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  1. #381
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    Default NK cells for crofty

    crofty asked: So theres a few of you out there getting an NK Biopsy - I have no idea what that is or what it's for??? can someone fill me in??
    So, OK.

    Here's an overview of immunology and NK cells. The immune system does go on to be much more fascinating than this account of the highlights.

    There are many different types of white blood cells that participate in your immune system. Each has its own particular way of patrolling the body and of responding to nasties. Although they're called white blood cells, many get permission to leave the blood****** and patrol through the rest of your body looking for trouble. The three most popular white blood cells are:

    * Macrophages (big eaters) wander around your tissues eating rubbish (bacteria and damaged bits of cells). Their keep things looking clean and tidy. They can often deal with little problems without needing specialist T or B cells to wade into the fight.
    * B cells make antibodies to fight things that are found outside the cells of your body. Mostly this involves killing or neutralising things that are in the blood******. Other body locations that are not inside cells include breast milk and the inside of your intestines. B cells make antibodies that are secreted into these locations too. (B stands for Bursa of Fabricius, which is the location of B cell kindergarten in birds. In people and other mammals B cells grow up in the Bone marrow. Handy that it also begins with a B.) But some nasty things prefer to live inside your body's cells which generally puts them out of a B cell's reach.
    * T cells attack things that are inside your cells. Mostly this involves destroying cells that have been hijacked by viruses that have taken up residence inside them. (T stands for Thymus. The thymus is T cell kindergarten and is located on top of your heart. It is not related to the thyroid which is at the front of your throat/neck.)

    Every cell in your body holds up a flag identifying itself as part of you (these are tissue-type markers that need to be matched for some transplants, they are also called MHC proteins). T cells inspect these flags for ones which aren't quite right which identifies that the cell has gone bad (eg. virus infection makes a slightly wrong flag and a mismatched transplant has a completely wrong flag). If T cells find something wrong then they seek permission to become armed and to fight/kill whatever they have found. But some viruses realise that if they make their hijacked cells hide their flags then they're completely hidden from T cells. To stop things hiding this way we need another white blood cell - NK cells.

    NK cells patrol the body looking for cells that aren't showing enough of the right flags. They go about armed and ready to kill, which is why they were named Natural Killer cells. Your healthy cells have to quickly show their flags and give the secret handshake in order to cancel the NK cell attack. The NK cell then moves on to challenge the next cell it finds.

    If your embryo was a clone of you (an identical twin), then the immune system wouldn't care about it. But your embryo is only half like you, and half like the genetic father. This means that if any of your T or B cells were to see it they would probably like to attack it for looking like the father. This is the issue for blood-type positive (Rh+) babies with blood-type negative (Rh-) mothers. The first such baby remains hidden from the mother's immune system during the pregnancy, but events during birth usually immunise the mother against that blood type, so any subsequent Rh+ babies will be attacked by the mother's immune system while in utero.

    Another consequence of the embryo only being genetically half-like you means that it might be a bit too slow at cancelling an NK cell attack, by having not enough of the preferred flags, and by being a bit clumsy at the handshake.

    It's reasonable to suppose that one reason why embryos don't implant is because the immune system is actively fighting it. The immune system isn't supposed to examine embryos, but sometimes cells like to go over and above their job description. In the uterus, NK cells are more common than T and B cells. Their numbers and activity seem to be greatest right when an embryo would like to implant, so NK cells are the prime suspects for this type of implantation failure. They have motive (genetic half-likeness), means (NK cell activity) and opportunity (right place at the right time).

    Uterine biopsies for NK cells are usually done at CD21 so as to get a picture of what's likely to be happening at implantation time. Both the number and activity (how good they are at killing) of the NK cells can be assessed. Activity might be more important than number. Some places offer a blood test, also done on or around CD21, to assess NK cell activity.

    If the tests indicate that NK cells are being overenthusiastic the treatment is to take drugs to suppress your immune system to give the embryo a chance to implant. Suppression continues through the first trimester. After that the embryo should be more robust to surviving little attacks and the pregnancy itself should be doing its own immunosuppression. This natural immunosuppression is why many autoimmune diseases go away during pregnancy - but they return afterwards.

