Excuse me while I feel sorry for myself. For some reason something trigger the poor poor pitiful me button tonight.
As Landon approaches two I keep remembering how close we would be to finding out whether we would be having a girl or boy. As much as I wanted a girl I was ready to welcome another boy into this world to snuggle with and play cars with.
I feel awful! I should be happy that I have a sweet healthy little boy that is going to be two! Instead I can only think of my failure of losing his brother or sister. Now you can tell me it wasn't my fault, I know that it was out of my hands but it doesn't keep me from thinking this way.
There are reminders everywhere. The girl who works down the hallway at my new job who is an ultrasound tech with a 20 week protruding belly. She told me (not knowing of course) that when I did get pg she could do my u/s at 12-13 weeks and tell me what I'm having. All I wanted to say was "Yeah I should be 18 1/2 weeks now." :::sigh::: But of course I don't.
I'm reminded by the maternity clothes that still hang in my closet that I washed because I knew my regular clothes soon wouldn't fit.
I'm reminded because we have to be cautious now, not having insurance and all. This wouldn't be the time to get pregnant! I think this is the hardest thing to face. If we had all our answers (blood tests) and were TTC, I think I could throw myself into that and let it in God's hands. But we're not there yet. I don't want to wish summer away because I LOVE summer. I don't want it to be fall yet because my EDD would be right around the corner.
Its just so hard. It sucks so bad. I hate this. Today I feel alone.
Tuesday, May 31, 2011
Monday, May 30, 2011
What Testing Can be Done for RPL? #3
The immune system is a very complex system. When an illness occurs and the body's tissues are attacked by its own immune system, this is known as an autoimmune disorder or disease. Some autoimmune issues include systemic lupus erythematosus (SLE), rheumatoid arthritis, juvenile diabetes (type 1), etc. All of these issues can contribute to infertility or RPL.
The immune system is another complex system. I will do my best to explain how it works but please check this site out "How Your Immune System Works".
-Dr. Alan E. Beer
What are Th1 & Th2? Well these are T-helper cells (CD4) or a type or white blood cells (leukocytes) that are produced in the Thymus (hence the T), the gland next to the heart. Th1 cells are responsible for sending a chemical message called lymphokines. This chemical message is sent to B cells (produced in the bone marrow) telling them to make antibodies. Th2 cells are a second type of T-helper cells that act to restrain antibodies. Th2 cells help the body to accept foreign material or cells. In sense, Th1 cells are the "aggressors" cells and the Th2 cells are the "pacifiers" cells. If the Th1 cells become overly aggressive they can attack the wrong targets causing an autoimmune disorder. However, sometimes Th2 is overly suppressing of the Th1 cells and this can leave the body very vulnerable, susceptible not only to infection but tumors as well.
All this talk about antibodies; so what are they? Antibodies are proteins that destroy antigens aka virus, bacteria, fungi or any harmful substance that enters the body. Every antibody belongs to a group of proteins called immunoglobulins (Ig). Attached to the surface of a B cell is an Ig molecule.
Hopefully this is making some sense and you can now see why the Th1:Th2 ratio is so important now. Moving on to what may also accompany an antibody onslaught. An overproduction of proinflammatory cytokines also known as the cells messenger. Cytokines "interact with cells of the immune system in order to regulate the body's response to disease and infection". They also "mediate normal cellular processes in the body".
These messages in between cells then prompts the NK cells, macrophanges, neutophilis and T cells to go in for the kill. Most commonly they will attack connective tissue (tendons, skin, muscles, etc), joints, nerves, thyroid and pancreas. These particular targets cause some commonly known autoimmune diseases including Arthritis, Lupus, Graves' Disease, Crohns Disease, Rheumatoid Arthritis, Guillain-Barre Disease and psorasis.
There is a test called Th1:Th2 Cytokine Assay that simply counts the number of each Th1 & Th2. While searching for normal lab values I came across this journal article Systemic Th1/Th2 cytokine responses to paternal and vaccination antigens in preeclampsia". Interestingly enough it was thought that a "Th1 shift has been suggested to be involved in the pathogenesis of preeclampsia". Hmm...however, apparently this article proved Th1 to be no different. Anyway, I have had poor results in finding a "normal" lab value for Th1:Th2 Cytokine Assay. If anyone has any insight please do not hesitate to comment below.
One other thing I want to review are ANA's or antinuclear antibodies. These are antibodies designed to go attack a cells nucleus. ANA is another test that can be performed with those who have infertility or RPL issues. Just because one ANA is positive does not indicate a cause of infertility or RPL. The presence of one antibody mayindicate other autoimmune issues. ANA's commonly go hand in hand with hyperactive NK cells.
"ANAs are found in 20-30% of women with RPL."
"7% of women who are unable to conceive naturally produce antibodies to sperm."
Two types of antithyroid antibodies (ATA's) exist: antithyroid peroxidase and antithyroglobulin antibodies. ATA's are also linked to a predisposition to other autoimmune disease. One important factor I want to mention is it is important when testing for ATA's that the lab use the test ELISA. If a less sensitive one is used 1 in 5 women who carry ATA's will go undetected. Women with ATA's should also be tested for elevated levels of CD56+ NK cells, CD19+/5+ cells and activated T cells, according to Dr. Beer.
- 30% of women with RPL will test positive for one or both ATA's and are twice as likely to have a m/c then women without ATA'S.
LAC or Lupus Anticoagulant are antibodies against phospholipids that prevent blood clotting in a test tube. The presence of LAC my be responsible for causing tiny blood clots. Lupus antibodies may be present in those with systemic lupus erythematosus (SLE) or without SLE. Due to temporary side effects of an infection, this test should be repeated in 6-8 weeks.
