Dr. Wang @ SIRM

     I finally got the opportunity to meet Dr, Wang at SIRM CT, my new RE, a couple of weeks ago for a 3D saline sonogram and some basic immune testing. Prior to this appointment, my thrombophilia panel showed a heterozygous MTHFR mutation (you can read more about MTHFR here). I also found out that my AMH has only dropped from .82 to .79 in one year, and my FSH actually went from 9 to 8.9 in a year. This is super good news because I was petrified that my fertility would have dropped significantly.

    So, I drove the 2.5 hours down to the office and met Dr, Wang. The first thing he said to me was "thank you" for driving down to his office. What?! When was the last time a doctor, especially a fertility doctor, thanked me for making the time to see him?! He performed the 3D saline sono himself, with a nurse and a PA student in attendance. The test went great, and we were able to see that my septum was successfully resected, and that no scar tissue is present in my uterus. Thank goodness! My septum had been 9-10mm and now it's down to 5mm, which still qualifies me as having an arcuate uterus, but shouldn't cause any issues.

The nurse then drew blood for the NK Cell and Th1/Th2 tests. Those test results came back last week. As Dr. Wang described it, NK cells are a component of our immune system that suveys the endometrium for bacteria and viruses, and attacks them when needed. He stated that they are also important in the regulation of embryo implantation since that can sometimes be viewed as an invasion of the endometrium. When NK cells are overly active, the theory is that they attack an implanting embryo which causes infertility, but more commonly miscarriages. He said that a normal NK cell level is less than 15%, and mine came back at 4.2%. Phew! This was super great to hear, as the commonly prescribed treatments for NK Cells are IVIG (which often isn't covered by insurance and is super, duper expensive...like $2-3k/infusion) or intralipids (a concentrated fat infusion), which is not always successful.

Next, he tested my Th1/Th2 Cytokine Ratio. Dr. Wang said that most immune tasks can be broadly categorized into the Th1 and Th2 modes. He said the Th1 mode is more pro-inflammatory and used for destroying enemies like bacteria and viruses. The Th2 mode is more surveillance/observation, which is ideal for pregnancy.  He likes to see the ratio between the two to fall under the 95th percentile and mine is between the 90-95th percentile - so a high normal level. To err on the side of caution, he told me to be cautious and start the following:

1) Begin 2000mg of Omega 3 fatty acids a day as Omega 3s may be able to reduce Th1 inflammation
2) Continue with 2000iu of Vitamin D (there is evidence that Vitamin D aids in restoring the appropriate ratio...and, as I learned last week, aids in decreasing autoimmune processes in the body)
3) He is going to start me on 10mg of Prednisone during my cycle when we begin stimulation.

A girl on the Resolve forum said that her Th1 was off-the-charts high and is recommending Humira pre-cycle for her. So there are a variety of treatments for this.

Well, a new day brings some more infertility news...how many more issues can we uncover?!