    Treatment also includes blood thinners (e.g. aspirin or Clexane/heparin). I'm not sure of the reason for including this in NK cell protocols, but following are a couple of possibilities.
    * If a couple of really eager white blood cells decide to have a go at the embryo despite the immunosuppression, the resulting inflammation may recruit platelets and start causing blood clots, which isn't good for the developing bub, so blood thinners will minimise that potential for damage.
    * IVF for women with anti-phospholipid antibodies is more successful when treated this way. Women with NK cell issues are more likely to have anti-phospholipid antibodies. Phospholipids form part of the outside of every cell in the body (and they make some of the insides too).

    Even if specialists are right about the immune system being involved in rejecting the embryo, but wrong about the particular cells responsible, the treatments they use basically covers all the bases.

  2. The Following 4 Users Say Thank You to felicita For This Useful Post:

    EternalOptimist  (17-05-2011),PinkButterfly  (16-05-2011),SimpsonDesert  (15-05-2011),Waiit123  (19-02-2016)

  3. #382
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    Wow, thanks for that Felicita! I had a basic knowledge of what the NK cells do, but that really helps me understand! I wonder if the Rh+ baby thing affected me as I had my DD back in 2004 with nearly no issues (conceived on 4th cycle with Clomid) and ever since then I've had problems. I had a traumatic birth (pre-eclampsia, induced at 37 weeks, 10hrs of hard labour only dilating to 4cm, then finally an emergency c-section as my BP was sky high) so I just figured that my body decided it didn't want any more pregnancies! Can't wait to find out my NK cell results... Kinda hoping for a positive so I know what's wrong!

  4. #383
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    EternalOptimist - day 2 FSH. This story makes sense, so it's probably true. I think it's answering your question.
    When it's easy to grow eggs then less FSH is needed. That seems obvious since some girls need more GonalF/Puregon than others. For natural cycles the body uses the minimum amount of FSH to get one egg produced. You "remember" from one cycle to the next how much FSH was needed so the day 2 measurement reflects your responsiveness on previous natural cycles which shouldn't be very different to what's going to be needed on the current cycle. FSH keeps going up until oestrogen produced by the developing follicle says there's enough to work. So when it starts getting harder to develop a follicle (e.g. in menopause) FSH will get much higher before enough oestrogen is produced to stop it. Menopur is FSH (and LH) collected from the urine of menopausal women.
    It's a similar story for sperm. FSH tells testes to grow sperm. Successful sperm production produces testosterone to say enough with the FSH. But if sperm are hard to make or if none are made then FSH gets higher (and testosterone stays low).

    I don't know when EPU is yet (but I suspect Wed). Crazy body doesn't like being predictable. But my left ovary did come out of hiding for my first scan so that's got to be a sign of good luck for this cycle.


    PinkButterfly - The FSH I quoted from my clinic was their wish-list not a strict cut-off for treatment. It's in keeping with the numbers in the link you posted for me.
    I haven't asked about their oestrogen cut-offs yet - I've had too many other questions at my latest appointments.


    crofty - yes, IVFA is a private clinic. The Westmead office is on Mons Road near the T-way-only bridge.

    Your AMH will be what it will be whether or not you find out it's value or are pleased with what you find out. I like knowing as much as possible so I'd get the test done. Would you finding out yours affect (a) how your FS treats your cycles, eg. prescribing DHEA if AMH is low? (b) how you feel about continuing IVF - for better or worse? or (c) how you feel about donor eggs? Check out the poor responders thread and have a chat with the low AMH girls there. I (usually) have a reasonable response to the stims and no reports from the lab about egg problems, but my FS put me on DHEA for egg quality because we can't do anything to help our poor sperm. He told me it shouldn't cause any problems but that it might just help get us over the line.

    Puregon to GonalF. GonalF have recently redesigned their pens so that each pen has more options for doses delivered. My FN said that previously you couldn't manage some doses with the old GonalF pen and had to use Puregon instead to get the right amount. That could be the part of the reason behind your brand change.