All this talk about Natural Killer Cells (NK Cells). What are they? They are type of white blood cells or lymphocytes responsible for attacking viruses and/or cancer. According to MILab website a NK cell assay, "tests the killing function of circulating NK cells as well as the ability of interleukin-2 (IL2) to stimulate and intravenous immunoglobulin (IVIg) to suppress that activity. NK activity can be measured as a bioassay that determines the ability of activated NK cells to kill their target (K562 cell line)."
- Approximately 40% of patients undergoing IVF who have been diagnosed with endometriosis display increased NK activity.
The following tests are from Dr. Beer's book, with little side comments about each. You can also find some of this information on his website.
CD3 (Pan T cells) - Normal Range: 63-86% - If CD3 is low this is when the immune system is weak. Typically infertile patients or RPL patients often have high normal range values.
CD4 (T-helper cells) - Normal: 31-53% - Again women with fertility problems are typically in the high normal range value. Those who are low could have a serious health problem.
CD8 (T-Cytotoxic Suppressors) - Normal: 17-35% - These cells moderate the activity of Th-1 lymphocytes. In women with RPL/infertility, CD8 is often low.
CD19 (B-Cells) - Normal: 3-8% - Once again usually women with high normal OR elevated percentages are in women with immune-mediated infertility or RPL.
CD56+/CD16+ (Natural Killer Cells) - Normal: 3-12% - Levels are often elevated in women with infertility or RPL, leading to IVF failure, BO, or CP.
CD56+ (Natural Killer Cells) - Normal: 3-12% - These particular NK cells can be turned on by pregnancy & deteriorates the embryo.
CD3/IL-2R+ Cells - Normal: 0-5% - Women who have an autoimmune disease may also have above-average levels.
CD19+/5+ (B-1 Cells) - Normal: 2-10% - These particular cells can produce antibodies to hormones and neurotransmitters.
Are you confused yet? Yes, this is all very overwhelming and can be very confusing! I hope I've simplified some of this information that you aren't confused right now. I remember the first time I read "Is Your Body Baby-Friendly?" I skipped a lot of it because even coming from a medical background the medical jargon intimidated me. Its ok. This is nothing that you need to understand over night.
The immune system is another complex system. I will do my best to explain how it works but please check this site out "How Your Immune System Works".
"The immune system is balanced between a Th1 (autoimmune) and Th2 (pregnancy or suppressive) response. Most people have a balanced system. Women with implantation failure or RPL are unbalance. They are too Th1 activated with the autoimmune 'bad guys'."
-Dr. Alan E. Beer
What are Th1 & Th2? Well these are T-helper cells (CD4) or a type or white blood cells (leukocytes) that are produced in the Thymus (hence the T), the gland next to the heart. Th1 cells are responsible for sending a chemical message called lymphokines. This chemical message is sent to B cells (produced in the bone marrow) telling them to make antibodies. Th2 cells are a second type of T-helper cells that act to restrain antibodies. Th2 cells help the body to accept foreign material or cells. In sense, Th1 cells are the "aggressors" cells and the Th2 cells are the "pacifiers" cells. If the Th1 cells become overly aggressive they can attack the wrong targets causing an autoimmune disorder. However, sometimes Th2 is overly suppressing of the Th1 cells and this can leave the body very vulnerable, susceptible not only to infection but tumors as well.
All this talk about antibodies; so what are they? Antibodies are proteins that destroy antigens aka virus, bacteria, fungi or any harmful substance that enters the body. Every antibody belongs to a group of proteins called immunoglobulins (Ig). Attached to the surface of a B cell is an Ig molecule.
Hopefully this is making some sense and you can now see why the Th1:Th2 ratio is so important now. Moving on to what may also accompany an antibody onslaught. An overproduction of proinflammatory cytokines also known as the cells messenger. Cytokines "interact with cells of the immune system in order to regulate the body's response to disease and infection". They also "mediate normal cellular processes in the body".
These messages in between cells then prompts the NK cells, macrophanges, neutophilis and T cells to go in for the kill. Most commonly they will attack connective tissue (tendons, skin, muscles, etc), joints, nerves, thyroid and pancreas. These particular targets cause some commonly known autoimmune diseases including Arthritis, Lupus, Graves' Disease, Crohns Disease, Rheumatoid Arthritis, Guillain-Barre Disease and psorasis.
There is a test called Th1:Th2 Cytokine Assay that simply counts the number of each Th1 & Th2. While searching for normal lab values I came across this journal article Systemic Th1/Th2 cytokine responses to paternal and vaccination antigens in preeclampsia". Interestingly enough it was thought that a "Th1 shift has been suggested to be involved in the pathogenesis of preeclampsia". Hmm...however, apparently this article proved Th1 to be no different. Anyway, I have had poor results in finding a "normal" lab value for Th1:Th2 Cytokine Assay. If anyone has any insight please do not hesitate to comment below.
One other thing I want to review are ANA's or antinuclear antibodies. These are antibodies designed to go attack a cells nucleus. ANA is another test that can be performed with those who have infertility or RPL issues. Just because one ANA is positive does not indicate a cause of infertility or RPL. The presence of one antibody mayindicate other autoimmune issues. ANA's commonly go hand in hand with hyperactive NK cells.
"ANAs are found in 20-30% of women with RPL."
"7% of women who are unable to conceive naturally produce antibodies to sperm."
Two types of antithyroid antibodies (ATA's) exist: antithyroid peroxidase and antithyroglobulin antibodies. ATA's are also linked to a predisposition to other autoimmune disease. One important factor I want to mention is it is important when testing for ATA's that the lab use the test ELISA. If a less sensitive one is used 1 in 5 women who carry ATA's will go undetected. Women with ATA's should also be tested for elevated levels of CD56+ NK cells, CD19+/5+ cells and activated T cells, according to Dr. Beer.
