about your BFNs.

I don't have any experience in NK testing but I am in the same position as you.

I got my second BFN after my first FET on Sunday and I am completely devastated.

Both times I got early BFPs on HPT which turned to BFNs on test day so look like chemical pregnancies even though my clinic doesn't really recognise early HPT tests.

Have you had any positive tests or do you not test early? I only tested early this time to see if it happened again!

I would be very interested to hear any advice or recommendations that anybody passes to you as I think that I need tok now why this is happening to me!

Pudding
X


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## Cay23 (Jan 12, 2011)

Hi Sueorr,

I'm sorry to read that your fresh cycle and FET were unsuccessful  

NK cells testing is quite new and controversial and that's why some clinics don't do it - my first included, who gave us a diagnosis of 'unexplained'. Unfortunately GP's are also unable to do it, as it's quite a complex test. I had three fresh and two frozen cycles before having my NK cells tested.

After our NHS cycles finished, we did a lot of research into immune issues (see Alan Beer's book Is Your Body Baby Friendly?') and decided to go for a fourth cycle at the Lister Fertility Clinic on Chelsea Bridge Road, as they do immunes testing. We had a very thorough consultation (£205) and based on our history the consultant recommended NK cell testing, a Thrombophilia panel and a DNA sperm fragmentation test for DH. 

The NK cells test is a blood test and the Lister do three things:

1) They check the overall number of NK cells, which has to be under 200. Mine was 179, so that was ok.
2) They test for the 'killing power' or potency of the NK cells you do have (this is called the cytotoxic assay). It has to be under 20% for an embryo to be 'safe'. Mine was 37%! 
3) They mix the cells with three drugs in the lab which can be used to reduce the killing power - steroids (Prednisolone tablets), intralipids (an infusion) and IVIG (intravenous immunoglobulin - an infusion), to see which is most effective at reducing it to a 'safe' level. Mine was IVIG which reduced it to 12%.

I understand how you feel about wanting to find out why your embryos aren't implanting. I felt the same way before the immunes tests, but now I feel like we finally have a proper diagnosis and some hope.  

Good luck xx


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## Sueorr (Jun 28, 2012)

Cay 23, thanx very much for your detailed response. I think I will call Lister to get an appointment.

Pudding, I know what you mean. This emotional toll of hope and disappoint with every cycle is just getting to me now. I did not do any early testing, dint have the courage!
My consultant at Guy's has asked me to go through a hysteroscopy to analyse my womb. You might want to get that done.

It's been a terrible 2 years since we started trying.

All the best xxx


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## Pudding34 (May 13, 2013)

Thank you Cay23,

Our clinic said that if we had three or more failures they would give us the drugs anyway but it seems form your post that here are different types of cells  and different therapies so perhaps testing would be best to make sure we are doing the right thing.

Sueorr I know that early testing can be scary and it is it's also very hard to have a positive and then have it taken away, after our first chemical which I found out because I was bleeding early so took a test at 6dp5dt just to get over it, but it cameup BFP even though I was bleeding we decided to start testing this time at 5dp5dt and didn't get a BFP until 8dp5dt so I got my hopes up as it had lasted longer this time.

I also had lots of symptoms and so when it was BFN on OTD I was devastated and every time it think of that BFP it hurts a bit more but in the larger picture I hope it will help having that knowledge for a future cycle.

I just wish I could rewind to Friday or Saturday when I has happy in my little cocoon of hope but I cant and I have to find a way to move on, as impossible as that sounds right now!

I started a negative cycle buddies thread on the negative cycle board and a lovely lady by the name of Tiffanymi has joined me you would be most welcome to join us and hopefully together we may be able to find a way through this hideous gloom at what should be a wonderful time of year!