    My first cycle I got AF 12 days after EPU (7 days after ET) while on crinone twice a day. Since then I've been much fussier with getting rid of the old crinone before putting in the new and have managed to keep progesterone above 30 until after my BT. FS & FN say 30 is high enough to sustain pregnancy and keep AF away, but my body says that's not exactly true. Are you able get your clinic to monitor your progesterone so you can intervene further if it starts dropping too low?

    Good luck with your next cycle.


    AFM - just jabbing away. On Friday the FS added a course of low dose pregnyl to this cycle because LH got too low! They make me come to the clinic every few days for that one. I haven't yet asked why they do it that way - it's probably to ensure that I don't inject so much that I trigger ovulation early.

    Enjoyed SILs wedding yesterday - the 3rd and last of DHs family to marry. Our nieces (the other SILs daughters, aged 2 and 3) stole much of the show. The minister started the service by saying that families include happy, noisy, active children and they are most welcome, but very shortly thereafter he picked up the youngest to "help" him with a bible reading, so as to stop the girls from playing so energetically together (spinning in circles next to the bride until they fall down laughing, jumping loudly off a step, playing with (pulling off) ribbons from the pews). Injection time very neatly fell in between dinner courses.

  5. #384
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    MrsDaisy- Sorry to hear your thyroid issue is taking some time to resolve. Does sound as though you have your hands full though with home loan arrangements and an upcoming honeymoon. Although it may not seem like it now, waiting a few extra months may be exactly what you need to get the non-IVF things sorted, and set you up for a BFP first go! Where are you going for your honeymoon?

    EO- At home, I'm not a keen shopper and I'm a huge tighta**e. But on my work trips its like I have this alter ego that can't get enough of shopping and I spend, spend, spend . Its like my brain thinks that 'cos its in another currency, it doesn't count. I have done exactly as you said, just worried how I'm going to squeeze it all into my luggage lol! Yay for O'ing early and fitting in the biopsy before your conference, must be nice to have your body cooperate like that .

    PinkB- yes it has been hard to tear myself away from the stores. I am loving the exchange rate, I checked my credit card statement on line and saw the charges were less than the checkout price . It has only encouraged me to buy more!

    Nat- Glad to hear the engagement party went well, would love to see pics. Hopefully your DD's b'day will go just as well. Very brave of you to take on 36 kids!! Good luck with your biopsy tomorrow, hope the procedure isn't too uncomfortable.

    Starf1sh- Oh I didn't realise your first lot of jabbing was to down-reg, I thought you had already been in the stim phase, dur! Well now you are officially stimming, I hope your ovaries are on their best behaviour and your follies will indeed reward you for the long break and extra goodies . I have bought some awesome stuff, will mention below.

    Quartz- that status update was beautiful.

    Crofty- I spoke too soon about the nice weather! Sure it was great in Louisiana & Missouri, but now I'm in Wisconsin and its super cold , high temps of 9-13 deg C. Apparantly there was still snow on the ground 2 weeks ago! Seems like you're having quite a few changes to your protocol for the next round, I'd much rather that than repeating what you know didn't work. Lets hope your FS has struck the magic combo . We also had some frozen sperm on stand-by incase there was an issue with DH's sample on EPU day. Thanks for going back and digging up the roll call, we'll need it now with quite a few of us about to cycle!

    Felicita- wow, your post on NK cells was awesome. Great analogy with the flags. The flower girls are always a big hit at weddings, clever of the priest to recruit one of them as a helper, probably not the first time he's had to do that to separate noisy kids! Very handy your injection fell between courses, although not sure how I'd manage having to jab in a public loo. Especially if it was an orgalutran shot, which I usually get DH to give me in the thigh. I could just imagine sneaking him into the ladies & us getting busted , we all know what the other person would be thinking .