- 30% of women with RPL will test positive for one or both ATA's and are twice as likely to have a m/c then women without ATA'S.
LAC or Lupus Anticoagulant are antibodies against phospholipids that prevent blood clotting in a test tube. The presence of LAC my be responsible for causing tiny blood clots. Lupus antibodies may be present in those with systemic lupus erythematosus (SLE) or without SLE. Due to temporary side effects of an infection, this test should be repeated in 6-8 weeks.
All this talk about Natural Killer Cells (NK Cells). What are they? They are type of white blood cells or lymphocytes responsible for attacking viruses and/or cancer. According to MILab website a NK cell assay, "tests the killing function of circulating NK cells as well as the ability of interleukin-2 (IL2) to stimulate and intravenous immunoglobulin (IVIg) to suppress that activity. NK activity can be measured as a bioassay that determines the ability of activated NK cells to kill their target (K562 cell line)."
- Approximately 40% of patients undergoing IVF who have been diagnosed with endometriosis display increased NK activity.
The following tests are from Dr. Beer's book, with little side comments about each. You can also find some of this information on his website.
CD3 (Pan T cells) - Normal Range: 63-86% - If CD3 is low this is when the immune system is weak. Typically infertile patients or RPL patients often have high normal range values.
CD4 (T-helper cells) - Normal: 31-53% - Again women with fertility problems are typically in the high normal range value. Those who are low could have a serious health problem.
CD8 (T-Cytotoxic Suppressors) - Normal: 17-35% - These cells moderate the activity of Th-1 lymphocytes. In women with RPL/infertility, CD8 is often low.
CD19 (B-Cells) - Normal: 3-8% - Once again usually women with high normal OR elevated percentages are in women with immune-mediated infertility or RPL.
CD56+/CD16+ (Natural Killer Cells) - Normal: 3-12% - Levels are often elevated in women with infertility or RPL, leading to IVF failure, BO, or CP.
CD56+ (Natural Killer Cells) - Normal: 3-12% - These particular NK cells can be turned on by pregnancy & deteriorates the embryo.
CD3/IL-2R+ Cells - Normal: 0-5% - Women who have an autoimmune disease may also have above-average levels.
CD19+/5+ (B-1 Cells) - Normal: 2-10% - These particular cells can produce antibodies to hormones and neurotransmitters.
Are you confused yet? Yes, this is all very overwhelming and can be very confusing! I hope I've simplified some of this information that you aren't confused right now. I remember the first time I read "Is Your Body Baby-Friendly?" I skipped a lot of it because even coming from a medical background the medical jargon intimidated me. Its ok. This is nothing that you need to understand over night.
Sunday, May 22, 2011
Another Perspective
I should know better than to ask people what they think of my problems. Unfortunately I require a lot of reassurance but sometimes I don't get that. I get the opposite of that and that for me can make my head spin and spin and spin. Then I'm back to needing reassurance. It is a vicious cycle you see.
Getting on to my story. I recently spoke to a retired Ob/Gyn that I know. I believe he practiced in the 60's - 80's maybe early 90's. However, I've asked for his opinion a few times over the past few months. Back when I was pg we had a conversation about miscarriages. Ever since the 1960's he has been a firm believer in extra folic acid, before there was a big push for folic acid (especially in women w/ RPL). So he always thought folic acid contributed in some way.
Recently I was discussing what has been discovered as far as being MTHFR positive and the treatment that it may require. He was not familiar with MTHFR since (I think) it was discovered in the 90's. After I got done explaining everything he warned me to be careful especially with going the route of Lovenox. Supposedly Lovenox is "too big" to carry over into the placenta but some science debates this original finding. He warned me not to get too caught up in this that it can become dangerous when your grasping for straws. :::sigh:::
[God darn it! I don't care if I'm grasping at damn little strings...I need something. This is ridiculous being 27, having 5 pregnancies and only one child to show for it.]
He also implied that because I have a healthy child that its like you start over and aren't considered to have RPL again until you m/c two or more times. He said you may not be at any greater risk than the average women now. More or less this last m/c could have been a 1 in 4 chance like any other woman. [psychotic tone: WHAT?! Are you kidding me!] Really just because I had a child means I get a fresh start? Too bad my emotions don't.
Getting on to my story. I recently spoke to a retired Ob/Gyn that I know. I believe he practiced in the 60's - 80's maybe early 90's. However, I've asked for his opinion a few times over the past few months. Back when I was pg we had a conversation about miscarriages. Ever since the 1960's he has been a firm believer in extra folic acid, before there was a big push for folic acid (especially in women w/ RPL). So he always thought folic acid contributed in some way.
Recently I was discussing what has been discovered as far as being MTHFR positive and the treatment that it may require. He was not familiar with MTHFR since (I think) it was discovered in the 90's. After I got done explaining everything he warned me to be careful especially with going the route of Lovenox. Supposedly Lovenox is "too big" to carry over into the placenta but some science debates this original finding. He warned me not to get too caught up in this that it can become dangerous when your grasping for straws. :::sigh:::
[God darn it! I don't care if I'm grasping at damn little strings...I need something. This is ridiculous being 27, having 5 pregnancies and only one child to show for it.]
He also implied that because I have a healthy child that its like you start over and aren't considered to have RPL again until you m/c two or more times. He said you may not be at any greater risk than the average women now. More or less this last m/c could have been a 1 in 4 chance like any other woman. [psychotic tone: WHAT?! Are you kidding me!] Really just because I had a child means I get a fresh start? Too bad my emotions don't.