Hugs

Pudding
X


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## agate (Nov 14, 2008)

there is a lot more info on this topic in the immune issues part of the board here:

http://www.fertilityfriends.co.uk/forum/index.php?board=52.0


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## loopee8 (Dec 19, 2011)

Hi Sueorr and Pudding
I hope my experience will help you, even in some small way. I went to the Lister clinic also where I was told that implantation failure and early miscarriage could be a result of 3 possible things: blood clotting issues, thyroid issues or high NK cells so I had all 3 tested at the Lister. As you can see from my history I had a failed NHS cycle where they tested for none of these, then I had my first fresh cycle at the Lister when I miscarried at around 8 weeks, so before my 3rd cycle the Lister recommended tests for blood clotting issues, made sure my TSH was below 2.5 (even though NHS consider anything below 4 to be normal, but reproductive immunologists think it should be below 2.5), and also did the same NK cells assay test as very well described by Cay23.
My thyroid was slightly high so I have been on levothyroxine since April this year. I didn't have any significant blood clotting issues but they had me on Clexane injections up until week 12 of my pregnancy as a precaution, and my NK cells were very toxic. The killing power was 39% (instead of under 20% they consider normal) but IVIg reduced their toxicity to 14%. So I had IVIg infusions on day of Egg Collection, week 6 of pregnancy and week 11 of pregnancy. IVIg is by far the more expensive solution (steroids and intrapallids are cheap in comparison) but IVIG was the only one that had an effect on the killing power of my NK cells.
I am currently 27 weeks pregnant - so I am hopeful this is my take home baby! I can feel him kick as I type 
The Lister Doctor was very honest and said to me that reproductive immunology is a very new science and he can not be sure if this pregnancy is working because of the thyroid meds, the clexane, the IVIG or if it was just 'the one' embryo that was the strongest and destined to survive. So it is not an exact science but I felt I had to try everything possible on this 3rd IVF attempt as the failures were heartbreaking and I wanted to at least say I had tried everything I could......fingers crossed it has worked for me this time (Yes I am still a paranoid pregnant woman despite having a huge belly and reaching 3rd trimester this week!)

Best of luck to you ladies

feel free to ask any more questions if you think I can help (I don't know 1% of what Agate knows, but I am happy to talk about any of my personal experience if it helps)
x


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## Cay23 (Jan 12, 2011)

Pudding34 said:


> Thank you Cay23,
> 
> Our clinic said that if we had three or more failures they would give us the drugs anyway but it seems form your post that here are different types of cells and different therapies so perhaps testing would be best to make sure we are doing the right thing.


I would recommend it. When I had mine done steroids reduced the killing power/aggressiveness to 23% and intralipids to 29% so still above 20%. IVIG is the only thing that reduced it to below 20% so the only thing that will work for me. This part of the test is called the Cytotoxic Assay - some clinics only test the first part, how many overall NK cells you have (which was a normal amount for me).

Congrats on your pregnancy loopee8! I have every faith so far in the Lister 

xx


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## Pudding34 (May 13, 2013)

Hiya

So I have called the Lister we have an appointment on Thursday this week.

My clinic are putting together a pack of info to help with the consultation.

I am starting to see some kind of possible hope again and I know this high won't last and I'll be mourning again soon but at least I have something to focus on.

Many thanks again for your help!

Pudding
X


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## loopee8 (Dec 19, 2011)

good luck Pudding
I had a missed miscarriage December last year so I know exactly how you feel about feeling blue this time of year :-(  5 days before Xmas I was in hospital having an ERPC. Devastating. The only positive I could think about was that I could drink some wine, or a lot of wine as the case may be!! But there is hope, so don't give up. I hope the Lister gives you some good advice. Happy holidays and indulge yourself


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## Pudding34 (May 13, 2013)

Thanks loopee8

I will definitely be indulging my two loves of wine and chocolate over the festive period.

The lady I spoke to at the lister was really helpful and has given me a new ***** of hope through this awful fog of another failed cycle.

Congratulations on your pregnancy.

Pudding
X


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## Sueorr (Jun 28, 2012)

Hi everyone, thanx very much for all the info.
Is it possible to get the NK testing done on the NHS via GP referral?

I just called Lister and they said I had it come for an initial appointment as I'm not registered there. So that means £205 for initial appointment + £590 for the test+ £145 for the follow-up. This seems very expensive.

