Q&A Immunology and Fertility
Hi everyone!
I am so sorry for the delay in getting this post out. I have been completely bogged down with work and taking a little time for myself since our last negative pregnancy test. It’s always like a dagger to the heart even when deep down you know the realities. I know you all understand and that is just another reason that I am grateful for each and every one of you.
Around my transfer, there were many questions regarding my experience with immunology. I am answering those today and sharing more about my overall experience. Please remember, I am not a doctor, or a nurse or any medical professional. I am just speaking about my overall experience. But, to learn a little more about my immune challenges; check out this post. And to recap, Hashimoto’s is what brought us to Dr. Kwak-Kim.
Questions
1. How can Hashimoto’s affect fertility?
FYI, Trent answered this question, as he researched it a ton for me.
Thyroid conditions are a well documented contributor to infertility. My condition of Hashimoto’s disease is where the immune system attacks my thyroid (a gland in the base of your neck below your Adam’s apple). The thyroid is part of the endocrine system and produces hormones that help regulate a lot of the body’s functions. Hashimoto’s can cause instances of both underactive thyroid (hypothyroid) and overactive thyroid (hyperthyroid). Studies show that untreated thyroid disease can be a cause for infertility or or recurrent miscarriage.
Hypothyroidism, is a frequent cause of infertility in a couple of ways. First, if the thyroid in under active, the hypothalamus and pituitary gland can sense this and try to kick things back to normal by increasing levels of the hormones TRH (thyroid-releasing hormone) and TSH (thyroid-stimulating hormone) in your body. TRH, produced by the hypothalamus, prompts the pituitary to release TSH, which in turn stimulates the thyroid to do its job. However, TRH also prompts the pituitary to release more of the hormone prolactin, which can interfere with ovulation. Second, low levels of thyroid hormone can also interfere with the rate at which your body metabolizes sex hormones, which can also cause ovulatory disorders. Lastly, because the thyroid hormone regulates cellular function, abnormal thyroid function can affect your fertility.
Hyperthyroid resulting either from an overactive thyroid gland or from taking too much thyroid hormone can also cause problems. Thyroid hormone can block the effect of estrogen at various points in the body. That means the estrogen will not be as effective at getting its job done. This can make the endometrium (uterine lining) unstable and cause abnormal uterine bleeding.
Fertility clinics and ob-gyns often don’t even include thyroid testing as part of a fertility testing and rarely include thyroid tests as part of a preconception examination. An interesting study published in the journal Thyroid reported that only 63% of the doctors are knowledgeable about the connection between thyroid and fertility. A higher percentage could be observed among endocrinologists followed by obstetrician-gynecologists.
2. My medications list and why?
Prednisone- to lower natural killer cells and overall immune response. We are hoping to suppress my immune system. This will then let the embryo thrive. Heightened immune responses create natural killer cells that “attack” the embryo.
Plaquenil- Similar in that we are looking to suppress my overall immune response.
Heparin- A blood thinner that helps with blood flow to the uterus. I have minor clotting, but hashimoto’s can cause not enough blood to travel to where it needs to in pregnancy.
Metanx- A partially digested Vitamin B/Folic Acid. My body does not absorb this properly causing potential blood closing and a poor cardiovascular response.
Progesterone- Gimme all the hormones. This was a little extra to help keep a baby thriving.
3. What tests did they do?
A ton. They test your hormones, blood for clotting, gene mutations and more. You can see the full list below. You will have to look these up, as I am not a doctor, and I don’t have explanations for all of them.
INTRINSIC FACTOR BLOCKING AB, SERUM
FOLATE, SERUM
VITAMIN B12, SERUM
FACTOR XIII ACTIVITY, PLASMA
IMMUNOGLOBULINS IGA+IGG+IGM, QUANTITATIVE, SERUM
DHEA, SERUM
PROTEIN S ACTIVITY, PLASMA
MTHFR (METHYLENETETRAHYDROFOLATE REDUCTASE) A1298C MUTATION, BLOOD/TISSUE
PLASMINOGEN ACTIVATOR INHIBITOR-1 (4G+5G) POLYMORPHISM, BLOOD
MTHFR (METHYLENETETRAHYDROFOLATE REDUCTASE) C677T MUTATION, BLOOD/TISSUE
HPA-1 GENOTYPING, BLOOD
F13 A1 GENE, QUALITATIVE, BLOOD OR TISSUE
FGB GENE MUTATIONS, BLOOD OR TISSUE
ACTIVATED PARTIAL THROMBOPLASTIN TIME, COAGULATION ASSAY, BLOOD
HBA1C (HEMOGLOBIN A1C), BLOOD
HOMOCYSTEINE, SERUM OR PLASMA
CBC W/ AUTO DIFF
CMP, SERUM OR PLASMA
TESTOSTERONE, FREE + TOTAL, SERUM
INFLAMMATION PANEL, SERUM OR PLASMA
HIV (1+2) AB SCREEN, SERUM
INSULIN, FREE, SERUM
ANA (ANTINUCLEAR ANTIBODIES) SCREEN, SERUM
ANTIBODY SCREEN, SERUM OR PLASMA
ANTIPHOSPHOLIPID ANTIBODY PANEL, SERUM
DHEA-SULFATE, SERUM
ANTI-MULLERIAN HORMONE (AMH), SERUM
VITAMIN D, 25-HYDROXY, TOTAL, SERUM
PROLACTIN, SERUM
THYROGLOBULIN AB, SERUM
THYROID PANEL, SERUM
NATURAL KILLER (NK) CELLS, BLOOD FLOW CYTOMETRY
PROTEIN C ACTIVITY, PLASMA
OVARY AB, QUALITATIVE, SERUM, IMMUNOFLUORESCENCE
PLASMINOGEN ACTIVATOR INHIBITOR-1 (4G+5G) POLYMORPHISM, BLOOD
4. What diet are you on?
I currently am gluten free and try to eat very clean. I am by no means perfect, but I really do try to maintain a healthy diet. Gluten is a big no-no for those with thyroid issues. I have researched this to great length and did the autoimmune elimination diet in January 2018. I found out that gluten and some dairy make me nauseous, give me migraines and make me lethargic. I have way more energy and feel 100% better since cutting out gluten. It can also mimic something in your body that then makes your body react by making more antibodies. This is bad because that can prevent and embryo from thriving. This may not be the case for everyone though (again, I am not a doctor).
5. Do you think Dr. Kwak-Kim will help?
The short answer is yes. Even though we didn’t have success on our last round, I do believe that auto-immune issues call for additional meds and special protocols.
I believe the main thing to remember is that everyone is different. I may have completely different challenges than you and what works for one will not necessarily work for the other. We are all on our own very personal journeys. The most important thing to remember is to be your own advocate and research a ton! Try to read reputable blogs and articles as there is so much noise out on the web.
Also, keep asking questions. I will continue to answer. Thank you all again and again. XO