Saturday, May 21, 2011
Could it be?
No I'm not pregnant. BUT after TTC since Oct 2007, changing Ob/Gyns not once but twice, changing from a local RE to an out of state RI, after 4 m/c and one live birth...I have a answer and possibly more to come.
I finally got my blood tests back that I had done at the end of April. And drum roll please..............one test came back POSITIVE!!! Seriously?! After 4 m/c? It infuriates me BUT at the same time I'm thrilled to no end to have an answer if not more to come.
So I'm positive for MTHFR. Not only am I positive for the gene mutation A1298c I carry T-W-O! Yes, that makes me homozygous. From my understanding, homozygous is worse then if I only had 1 copy or heterozygous. So let's review a little. MTHFR puts people more at risk for blood clots, in this case usually in very small and tiniest blood vessels. Guess where tiny blood vessels exisit? Yup, your uterus among other places.
So why does this put you more at risk for blood clots? Well when the mutation exists your body does not absorb Folic Acid properly possibly due to a lack of Vitamin B complex (B6 & B12, I think). So not ony will I be taking extra folic acid I will also be taking extra Viamin B6 & B12. There is a possibility since I'm homozygous that they may recommend taking Lovenox as soon as I get a bfp. Obviously there are pro's and con's to Lovenox but we'll cross that bridge when we get there.
There is another MTHFR mutation, C677T that is worse then A1298C. And a compound meaning a carrier of each mutation is just as bad.
I have some questions as to whether DH & Landon should be tested. Why did I have such a normal pregnancy with Landon? Thank GOD I did! I'm curious if DH is a carrier of the mutation or not. Is it possible if he is at least heterozygous that all the babies we lost were homozygous and Landon was not? Would that affect anything or have nothing to do with it? I DON'T KNOW. If you know anything about me...I HATE NOT KNOWING!!!!!
Or is it possible after being on extra folic acid since my 1st baby, my body was getting enough and Landon was a result of 10 months extra folic acid? Not sure.
Having MTHFR will not only affect you during your childbearing years; it will put you at higher risk for thrombosis (blood clots), arteriosclerosis (hardening of arteries), Alzheimer's, stroke, heart attack, Fibromyalgia, migraines (especially with "Aura" migraines), osteoporotic fractures, bone marrow disorders and for those of child bearing years, it has found to be connected to higher incidences of down's syndrome, spina bifida, other neural tube defects, trisomy, miscarriage, stillbirth, implantation failure, placental abruption, preeclampsia, higher incidences of autism, among others.
So expect to see some new resources in the upcoming weeks about MTHFR.
I finally got my blood tests back that I had done at the end of April. And drum roll please..............one test came back POSITIVE!!! Seriously?! After 4 m/c? It infuriates me BUT at the same time I'm thrilled to no end to have an answer if not more to come.
So I'm positive for MTHFR. Not only am I positive for the gene mutation A1298c I carry T-W-O! Yes, that makes me homozygous. From my understanding, homozygous is worse then if I only had 1 copy or heterozygous. So let's review a little. MTHFR puts people more at risk for blood clots, in this case usually in very small and tiniest blood vessels. Guess where tiny blood vessels exisit? Yup, your uterus among other places.
So why does this put you more at risk for blood clots? Well when the mutation exists your body does not absorb Folic Acid properly possibly due to a lack of Vitamin B complex (B6 & B12, I think). So not ony will I be taking extra folic acid I will also be taking extra Viamin B6 & B12. There is a possibility since I'm homozygous that they may recommend taking Lovenox as soon as I get a bfp. Obviously there are pro's and con's to Lovenox but we'll cross that bridge when we get there.
There is another MTHFR mutation, C677T that is worse then A1298C. And a compound meaning a carrier of each mutation is just as bad.
I have some questions as to whether DH & Landon should be tested. Why did I have such a normal pregnancy with Landon? Thank GOD I did! I'm curious if DH is a carrier of the mutation or not. Is it possible if he is at least heterozygous that all the babies we lost were homozygous and Landon was not? Would that affect anything or have nothing to do with it? I DON'T KNOW. If you know anything about me...I HATE NOT KNOWING!!!!!
Or is it possible after being on extra folic acid since my 1st baby, my body was getting enough and Landon was a result of 10 months extra folic acid? Not sure.
Having MTHFR will not only affect you during your childbearing years; it will put you at higher risk for thrombosis (blood clots), arteriosclerosis (hardening of arteries), Alzheimer's, stroke, heart attack, Fibromyalgia, migraines (especially with "Aura" migraines), osteoporotic fractures, bone marrow disorders and for those of child bearing years, it has found to be connected to higher incidences of down's syndrome, spina bifida, other neural tube defects, trisomy, miscarriage, stillbirth, implantation failure, placental abruption, preeclampsia, higher incidences of autism, among others.
So expect to see some new resources in the upcoming weeks about MTHFR.
Wednesday, May 18, 2011
What Testing Can be Done for RPL? #2
Moving onto homronal imbalances, such as FSH, LH, Estradiol, Progesterone, TSH, T4, Prolactin, (Fasting) Glucose and Insulin and Inhibin B.
FSH stands for Follicle-Stimulating Hormone. FSH is secreted from the pituitary gland and is responsible for stimulating the production of eggs and producing a hormone called Estradiol (E2), better known as estrogen, during the pre-ovulatory phase of the menstrual cycle. FSH & E2 are tested on cycle day 3 because typically this is when FSH peaks. If the FSH is below 12 and E2 is below 35 a fertile cycle is likely to occur. However, if the levels of FSH are above 12 and E2 is above 35 an unsuccessful cycle most likely will occur. This can be a good indicator antibodies are at play too.