    Big hello to everyone else

    AFM- I've moved on to chilly Milwaukee, Wisconsin. Its mid-spring and its colder than Sydney's winter *shiver*. Sat was so cold, windy & rainy I didn't dare venture out, 6 deg C is definitely indoors weather. Fortunately it was a little warmer the day I arrived and I was able to do some MORE shopping, yes there's a mall next to this hotel too . In Missouri, I picked up 2 nice dresses, 2 tops, t-shirts for DH, local beer bottles for DH's collection, and a really good backpack (I bought it to carry on board since I'll need to use my wheelie cabin bag for extra luggage & check it in). So far in Wisconsin I've bought a wool jacket, a nice dress shirt for DH & a few t-shirts for my nieces. There's still one more store to hit though, so I'm not done yet . Plus I've sent my brothers a store catalogue via email and expect they'll order some Nikes. The jacket I got is Calvin Klein with retail price $250, and I paid $80 'cos its end of season clearance . CK is a regular brand here, not premium like it is in Aust. I'd be lucky to pay $250 on special back home! I'm seriously worried about squeezing everything into my bags, may have to Fedex my work documents to make space! Oh well, that's a good problem to have hey?

  6. #385
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    Morning all! Yet another freeeeezing morning (I start work at 6am so I really get to enjoy it!!)

    I have my NK cell biopsy this afternoon at 4.15pm.... Arghhh!!

    I just hope it doesn't hurt too much (but I guess it's nothing compared to going through labour huh?!)

    I'll let you know how I go with it later on. Enjoy your day :-)

  7. #386
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    EternalOptimist is offline Never say you have failed until you have reached your last attempt; never say you have reached your last attempt until you have succeeded.
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    Felicita: Your description of the NK cells was awesome. I have read Dr Beers book about 4 times cover to cover and I still think your explanation is more thorough and easily understood (you must make a great Tutor). All the best for your EPU, I have never asked my estrogen levels before but I think I will definitely do so on my next cycle. Glad your injections were timed well, I hate doing mine when I am not at home, makes me feel like I am a junkie shooting up in the toilets. My clinic insist on them doing the Pregnyl injections as well, because too much can cause ovulation so they want to monitor it VERY closely.

    Nat: Goodluck with your biopsy hon, can’t wait to hear how it goes. I have mine on Friday. My FS told me to take 2 panadol 30 mins prior to my procedure, I still have Panadeine forte from my D&C so am gonna take one of these before. I have also locked in my follow up appt with FS on 7th June to go over the results.

    Lindylou: I like that way of thinking, not in Australian dollars so doesn’t count . I will try that with my DH next time we go overseas (might be a long way off for that though). I have brought too much on an OS trip before and had to send stuff home in the post to avoid huge excess baggage claims. From memory the US has large limits than most countries don’t they? I am starting to think that all those Sharkey herbs and vitamins etc that I have been taking somehow contributed to me O’ing on time. We just had a friend tell us over the weekend that they are 8 weeks pregnant from being on the Sharkeys stuff for the past 3 months, they have been trying for 3 years for a bub, it was great for DH to hear because its someone other than me spruking how good they are, I think it will also give him the extra incentive to do the right thing now (probably cause this will make us the last couple in our circle of friends who don’t have kids or are UTD now)

    Starfish: How are you going darl with your cycle? When is your first scan, I can’t wait to hear all about it. Well DH has been for 2 surfs last week and done 1 already this week, I don’t think it will last too much longer (he says the water is very warm) oh well I will just take what I can get him to do at the moment. He is still trucking along with all his herbs and supplements, so every little bit helps I figure. I agree, give it absolutely everything you have got this time around so that way you know you gave it your best shot .

    Crofty: I started out with lots of annual leave before starting our IVF journey, but each time I had a transfer I took the week off work, my boss is a very NASTY lady and the stress I have when I am around her is very noticeable so figured why not take the leave. Needless to say after 5 cycles, time for FS appointments, EPU, miscarriage and D&C etc i have none left now. Lucky I got a new job since being on my IVF break so hoping I won’t need to avoid work as much now I don’t have my old boss to deal with. I tried swapping from Puregon to Gonal F for my last cycle as well, and my FS told me it was just a brand thing as well. As for keeping your feet warm and tummy warm, my acupuncturist told me to wear socks during my ENTIRE IVF cycle and also to make sure I keep my tummy warm, apparently helps with implantation. I have done it on every cycle and had a BFP, chemical and 2 BFN so not sure how much of a difference it makes. When will you be doing yor next cycle?

