Unexplained no more.

Last night I had my follow-up appointment with Dr. Sher. It was short and to the point, which is ok with me.

My Natural Killer cells are activated. Is that even the right way to say that? Also, my blood work was positive for antiphospholipid antibodies, including, but not limited to, the “bad ones”, a-PS, aPE, and aPC.

Dr. Sher says this is why I haven't gotten pregnant. His protocol for me would be Intralipid+Heparin+IVF.

After we hung up the phone, I cried. I cried tears of relief, tears of scared-shitlessness, tears of realizing that I will probably never be able to conceive the "normal way". The way that most people do it. The way crackheads and teenagers do. It's a tough pill to swallow, to be honest.

But it's not like I wasn't expecting it. I figured there would be *something*, ya know? And I've never been one for following the crowd. My body just decided to follow suit with how I live my life. That's what I'm telling myself, at least.

So having the night to think on my diagnosis and options, I came up with a list of questions for Dr. Sher and his office. He had mentioned to me that I am eligible for their Micro-IVF program, which is $6250 + meds. There is no difference between this and normal IVF, other than I won't require as much tender loving care. Couples who have severe male factor or ovulation disorders do not qualify for Micro-IVF, and neither do women over a certain age.

I called Dr. Sher's office when they opened to ask my questions. The only one I was able to get answered on the phone was the cost of the Intralipid treatment. It's usually around $300 per infusion, and I would require two, most likely. One prior to my IVF, and one after a positive beta.

The receptionist gave me Dr. Sher's email, and I emailed him the rest of my questions. She recommended making them short, otherwise he may want me to call back in for another consult instead of responding directly to email. Luckily, he responded to my email! And in less than an hour. How's that for service? I love this man more and more each time we communicate!

Here is the Q&A that transpired earlier through email:

Me: What level of NKa do I have? I have read there is low, borderline, normal, high, etc. 

Geoffrey Sher MD: Anything above 10% killing is abnormal. The range of abnormality is usually between 10% and 12%...so in your case, given that a reading was at 10.7% puts you firmly in a distinctly abnormal category.
Me: Are my NK cells activated because of the APA?  

Geoffrey Sher MD: Almost certainly, yes.
Me: Which type of APA did I test positive for? (I read there are 21 types, including Lupus)

 Geoffrey Sher MD: A wide range were abnormal, including (but not limited to the “bad ones”, a-PS, aPE, and aPC. The APA results were thus strongly +ve!
Me: This is an autoimmune disorder, correct? As opposed to Alloimmune?

 Geoffrey Sher MD: Almost certainly…yes! But to rule out alloimmune implantation dysfunction completely, we would need to test both you and your husband for DQalpha and HLA similarities.
Me: What about low-dose aspirin + Heparin to treat the APA? Or is the Intralipids for the NKa enough? 

Geoffrey Sher MD: We would add low molecular weight heparin (Lovenox or Clexane) but no aspirin should be used.
Me: Is it possible to do Intralipids + IUI prior to IVF?

Geoffrey Sher MD: Yes, but: a) the success rate is low (about 12-15%) b) with such a low success you would have to take steroids and IL each time and c) (most importantly) your prior poor response to stimulation suggests that your ovarian reserve could be diminishing and as such you simply cannot adfford to waste time on a lesser procedure such as IUI. 1 attempt at ET (with blastocysts) would improve success potential about 3-4 fold. 

Me: Any insight you could give me would be great! I didn't want to take up your time in a phone call, so if these could be answered via email, I would really appreciate it. 

Geoffrey Sher MD: If you want to talk again, call and set up another phone consultation. 

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I then sent a couple follow up emails with more questions. Here they are:

Me: Wow, thank you so much for your quick response! I really appreciate it. I'm doing my best to try to learn everything I can about this. I like being informed. Thank you again, and hope to meet you in person soon! 

Geoffrey Sher MD: Excellent!

However please be aware that out of “ignorance”, “arrogance” or both, many RE’s shun the concept of immunotherapy for IVF. Unfortunately this makes patients such as you potential victims. The truth is that the field of reproductive immunology is far more complex than IVF itself and most simply are not informed adequately. Even though the number of “believers” is growing by the day (simply go to Google to see) “Immunology in IVF” unfortunately has become a political football.

GS

P.S. Please read my 2 very recent blogs at www.IVFauthority.com on immune issues.

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Me: How many embryos would you transfer for my IVF? 

Geoffrey Sher MD: I would suggest two!


Me: So because my blood work was + for Antiphospholipid Antibodies, does this mean I have Antiphospholipid Antibody Syndrome? 

Geoffrey Sher MD: No! 

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So that's that! I have been pricing out hotels and plane tickets. Buster is officially ON BOARD for Vegas IVF!! He loves Dr. Sher as much as I do. I think it's because Dr. Sher called him a stud when I asked about the sperm DNA testing we had done.

I've found pretty affordable flights and hotels, so my only real issue is getting the time off from work. I've googled "FMLA for IVF" and found that many people were able to use FMLA. I think I would just need Dr. Sher to write something saying that I would be unable to work for 3 days. I will not have any vacation or sick leave to use, so my choices are:

• FMLA (unpaid time off)
• Regular unpaid time off, if they would grant it
• I could plead my case for working from the hotel. I have a powerful laptop that would allow me to do the work I need to do.
• Don't go to the beach in July with my family, and use that time for Vegas. I know, this seems like it would make the most sense, right? But I just can't agree to this option right now. I am sooooo looking forward to the beach. We didn't go last year, and I need it. But, if this was my only choice, I'd do it.

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Any advice/info/opinions on what you've read up there would be BEYOND appreciated, especially if you have had a similar diagnosis.