LH or lutenizing hormone is responsible for giving us positive OPK's. This is because E2 reaches its peak around the day of ovulation which sends a signal to the pituitary gland to secrete LH. LH is responsible for triggering the ovary to release an egg. Normal results vary between 6-30 U/L. Typically LH tests are performed when a woman is going through IVF to determine when ovulation would occur but this could also determine: anovulation, ovarian failure, PCOS (polycystic ovarian syndrome), pituitary disorders and chromosomal abnormalities.
Progesterone (P4) should be low during preovulatory phase and increase post-ovulation. The corpus luteum is responsible for the progesterone after ovulation. The production of progesterone helps in aiding a blastocyte to implant to the uterine wall. Normal P4 values at cycle day 3 should be < 1.5 ng/ml and at 7 dpo should be > then 10-15. Low progesterone may indicate a luteal phase defect, meaning there are too few days between ovulation and menstruation.
Prolactin as many of us know is the milk secreting hormone. Elevated levels when not breastfeeding may interfere with ovulation and conception. Hyperprolactinemia is commonly associated with PCOS. Normal levels at cycle day 3 are <24 ng/ml.
Another important hormone test is thyroid testing which includes TSH (thyroid stimulating hormone) and T4 (thyroxine). TSH & T4 will help determine if hypothyroid (lack TSH &/or T4) or hyperthyroid (produce too much TSH &/or T4) conditions are present. TSH is produced by the pituitary gland and signals the thyroid to make hormones.
Symptoms of Hypothyroidism:
- Fatigue
- Weakness
- Weight gain or increased difficulty losing weight
- Coarse, dry hair
- Dry, rough pale skin
- Hair loss
- Cold intolerance (you can't tolerate cold temperatures like those around you)
- Muscle cramps and frequent muscle aches
- Constipation
- Depression
- Irritability
- Memory loss
- Abnormal menstrual cycles
- Decreased libido
Symptoms of Hyperthyroidism:
- Palpitations
- Heat intolerance
- Nervousness
- Insomnia
- Breathlessness
- Increased bowel movements
- Light or absent menstrual periods
- Fatigue
- Fast heart rate
- Trembling hands
- Weight loss
- Muscle weakness
- Warm moist skin
- Hair loss
- Staring gaze
Signs and symptoms vary due to severity and are different for everyone.
- 10 million AMERICANS have hypothyroidism.
- Approximately 10% of women suffer from some type of thyroid hormone deficiency.
A great resource I found while researching thyroid conditions; www.endocrineweb.com.
The fasting insulin and glucose is a test for diabetes. There are 2 types; Type 1 & Type 2. Type 1 Diabetes typically comes on gradually but symptoms develop quickly. With Type 1 Diabetes your body loses its ability to produce insulin. This increases glucose levels.
Signs & Symptoms of Diabetes Type 1 include:
- Extreme weakness and/or tiredness
- Extreme thirst—dehydration
- Increased urination
- Abdominal pain
- Nausea and/or vomiting
- Blurry vision
- Wounds that don’t heal well
- Irritability or quick mood changes
- Changes to (or loss of) menstruation
- Weight loss—despite eating more
- Rapid heart rate
- Reduced blood pressure (falling below 90/60)
- Low body temperature (below 97ยบ F)
There are actually two types of Type 2 Diabetes; insulin resistant and not insulin resistant. Insulin resistant means your body does not use insulin properly. If you are not insulin resistant it means your body does not produce enough insulin to break down glucose.
Signs & Symptoms of Diabetes Type 2 include:
- Fatigue
- Extreme thirst
- Frequent urination
- Extreme hunger
- Weight loss
- Infections
- Slow wound healing
- Blurry vision
Inhibin B is a protein hormone that is secreted by your follicles once FSH has worked hard to develop those follicles. Inhibin B inhibits the pituitary from secreting FSH and will reach a peak in early-mid follicle phase and then a second peak at ovulation. The test is performed on cycle day 3 as well. This test is a newer test for predicting ovarian reserve or quantity and quality of eggs. This seems to be a more reliable for predicting ovarian reserve over FSH.
- Millenova Lab
Stay tuned for more tests.
FSH stands for Follicle-Stimulating Hormone. FSH is secreted from the pituitary gland and is responsible for stimulating the production of eggs and producing a hormone called Estradiol (E2), better known as estrogen, during the pre-ovulatory phase of the menstrual cycle. FSH & E2 are tested on cycle day 3 because typically this is when FSH peaks. If the FSH is below 12 and E2 is below 35 a fertile cycle is likely to occur. However, if the levels of FSH are above 12 and E2 is above 35 an unsuccessful cycle most likely will occur. This can be a good indicator antibodies are at play too.
LH or lutenizing hormone is responsible for giving us positive OPK's. This is because E2 reaches its peak around the day of ovulation which sends a signal to the pituitary gland to secrete LH. LH is responsible for triggering the ovary to release an egg. Normal results vary between 6-30 U/L. Typically LH tests are performed when a woman is going through IVF to determine when ovulation would occur but this could also determine: anovulation, ovarian failure, PCOS (polycystic ovarian syndrome), pituitary disorders and chromosomal abnormalities.
Progesterone (P4) should be low during preovulatory phase and increase post-ovulation. The corpus luteum is responsible for the progesterone after ovulation. The production of progesterone helps in aiding a blastocyte to implant to the uterine wall. Normal P4 values at cycle day 3 should be < 1.5 ng/ml and at 7 dpo should be > then 10-15. Low progesterone may indicate a luteal phase defect, meaning there are too few days between ovulation and menstruation.
Prolactin as many of us know is the milk secreting hormone. Elevated levels when not breastfeeding may interfere with ovulation and conception. Hyperprolactinemia is commonly associated with PCOS. Normal levels at cycle day 3 are <24 ng/ml.