    Quartz: Love the status quote darl , I had another friend of mine from BH email it to me the day before your post.

    PinkButterfly: Yep I was pretty shocked it was day 14, my AF must of read the textbook this month . How are you going with your next cycle? Did you manage to get Dr S to give you Melatonin for the next one?

    AFM: I have my Biopsy on Friday, haven’t got the time locked in as yet they will tell me on Thursday, hoping its first thing in the morning as I have such a busy day at work and can’t go changing all my client meetings again. I had a routine BT yesterday checking my levels prior to the biopsy and it also checks for signs of pregnancy (the clinic clearly know why I am doing IVF and that it is PHYSICALLY impossible for me to get pregnant without IVF) yet they still persisted on the BT and then when they rang to tell me the results the nurse says “Yep we have confirmed there is definitely no sign of a pregnancy trying to occur this month” – No 5hit! It was just the way she said it that ticked me off. Sorry for the negativity girls. On a positive note, I am halfway through my 3 month break and DH and I are really enjoying the time off getting ready for our next cycle.

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    Oh crap I'm nervous. Sitting in the waiting room with butterflies in my tummy SO bad. I didn't take any panadol, so hopefully it's not too painful.....

    Hurry up Dr! Every minute that passes makes me more nervous...

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    Default Rh factor

    nat84u wrote: I wonder if the Rh+ baby thing affected me

    The babies are fine so long as none of your B cells ever see any of their red blood cells. Your cells are usually given the chance to see the baby's blood during birth. Doctors act to prevent future problems by giving Rh- mothers having Rh+ babies an injection of antibodies shortly after delivery (and at any other time during the pregnancy that they think that B cells are seeing or might have a chance to see the baby's blood).

    The injected antibodies bind to the baby's red blood cells which block mum's B cells from getting a chance to see the Rh. Then other white blood cells come along to destroy anything that has antibody stuck to it and so that removes the baby's blood cells and your B cells never discovered that the Rh was ever there.

    If you didn't get the treatment (RhIg, Rhogam), and if your B cells did get a chance to respond to Rh factor then you have made antibodies to it. Immunosuppression like prednisone acts on cells, but it won't affect antibody that's already been made and put out there. You can be tested to see if you have anti-Rh antibodies, and there are things that can be done in future pregnancies if you are already affected.

    The baby might need a blood transfusion soon after birth to replace the red blood cells that have been attacked with brand new ones.
    The baby might require a blood transfusion before it's born. They swap the baby's blood for some Rh- blood so there's nothing for mum to attack. As the baby makes new blood cells from it's bone marrow these will still be Rh+, so more than one transfusion may be required during the course of the pregnancy.
    The baby might need to be delivered early if the mum is making a response that's too aggressive.

    If antibody levels are so high that the embryo can't survive long enough for a transfusion, then PGD (only if the father has the Rh- gene as well as the Rh+ one) might be applicable.
    Plasmapheresis (a procedure similar to dialysis) can be used to remove offending antibodies, but I don't think it is routinely used for Rh factor applications, and prednisone used to discourage the B cells from making more antibody. Some autoimmune diseases are managed this way.

  10. #389
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    Wow! I don't know what I was so scared of, the NK cell biopsy was nothing! A bit uncomfy but that's it, it's about the same as an embryo transfer...

    So for the rest of you that are having it done, relax! It's quick, easy and painless!

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  12. #390
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    Not a good sperm day for us today. All non-motile. So they've decided to give the most handsome six a chance at fertilisation (ICSI of course).
    Sometimes I wonder if my standards in men are too low when I'm pleased with 1. alive, 2. roughly the right size and shape, 3. no vacuoles, 4. movement optional.

    (I thought that last sentence (actually referring to the poor sperm) was going to sound funny, but then when I added number 4 I decided it hit too close to the mark to make the beginning amusing anymore. But I've run it by DH, and when he finally stopped laughing he told me to post it.)


 

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