* pregnancy and fear of pregnancy loss mentioned*
Yesterday afternoon I spoke with Dr. Braverman, my Reproductive Immunologist. The test results from my immune monitoring were back and had been analyzed. He emailed me my report and called me at the same time so I hadn’t even seen the report when, after the usual pleasantries he said “unfortunately, your levels [of inflammatory cytokines and chemokines] are back up”. In addition, my white blood count (WBC) dropped by over 40% despite my daily Neupogen injections. Not good.
I was blown away. Like a true fool, I somehow believed that since I had a “textbook perfect” response to the immune protocol during my last immune monitoring period, the same or similar would be true now. Of course I should have know better.
After all, I’d been having histamine reactions for days. But that has happened in the days leading up to each Intralipid treatment since we cut them back from weekly to biweekly after my embryo transfer. And I had emailed Dr. B about that very issue because this time it was much worse than ever before.
My original question in yesterday’s email to Dr. Braverman was whether I could stay on the immune meds until after what right now is intended to be the last monitoring panel of bloodwork is drawn, results are back and my next report prepared because I was fearful of a histamine response and the possibility that I lack certain chemicals that occur in people with healthy immune systems to counteract the histamines when they go wacky. That isn’t a test that’s currently available according to Dr. B’s website so naturally given my history of histamine reactions it causes me some worry. Histamine issues can result in second trimester losses. I don’t need or want to add that to my resume.
Little did I know things have already gone to hell in a hand basket with my immune system. The elevated levels (and reduced WBC?) could be the result of any of all of the following, according to Dr. Braverman:
1. I have antibodies to the LP’s sperm (we’ve never tested this – why the heck not? I wanted to ask yesterday but didn’t as I was in listening mode and, well, in shock).
2. I have Hy-restricting HLA genes for which no tests have yet been developed.
3. The natural lowering of hCG that occurs around 8 weeks removes the ameliorative effect hCG has on the immune system and consequently my immune system or suspected endometriosis (or both) took this opportunity to go wild.
4. My immune system has developed an adaptive response to the immune medications and is once again dead set on destroying yet another life or at least messing with pregnancy #10.
In case it isn’t obvious (and I can see how it wouldn’t be, this stuff is not a walk in the park to understand, I know) all of these options suck.
My protocol has therefore been changed as follows:
A. Increase Neupogen from 1 mcg/kg to 1.5 mcg/kg. In other words, a 50% increase.
B. Increase Prednisone from 20 mg per day to 40 mg per day, taken in 20 mg doses in the morning and evening (a 100% increase).
I started the increased levels last night. I also had another Intralipid infusion last night.
In case you missed my saying so yesterday, it been a very long and rough week and a bit. Yesterday’s report and call have scared the pants off of me. I am astonished at how quickly things can go from textbook perfect to atrocious and ominous.
On the upside, Dr. Braverman tried to reassure me that the risk of us losing this baby has gone down after week 8 (I’m almost 10.5 weeks now) is reduced considerably in my case. There are no guarantees, of course. But he said his biggest objective in aggressively treating these changes now is to help me avoid serious complications later in pregnancy. I meant to circle back to that part of our conversation later in the call but I forgot. He told me that after reading the report he knew I would have more questions and invited me to email in response to which he would either email or call me at my preference. I have more questions, including this one, but I am going to sit with this for a few more days and gather my thoughts and reassure myself that my feet are still firmly planted on the ground.
If there is one overarching thing I have come to appreciate on this journey and my foray into reproductive immunology, it is this. Comprehensive testing and monitoring during pregnancy matters. In my case, it matters a great deal. For those of you who may not share my views or always appreciate my pushy encouragements to you, please understand that *this is my context*. This is the place from which I write. It is a place where the unexpected can come to pass very swiftly and without much warning. This place is one without certainty or security in which playing ostrich has meant certain death and almost certainly would again.
From this place, I look forward and hope, pray, plead with the powers that be to let Azulito/a live. Please, little spirit baby, please keep chugging along on your long journey home. In the big picture, you are almost there. Please stay. We love you so.