Another important hormone test is thyroid testing which includes TSH (thyroid stimulating hormone) and T4 (thyroxine). TSH & T4 will help determine if hypothyroid (lack TSH &/or T4) or hyperthyroid (produce too much TSH &/or T4) conditions are present. TSH is produced by the pituitary gland and signals the thyroid to make hormones.
Symptoms of Hypothyroidism:
- Fatigue
- Weakness
- Weight gain or increased difficulty losing weight
- Coarse, dry hair
- Dry, rough pale skin
- Hair loss
- Cold intolerance (you can't tolerate cold temperatures like those around you)
- Muscle cramps and frequent muscle aches
- Constipation
- Depression
- Irritability
- Memory loss
- Abnormal menstrual cycles
- Decreased libido
Symptoms of Hyperthyroidism:
- Palpitations
- Heat intolerance
- Nervousness
- Insomnia
- Breathlessness
- Increased bowel movements
- Light or absent menstrual periods
- Fatigue
- Fast heart rate
- Trembling hands
- Weight loss
- Muscle weakness
- Warm moist skin
- Hair loss
- Staring gaze
Signs and symptoms vary due to severity and are different for everyone.
- 10 million AMERICANS have hypothyroidism.
- Approximately 10% of women suffer from some type of thyroid hormone deficiency.
A great resource I found while researching thyroid conditions; www.endocrineweb.com.
The fasting insulin and glucose is a test for diabetes. There are 2 types; Type 1 & Type 2. Type 1 Diabetes typically comes on gradually but symptoms develop quickly. With Type 1 Diabetes your body loses its ability to produce insulin. This increases glucose levels.
Signs & Symptoms of Diabetes Type 1 include:
- Extreme weakness and/or tiredness
- Extreme thirst—dehydration
- Increased urination
- Abdominal pain
- Nausea and/or vomiting
- Blurry vision
- Wounds that don’t heal well
- Irritability or quick mood changes
- Changes to (or loss of) menstruation
- Weight loss—despite eating more
- Rapid heart rate
- Reduced blood pressure (falling below 90/60)
- Low body temperature (below 97ยบ F)
There are actually two types of Type 2 Diabetes; insulin resistant and not insulin resistant. Insulin resistant means your body does not use insulin properly. If you are not insulin resistant it means your body does not produce enough insulin to break down glucose.
Signs & Symptoms of Diabetes Type 2 include:
- Fatigue
- Extreme thirst
- Frequent urination
- Extreme hunger
- Weight loss
- Infections
- Slow wound healing
- Blurry vision
Inhibin B is a protein hormone that is secreted by your follicles once FSH has worked hard to develop those follicles. Inhibin B inhibits the pituitary from secreting FSH and will reach a peak in early-mid follicle phase and then a second peak at ovulation. The test is performed on cycle day 3 as well. This test is a newer test for predicting ovarian reserve or quantity and quality of eggs. This seems to be a more reliable for predicting ovarian reserve over FSH.
The mean value of Inhibin B for normal women on day 3 of the menstrual cycle is 40 pg/ml and the 95% confidence interval of the mean is 33 to 45 pg/ml. Women undergoing IVF with day 3 Inhibin B concentrations less than 45 pg/ml have a pregnancy rate 70% less than women with day 3 Inhibin B concentrations greater that 45 pg/ml.
- Millenova Lab
Stay tuned for more tests.
Sunday, May 15, 2011
Seriously?!
I'm beyond fed up at this point! Why do things continue to go downhill when I thought I was seeing a light at the end of the tunnel?
As the time gets nearer for me to change jobs, I'm becoming more and more anxious. I HATE that we cannot move forward with any type of testing until August. And this puts TTC off until fall. I am, however, waiting for the results of my blood work that I had done after I came back from Holland. These include my Thrombophilia labs: Antithrombin III, Protein C &C activity, MTHFR, Homocysteine, Factor II and TSH, T4, Antithyroid antibodies, Prolactin, (Fasting) Glucose and Insulin. I'm hoping to have the results this week.
Once my insurance kicks in we will proceed with the immune testing & the cycle day #3 labs: FSH, LH, Estradiol. We may pursue the immune testing while on Cobra since this will probably be an OOP expense either way. The other testing that is on hold is the SHG and semen analysis.
On top of this we are still dealing with DH's endocrine issues. I don't think I've mentioned this before. The short story on that is DH was diagnosed about 6-8 months ago with hypothyroid and low testosterone (Low T) by his PCP. He has since gone to an endocrinologist. Despite being on Synthroid he was still not feeling all that better. The endocrinologist, Dr. P (I'll call him), was not happy with his hormone levels and wants to increase his synthroid as well as put him on Androgel to increase his testosterone. Dr. P seemed certain that these issues have nothing to due with my RPL. However, Dr. Corley was pretty adamant that this is not the case unless a semen analysis was performed to determine this. Why is no one ever on the same page?
So the WTF news of the week, is DH called Dr. P because we are having trouble getting the Androgel approved by insurance. Dr. P mentioned we may want to consider freezing DH's sperm because Androgel may decrease his sperm count. Excuse me? Why was this not mentioned before?! He damn well knows our history of RPL and wanting to conceive. DH thinks its just to cover his tail, which I understand but this is a HUGE deal in my book. And I'm disgusted that he hasn't ordered a sperm analysis at least a comparative one before and after Androgel to see if this does affect his count.
So at this point I have emailed Dr. Corley and his nurse Lisa to let them know where we stand and to acquire his opinion on whether we should do a sperm analysis before starting the Androgel.
