# Immune Tests



## suitcase of dreams (Oct 7, 2007)

Hi all,

OK, so I know there is lots of information on FF on this topic, but I'm being a bit lazy and trying to gather my thoughts and relevant info in one place  

After 3 failed fresh cycles (plus the short lived BFP after FET), it has been suggested several times that I get some immune tests done. I have scanned through Dr Beer's book (will try to sit down and read it properly but found it a bit hard going tbh) but other than that have not really done any research into this area.

On previous cycles I have been on aspirin, clexane/heparin, and gestone. On my next cycle I will also be on 20mg prednisolone.

My question essentially is whether it is worth getting any immune tests done? Is there anything they would do differently with my tx even if I did get the tests? (bearing in mind that IViG is not an option as so few clinics do it and ARGC won't treat singles)

What do you think, should I go and see Dr ******* and get some basic tests done? Or am I wasting time and money when the main lines of treatment are aspirin, steroids and clexane anyway?

Thoughts appreciated,
thanks!
Suitcase
x


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## annacameron (Dec 16, 2008)

I understand exactly where you are and what you are asking. I actually posed a very similar query about a year ago on ff. I ddcided then not to bother and took the whole malarkey for natural cycles too. (great nuisance!)

One positive reason for getting the testing is that Clexane and Pred do have side ffects and you certainly feel weird on them. I wldn't take them if there were a chance I didn't need them. I think you have got the point re IVIg -if you had immune issues, some might respond better to the way that IVIg works rather than Pred. BUT...it's a big "if". Ditto Humira for high tnf, which is again a different immune issue. 

THe second reason for getting testing is that otherwise you will be more or less assumed to have chromosomal rather than immune issues. I personally would recommend eliminating the immunes NOW (ARGC 780 pounds or Lister 550, if your GP will do some) as otherwise it would be at the back of my mind all along. You need more clarity. 

Re your transfers, I was mulling over them. I myself agonised over why I was transferring perfect blasts and getting nowhere. I thought perhaps they were losing mitochronidral energy in the petri dish etc., or that I had immune issues or even that the embryologist wasnt great! 

I then read a posting here which said that someone had had genetic testing on 8 supposedly perfect graded blasts and that only one was chrom perfect. that shocked me into the realisation that age is SUCH an issue with genetics. SHe was 38/39. A friend (36) had 3/8 blasts test perfect genetically.  So I started to accept that immunes were probably a red herring for me at least. I tell you this so that you understand that it's probably not worth agonising over them. I do think it';s worth eliminating them though.  

PS Beer's book covers everything but is badly written and poorly structured. I summarised eveyrthing to make sense of it.  

PPS I do feel very much for you. You are being very brave and doing so much on your own. Feel free to pm me any queries.  xxx


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## ♥JJ1♥ (Feb 11, 2006)

Suity the complete panel of immunes won't be done via a GP, MR ******* (I paid about £1500 for tests and 2 appts, will do them for you- google the miscarriage clinic, he has clinic around London and Harley st, also Dr Gorgy (ex ARGC) will do immune testing and not treat you as a pt, I am not sure if he treats singles- he is under the fertility academy.  Also Dr Armstrong at the Portlnd- doens't do IVF but will do the immune tests for you- all three will do/arrange IVIG although Dr Gorgy will also do Intralipids- newer than IVIG and a fraction of the price! ARGC are not moving onto it yet. SIRM in the USA use it.
The complete set of immunes give you the response ratios to pred of different doses and the IVIG.

I personally think that steroids and cleanxe are ok and not too fussed about side effects of them but I have never had either of them for more than 2 wks.


The Immunology thread if very good source of info or pm Choice4 as she had been doing lots of research on them and had various cycles.

L x


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## ♥JJ1♥ (Feb 11, 2006)

CGH is the process that CARE are going to start doing, it has been avialiable widely at SIRM in the USA, (they work closely I think as CARE also use vaginal viagra) but I'd be interested in getting some info from you Rose.  PGD and PGS are not as realiable as first seemed.

