A new direction

Following the last transfer (#6) I was so convinced it hadn't worked that I made a call to a Reproductive Immunologist, Dr Gamal Matthias, who specialises in recurrent pregnancy loss and IVF implantation failure. I learned about him through ladies on various forums that I read. He is one of 2 RIs in Australia that treat for Natural Killer cells and immune issues they way they are treated in the USA and UK (agressively). A lot of FSs are against the protocol he uses, but we're running out of options so we manage to get an appointment for early August to see him.

He is a lovely man. Very proactive and reassuring. He booked me for a Hysteroscopy (to check the uterine cavity for polyps, fibroids and lesions) and Endometrial Biopsy (to test for NK cells). I also go for more blood tests. Surgery was done the following week with a follow up phone consultation 3 weeks later. He found:

- 4 polyps in the uterus. Even one polyp can severely impede an embryo's ability to implant. They almost work like an IUD. So having 4 was not good. But Dr M removed them and said that other than the polyps there was nothing else unusual.

- Acceptable levels of CD 57 Natural Killer cells (uterus)

- High Levels of CD 56 Natural Killer cells (blood). If you don't know about NK cells here is an excerpt from a website:

There are several different types of cells used by the immune system which can determine whether the body will attack or accept the embryo. When this attack does occur due to immune system errors, it can continue to cause multiple miscarriages until corrected. One of the most influential cells in this respect is the natural killer cell (NK cell). These cells are, as the name suggests, designed to kill other dangerous cells and will do so when given an activating signal. In cases of immune system error, NK cells may mistakenly attack the embryo and the attack will continue unless the cell receives specific signals to cease. Certain tests can determine whether or not NK cells are attacking cells, as we have learned that there are many subsets of these NK cells and not all are harmful to the embryo.

Dr M advises me that he recommends an aggressive immune protocol to be used in conjunction with my next IVF/ICSI fresh stimulated cycle. He feels confident that my NK cell levels, along with the polyps have prevented my embryos from implanting and that this can be overcome.

The protocol (and I must stress that this is specifically designed for my unique immune issues and should not be used unless under the guidance of a qualified specialist) is as follows:

Prednisolone: Begin 2-3 weeks before anticipated embryo transfer with daily dosage of 25mg. Increase to 30 mg on day of ET. Increase to 35mg if pregnancy test is positive.

Clexane Injections: Begin between day 2-5 of cycle. Stop 2 days before and day of EPU, and none on day of ET.

Antibiotic - Doxycycline: Begin 5 days before transfer. Take until finished.

Progesterone Pessaries: Double the dose recommended by FS. For me, this will be 400mg once a day from EPU, then increase to 400mg twice a day from ET. 800mg/day total. Had to get this strength made up by a compounding pharmacist. If positive pregnancy test this may be increased to 1200mg/day, depending on my P4 levels.

Intralipid Infusion: 1-2 weeks before transfer.

I bring this protocol to my FS who really has no choice to agree to let me do it. If he didn't I would simply have gone elsewhere. He says he has been hearing good things about Intralipids but is against the high doses of Prednisolone. Oh well! 

I book in for my third stimulated cycle. It will be antagonist with Gonal-F (150) to stimulate follicle growth, Orgalutron (to prevent early ovulation) and Ovidrel (trigger injection). All these, along with daily Clexane (blood thinning) injections have made my stomach look like this:

It ain't pretty. The awesome bloating is also from the drug cocktail. I think I'm actually getting worse at giving myself injections, not better! I've never had this many bruises before. 

This cycle so far has seen me jab a grand total of 26 injections in 11 days into my poor stomach :( I think back to my first ever injection that I had to do. I sat on the couch for about 45 minutes before I worked up the courage to jab it in. Now I can jab 3 times in under 30 seconds!

I'll continue after EPU with just one Clexane injection per day. If I get a positive result this may continue until about 30 weeks of pregnancy, so I better improve my technique!