It is important to DH that we do something and soon. His symptoms continue to get worse and both the hypothyroid and Low T are most likely related. The hypothyroid and Low T have affected his sleeping, increased fatigue, inability to lose weight, loss of hair, mood swings, weakness, occasional ED, and muscle cramping.
Any other monkey wrenches?
As the time gets nearer for me to change jobs, I'm becoming more and more anxious. I HATE that we cannot move forward with any type of testing until August. And this puts TTC off until fall. I am, however, waiting for the results of my blood work that I had done after I came back from Holland. These include my Thrombophilia labs: Antithrombin III, Protein C &C activity, MTHFR, Homocysteine, Factor II and TSH, T4, Antithyroid antibodies, Prolactin, (Fasting) Glucose and Insulin. I'm hoping to have the results this week.
Once my insurance kicks in we will proceed with the immune testing & the cycle day #3 labs: FSH, LH, Estradiol. We may pursue the immune testing while on Cobra since this will probably be an OOP expense either way. The other testing that is on hold is the SHG and semen analysis.
On top of this we are still dealing with DH's endocrine issues. I don't think I've mentioned this before. The short story on that is DH was diagnosed about 6-8 months ago with hypothyroid and low testosterone (Low T) by his PCP. He has since gone to an endocrinologist. Despite being on Synthroid he was still not feeling all that better. The endocrinologist, Dr. P (I'll call him), was not happy with his hormone levels and wants to increase his synthroid as well as put him on Androgel to increase his testosterone. Dr. P seemed certain that these issues have nothing to due with my RPL. However, Dr. Corley was pretty adamant that this is not the case unless a semen analysis was performed to determine this. Why is no one ever on the same page?
So the WTF news of the week, is DH called Dr. P because we are having trouble getting the Androgel approved by insurance. Dr. P mentioned we may want to consider freezing DH's sperm because Androgel may decrease his sperm count. Excuse me? Why was this not mentioned before?! He damn well knows our history of RPL and wanting to conceive. DH thinks its just to cover his tail, which I understand but this is a HUGE deal in my book. And I'm disgusted that he hasn't ordered a sperm analysis at least a comparative one before and after Androgel to see if this does affect his count.
So at this point I have emailed Dr. Corley and his nurse Lisa to let them know where we stand and to acquire his opinion on whether we should do a sperm analysis before starting the Androgel.
It is important to DH that we do something and soon. His symptoms continue to get worse and both the hypothyroid and Low T are most likely related. The hypothyroid and Low T have affected his sleeping, increased fatigue, inability to lose weight, loss of hair, mood swings, weakness, occasional ED, and muscle cramping.
Any other monkey wrenches?
Sunday, May 8, 2011
What Testing Can be Done for RPL?
Doctors have many different opinions on what types of testing are necessary for RPL. This post is for those who are unsure if they are being "cheated" by their RE or Ob/Gyn and not getting the care that they deserve. I've been there and want to make you aware of what is available. I am NOT a doctor and I am not a know it all. I do this in my free time, reading & researching RPL. Researching the possibilities of why I lost my 4 angels. If no one else is going to give me answers I have to research to hold on to my hope, faith and sanity. This is what I have found and there very well could be more out there. If something is incorrect please leave me a message. If you are looking for more about a particular diagnosis leave me a message and I'll be glad to try and help you.
Let's start with thrombophilia for this post. Approximately 40% of those who have thrombophilia have inherited it. Thrombophilia means a person is prone to develop blood clots due to defect in the process of coagulation. Some interesting facts about thrombophilia related to RPL:
~ Found on the Millenova Lab website
Thrombophilia labs include Antithrombin III, Protein C & S activity, MTHFR, Homocysteine, Factor II and Factor V Leiden.
So what are these tests and what are the tests testing for?
Antithrombin III test is to determine how the amount of AT III in the blood, a protein that assists in blood clotting. When you have an AT III deficiency often times these things may appear:
1) Increased risk of venous thrombosis and pulmonary embolism. Venous thrombosis occurs most frequently in the deep veins of the lower extremities.
2) Thrombotic events begin in mid-late teenage years.
3) Mesenteric veins, inferior vena cava, renal veins are all susceptible.
4) Cerebral vein thrombosis can occur.
5) Events occur with AT activity at 40-60% of normal. Homozygosity is fatal in utero.
6) May be precipitated by provocations such as surgery, trauma, pregnancy, oral contraceptive (OCP) use, or infection.
Protein C & S activity is another blood test that examines the function (activity) or quantity (antigen) of both proteins. The lack of one or the other protein or possibly both (highly unlikely) indicates that you do not produce this substance to help prevent blood clots.
- 1 out of every 300 people has one normal gene and one faulty gene for protein C deficiency.
- Protein S deficiency is less likely and only occurs in about 1 in 20,000 people.
- 20-40% of women who have had two or more consecutive m/c have an incidence of Protein C deficiency.
Next, MTHFR. The full name Methylenetetrahydrofolate reductase. From my understanding a blood test helps to identify a mutated gene. This can be heterozygous (inherited by one parent) or homozygous (inherited by both parents). A defective MTHFR gene cannot process folic acid and B12 properly. As we all know folic acid is very important for a developing fetus.
- The incidence of a heterozygous MTHFR condition in women with RPL is about 25-30%.
- Where as the homozygous MTHFR condition is found in 14% of women with RPL.
- MTHFR is the most common abnormality in women with thrombophilia.
High homocysteine levels are usually found in those who are carriers of a MTHFR mutation. Not all the time is there a connection. People who are deficient in folic acid, B6 & B12 may have high homocysteine levels as well.