Dr Scher can do phone consultations free of charge and he spoke to me about this, he said that i should go to to Las Vegas and have CGH instead of DE's, and then he would find an egg as good as a young donor (where out of my 3-4) and then bring a surrogate and have it implanted into her- he wouldn't put them back into me and I didn't have a surrogate so never went any further down that route.

L x


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## annacameron (Dec 16, 2008)

yes big issues with mosaicism and inaccurate testing as they can only test 1/8 of the cells. 

i suppose in terms of probability that means that there will be more embryos attributed "good" status when they are, in reality, "flawed" than vice versa. 

hmmm, just scared myself there. 

CGh I need to look into.


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## midnightaction (May 20, 2003)

*Suity*

To add my thoughts on the matter, I am one of the great unknowns, I apparently have nothing wrong with me but am unable to concieve. I have been an egg sharer twice and both times my recipient has become pregnant and I have not so my initial reaction was to assume that I had immune issues, and in fact I held on to the fact that immune issues were the problem and as soon as we could find that out I could take the correct drugs I would be pregnant straight away !!

Well I had all the tests done through the Lister (Who I would highly recommend, they are such an amazing clinic and could I afford another cycle with them I would be there in a shot !!) and every single test came back negative, including the NKC test which I was convinced was gonna be positive.

I really wish I had not had these tests done (but please bear in mind that is just my opinion !) because now they have come back negative I have nothing really to blame for my lack of pregnancy and I am even more confused then when I started

Please please please bear in mind this is just my personal experience and I would hate for you to decide what to do purely based on what happened to me, all I am saying is that for me the tests just made me even more confused and left me out of pocket but no closer to the thing I desired.

Sarah (Who would pay anything if anyone could actually tell her what the hell is wrong !! ) xx


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## Han72 (Feb 15, 2007)

annacameron said:


> yes big issues with mosaicism and inaccurate testing as they can only test 1/8 of the cells.
> 
> i suppose in terms of probability that means that there will be more embryos attributed "good" status when they are, in reality, "flawed" than vice versa.
> 
> ...


Scuse me for butting in guys but Anna, how can you say that? What is the probability that in a chromosomally damaged egg
1. there would be 1 cell which looks normal while the rest were banjaxed and 
2. that would be the one which was tested?

I have to admit that I haven't done much research on this one, maybe out of 8 cells you could have 4 normal and 4 abnormal which then does increase the chances of a damaged embie being classed as ok but it doesn't seem that likely to me As I understand it the best way around this is to test 2 cells instead of one but obviously this increases the chances of damage to the embie....

It's a proper hornet's nest this business innit?!

xxx


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## annacameron (Dec 16, 2008)

Nix, hi, 

to any embriologists i'm about to oversimplify, but the logic of it is something like this: 

1. they test 1/8 of the cells and they cannot test more without compromising the embryo's viability. So 1 out of 8. I am not sure if this automatically means the matching pair is the same. ie if you test 1/8 you get results for 2/8. 

let's assume 1. 


No mosaicism
2. (a) if the result is a "good" at 8 cells, there is still a chance that a "bad" could develop from then towards blast or beyond. This is why testing a cell of a blast (as per the US i think) is much more accurate. This is also why many embryos collapse between 8 cells to blast. So, a good can become a bad. 
3. (b) If it is a "bad", with no mosaicism, it is an accurate result. 

Mosaicism
3. if assigned a "bad" and there is a mixture of cells, again, these have plenty of time to replicate before reaching the blast stage. (Admittedly, a few embryos do self correct but this is mostly in younger women with a tiny % of "bad".) Again more "bad" can develop.  
if assigned a "good" and there is a mixture of cells, the same point applies - the existing bads will replicate and again more problems could develop splitting towards blast.

That's what it boils down to - extra splitting going awry before blast stage. 

i'm also starting to think, as I type, that, if you think going to blast makes sense to "weed out" embryos, you should be testing blasts not the 1/8.  Supporting use of blast culture but testing at day 3 are mutually incompatible. 

any other thoughts anyone?
interested to hear what any cons have said on it....


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## suitcase of dreams (Oct 7, 2007)

Thank you to everyone who has responded. 

