Is My Body At War With Itself?
In part one of our three part series that talks about auto immune disorders we talked about what immune issues were, what some doctors think about immune issues and how they affect fertility and pregnancy.
In part two I want to talk about what does a basic immune panel look like? Below you will see a list of the basic blood work-up for auto immune disorders.
If you are thinking about doing IVF or have undergone IVF and you have had a negative cycle or have miscarried: (However, I think you should test before):
• Antiphospholipid antibody panel (APA)
• Antinuclear antibody panel. (ANA)
• Antithyroid antibody panel.
• Immunophenotype for NK cell number.
• NK/IVIg assay for NK cell activity.
Also very useful:
• TNF alpha (intracellular) assay.
• Gene mutations for inherited thrombophilias.
• DQ alpha genotyping (couple).
Leukocyte antibody detection/blocking antibodies.
What are these tests and what do they mean?
Antibodies are specific kinds of cells that are supposed to help our bodies attack foreign bodies, like different bacteria from colds and infections. However, sometimes, the body mistakes its own cells (like a embryo attempting to implant into the wall of your uterus) for invaders and attacks them, causing a whole different set of issues like miscarriage or failure of the embryo to implant where it’s supposed to.
Antiphospholipid antibodies are proteins that circulate around in the bloodstream. These proteins bind to cell membranes, making them sticky. This prevents our blood from flowing properly, resulting in blood clots. These antibodies can endanger the health of both you and your baby.
In women with auto immune diseases these antibodies cause inflammation in joints and organs. Think Rheumatoid or Osteoarthritis, Lupus, Celiac disease, Graves’ disease and (over active thyroid), Hashimoto’s (underactive thyroid) just to name a few. In women with no auto immune diseases but a positive antibody, the antibody causes inflammation around the embryo at the time of implantation or in the placenta after implantation. This kind of inflammation is exactly the same as occurs if you get a sliver or develop a pimple — The tissue around the area gets hot, red and swollen and it can happen rather quickly.
So you might be wondering who the heck has these Antiphospholipid Antibodies? Well, yes they can cause issues and yes they are a pain in the neck but 5-10% of the population in in the world that’s healthy has these antibodies in their blood with no issue. The levels these individuals have is very low and that’s why they don’t cause problems. When the levels become high that when the antibody issue comes into play.
We find that those who have antibody or immune issues are also found in the folks who have
• Unexplained infertility
• Migraine headaches
• Deep vein thrombosis
Not to complicate your life further, but there are several complications that are associated with high levels of antibodies especially the antiphospholipid antibody and those are:
• Blood clotting
• Heart attack
And to tie this all together we often find that higher level of antiphospholipid antibody are often associated with unexplained infertility including:
• Recurrent miscarriage
• Placental insufficiency
• Implantation failure
• Increased rates of IVF failure.
Word on the street is that that antiphospholipid antibodies reduce the efficiency or compromise the job of the placenta which nourishes your baby. Because the antibodies cause clotting, the embryo is cut off from oxygen and nutrient support. Because of this spontaneous miscarriages can happen the clotting factor can also cause distress to the placenta, which makes it harder to have a successful implantation.
When we receive our results the tests are measured in what we refer to as titers. What is this? It’s a measurement of how much of your blood can be diluted until there are no more antibodies present. There’s three results – normal, borderline (which many fall into), or high. High levels are between 1:100 and 1:400. So if you have a high level of antibodies in your bloodstream it’s possible that these antibodies might be what’s preventing you from getting pregnant or causing repeat miscarriages.
Your doctor will discuss your results and together you both can develop a plan of action.