Pudding, are u having to pay for the initial appointment as well?

Sue x


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## geegg13 (Dec 8, 2013)

I am really pleased to find this thread currently on 2ww of first icsi attempt I have been researching lots of things on the net over the past couple of days and if this cycle doesn't work then I am def going to go down the above route for testing I know it will cost a lot of money but being self funding and paying 7 k per treatment it is less in the long run !!!!!
Please add as much info as possible ladies it all helps !!!


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## Pudding34 (May 13, 2013)

Hi Sue

Yes we are paying for the initial appointment and then they will give us an idea of the additional costs for the tests that hey think we need.

I know it may seem like a lot of money but to be honest as my clinic doesn't do immune testing I am happy to pay out this money if there is a chance that they can give us a answer as to why the chemicals have happened and maybe give us a chance at a successful cycle.

Do you think you will book an appointment?

Pudding
X


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## Sueorr (Jun 28, 2012)

Hi Pudding,

Yes, I guess in the grand scheme of things, the cost is not a bug deal. I have booked an appointment for this Thursday as well. Would you like to catch up?

Sue


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## Luck2014 (Oct 1, 2013)

Hi 

They do testing at Warwick for £360.


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## jane29 (Aug 11, 2013)

Hey i don't know the answer to that but i was reading about something called Intralipid Infusion the other day and how it can be beneficial for things like this and repeated miscarriages x


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## agate (Nov 14, 2008)

there is info on the costs at quite a few places and about intralipids in the immunes section of the board http://www.fertilityfriends.co.uk/forum/index.php?board=52.0

(its a big topic!)


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## Pudding34 (May 13, 2013)

Hi Sue

So glad you booked an appointment, I think it is helping me to have something new to focus on if you see what I mean. 

It has in some way restored some semblance of hope in my heart although the pain is still almost unbearable when I stop being busy and think about it.

My clinic asked me to carry on with my drugs and test again this morning and of course it was BFN and it was like another knife in my heart.

Will be on a a tight schedule tomorrow in London as we live outside London but it would be great to compare notes on here or private message after our appointments to see what they said!

Deep down inside I am scared they won't find a reason for the he implantation failure and we will be back to square one!

Pudding
X


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## Sueorr (Jun 28, 2012)

Can't agree with you enough Pudding, that's exactly how I feel as well. I feel so overwhelmed with everything I need to do next and at the same time so scared to even hope. 
Hopefully it will get better.
Yes let's chat on personal mail after our appointment tomorrow.

Sue x


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## Pudding34 (May 13, 2013)

Hi Sue I just sent you a PM.


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## simi0100 (Mar 17, 2011)

Hi Pudding,

Just been reading these posts.  I am based at Guys and have been told the same thing that they don't believe in NK testing etc.  I am due to start ivf again in Jan but keen to get these tests done beforehand if possible.  can you tell me how long it takes to get all the tests done?

thanks
Simi


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## Pudding34 (May 13, 2013)

Hi Simi

We had our first consult at the Lister the week before Christmas and had our blood drawn for the various tests; karotyping for DH and thyroid, clotting and nk cells for me.

We were told that the longest tests, those for NK as they are more involved, they test the various possible treatments as well to see what your nk cells will respond to if they are found to be high will be about a week and the others a couple of days.

With Christmas closing it's been a bit longer for us but I am hoping that they will be able to give us at least all but NK when they open again on the 2nd and an idea of when the NK tests will be available.

I hope that that helps, if you are in any doubt of doing these tests I can tell you the Lister were amazing, really helpful and easy to understand, this can all be very complicated but they made all those complicated technical terms easy to wrap our heads around, also I have spoken to a couple of women on here who have had many disappointments until doing immunes and had success. Of course I know nothing is a magical cure and it may not work for us but we have to have hope and we don't want to look back and think I wish I had done this or that.

Happy new year to you Simi, good luck with you upcoming cycle, let's hope all our dreams come true in 2014!

Pudding
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