I've been doing some googling and reading up on all this and I'm still confused as to what to do next!

I have this feeling (fear I guess - can really empathise with your post Sarah) that this is not an immune issue, but rather that my eggs are just old and poor quality. Given that I have been pregnant once (albeit for a brief 8 weeks) I know that I can get pregnant so it would seem that I do not have implantation issues

My gut feeling is that perhaps the cgh is what I need to be looking at - will read up some more on that, thanks for the offer of info Rose  

I'll continue to read up on the immune tests and consider getting the level 1 tests. Thanks to my hostile GP I know I'm going to have to pay for the whole lot and whilst it's a small price to pay if it identifies the issue and means it can be treated, I just have this gut feeling that the tests will all come back OK and I'll be left out of pocket and no wiser....

Gosh, it's all such a minefield isn't it....I shall ponder on - if there's anyone else out there with a view feel free to share it - might help me work out what next  

Thanks as always,
Suitcase
x


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## ♥JJ1♥ (Feb 11, 2006)

What are the pros and cons of doing the eggs vs embryos?  She-hulk had hers done at SIRM but infact got her baby from ARGC with CGH

L x


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## blueytoo (Oct 5, 2003)

Suitcase - I have an 11 year old and have been pregnant once since as you can see from my signature, but yet I have huge, massive immune problems. So you can't rule out implantation or immune issues from having been pregnant.

I didn't have my immune tests until after a couple of cycles and now wish I had them done at the beginning as recommended by the Lister. All that wasted money!! Steroids, clexane and gestone were not enough for me and so I then had the second level tests which showed that only IViG was ever going to be any use. Which just made me regret not having both level of tests at the start.

You have nothing to loose by having the tests. It would help you rule out a possible issue. I just hate to think of FF'ers living in regret like I have. Effectively I wasted many, many thousands of pounds on attempts at IVF, all along all my recipients getting pregnant as I was an egg sharer whereas I was not.

I've also spoken to Dr Sher and his opinion is completely inline and he states clearly that all my non-IViG cycles were a couple waste of time and money.


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## ♥JJ1♥ (Feb 11, 2006)

Coco - You're GP won't be able to do the full range of immune tests what are known as the Chicago Tests are not available on the NHS they may do simple anti coagulant tests, and if you want a full range of tests then you will have to go to other places Eg: Mr ******* - google miscarriage clinic (I was diagnosed there and then had a cycle at the Bridge with his drugs), other places to consider are Dr Gorgy who can do the extended panels, or Dr Paul Armstrong at the Portland or Dr Raj Rai who works at St Mary's recurrent miscarriage clinic but see private pts at 92 Harley St (google it and it comes up) they don't believe in immunes and look for other things like Lupus. ARGC will also do testing on their pts, as will CARE at Nottingham (Dr George Ndwuke is the immune expert there) and I believe that some of the Lister Drs are in the immune school of thinking.

There are some excellent links that you can read through on the immunology thread and also of course Alan Beers book, listing all the tests
http://www.fertilityfriends.co.uk/forum/index.php?topic=80433.0

Londonlou was the lady who introduced me to immunes (she had 4 mc) and started a thread, there was a cheaper way of getting them done and couriering them over to RFU in Chicago lab but ARGC closed that link and charge £700 more!!
http://www.fertilityfriends.co.uk/forum/index.php?topic=82741.0

Take care and good luck

L x


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## Annaleah (May 14, 2008)

Coco, 
GP may able to do thrombophilia screening test which includes factor v leiden, lupus, prothrombin and they should also be happy to check your thyroid function. as JJ1says they won't be able to do full range of tests. I know my clinic do not support NK cells testing because evidence is controversial.  I have Dr Beer's book which I've dipped into but don't fully understand it.

hope your appt with GP goes ok and that they are happy to do basic tests. 
Annaleah xx


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## Betty-Boo (Oct 14, 2007)

Coco I had my tests done at the hospital after my PE and before I started on this journey.  My consultant recommended them and didn't have to pay - probably because of history with clotting issues.
Good luck honey x x


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