Factor II deficiency is is present when there is a lack of Prothrombin in the blood, this creates a blood clotting/coagulation problem. Both parents must be carriers of Factor II to pass it along to their children. Factor II deficiency is most commonly caused by lack of Vitamin K. Some babies are born with a Vitamin K deficiency which explains why a Vitamin K shot is given shortly after birth.
- 8% of women who experience fetal loss have this mutation.
People with Factor V Leiden not only have a higher chance of developing blood clots but have a high chance of the blood clot breaking away from the original site. Some history about Factor V Leiden, it was named after a Dutch professor who discovered it in 1994. I find that interesting since I'm half Dutch. ;-)
- Between 3% and 10% of Caucasian people are heterozygous for Factor V Leiden, and a much smaller percentage are homozygous.
- In Sweden the rate of heterozygous mutation may be as high as 15%.
- Approximately 1 in 100 women who have FVL will have a serious deep vein thrombosis (DVT) during pregnancy.
While researching Factor V Leiden, I came across an informative website for those who have been diagnosed with Factor V Leiden. I also came across this article, "Pregnancy, Clotting, and Factor V Leiden: An Overview"
Stay tuned! More info to follow on immune and hormonal blood tests.
Let's start with thrombophilia for this post. Approximately 40% of those who have thrombophilia have inherited it. Thrombophilia means a person is prone to develop blood clots due to defect in the process of coagulation. Some interesting facts about thrombophilia related to RPL:
"Inherited thrombophilias have been associated with early and late recurrent pregnancy loss as a result of uteroplacental microvascular thrombosis and hypoperfusion. Obstetrical complications such as intrauterine growth retardation, placental abruption as well as preeclampsia have also been related to abnormal placental vasculature. Genetic thrombophilia are suspected to account for about 30% of these obstetrical complications. Poor pregnancy outcomes are associated with maternal thrombophilia but may also be associated with fetal thrombophilia by inheritance of maternal and paternal thrombophilic genes."
~ Found on the Millenova Lab website
Thrombophilia labs include Antithrombin III, Protein C & S activity, MTHFR, Homocysteine, Factor II and Factor V Leiden.
So what are these tests and what are the tests testing for?
Antithrombin III test is to determine how the amount of AT III in the blood, a protein that assists in blood clotting. When you have an AT III deficiency often times these things may appear:
1) Increased risk of venous thrombosis and pulmonary embolism. Venous thrombosis occurs most frequently in the deep veins of the lower extremities.
2) Thrombotic events begin in mid-late teenage years.
3) Mesenteric veins, inferior vena cava, renal veins are all susceptible.
4) Cerebral vein thrombosis can occur.
5) Events occur with AT activity at 40-60% of normal. Homozygosity is fatal in utero.
6) May be precipitated by provocations such as surgery, trauma, pregnancy, oral contraceptive (OCP) use, or infection.
Protein C & S activity is another blood test that examines the function (activity) or quantity (antigen) of both proteins. The lack of one or the other protein or possibly both (highly unlikely) indicates that you do not produce this substance to help prevent blood clots.
- 1 out of every 300 people has one normal gene and one faulty gene for protein C deficiency.
- Protein S deficiency is less likely and only occurs in about 1 in 20,000 people.
- 20-40% of women who have had two or more consecutive m/c have an incidence of Protein C deficiency.
Next, MTHFR. The full name Methylenetetrahydrofolate reductase. From my understanding a blood test helps to identify a mutated gene. This can be heterozygous (inherited by one parent) or homozygous (inherited by both parents). A defective MTHFR gene cannot process folic acid and B12 properly. As we all know folic acid is very important for a developing fetus.
- The incidence of a heterozygous MTHFR condition in women with RPL is about 25-30%.
- Where as the homozygous MTHFR condition is found in 14% of women with RPL.
- MTHFR is the most common abnormality in women with thrombophilia.
High homocysteine levels are usually found in those who are carriers of a MTHFR mutation. Not all the time is there a connection. People who are deficient in folic acid, B6 & B12 may have high homocysteine levels as well.
Factor II deficiency is is present when there is a lack of Prothrombin in the blood, this creates a blood clotting/coagulation problem. Both parents must be carriers of Factor II to pass it along to their children. Factor II deficiency is most commonly caused by lack of Vitamin K. Some babies are born with a Vitamin K deficiency which explains why a Vitamin K shot is given shortly after birth.
- 8% of women who experience fetal loss have this mutation.
People with Factor V Leiden not only have a higher chance of developing blood clots but have a high chance of the blood clot breaking away from the original site. Some history about Factor V Leiden, it was named after a Dutch professor who discovered it in 1994. I find that interesting since I'm half Dutch. ;-)
"The factor V Leiden mutation is associated with a slightly increased risk of pregnancy loss (miscarriage). Women with this mutation are two to three times more likely to have multiple (recurrent) miscarriages or a pregnancy loss during the second or third trimester. Some research suggests that the factor V Leiden mutation may also increase the risk of other complications during pregnancy, including pregnancy-induced high blood pressure (preeclampsia), slow fetal growth, and early separation of the placenta from the uterine wall (placental abruption). However, the association between the factor V Leiden mutation and these complications has not been confirmed. Most women with factor V Leiden thrombophilia have normal pregnancies."
- Between 3% and 10% of Caucasian people are heterozygous for Factor V Leiden, and a much smaller percentage are homozygous.
- In Sweden the rate of heterozygous mutation may be as high as 15%.
- Approximately 1 in 100 women who have FVL will have a serious deep vein thrombosis (DVT) during pregnancy.
While researching Factor V Leiden, I came across an informative website for those who have been diagnosed with Factor V Leiden. I also came across this article, "Pregnancy, Clotting, and Factor V Leiden: An Overview"
Stay tuned! More info to follow on immune and hormonal blood tests.
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