Well, evidently, all my research on the NK Cell Assay was in vain.
I spoke with Dr. Kwak-Kim this morning, and what she said was my NK Cells look great right now. The "activity" of them is represented by the B cells, and my number was 1%. Although my T cells had elevated activity, she said that this should be looked at as a percentage of the activity of the B cells- so, 40% of 1% is actually still really low.
As for the 96.8%, she said it's normal to see increased numbers of the CD3 cells when the B cell activity is so low.
Something like that.
She also said I am not quite anemic, even though my red blood cell count and hematocrit were decreased. So that's good(??) - though, I was hoping it was the reason for my fatigue.
Her concern right now is my T3 level. She said although T3 is the "minor" thyroid hormone, research has shown that hyperactivity of the thyroid can cause genetic defects in babies :( So she definately wants to get this under control, and has recommended we start by cutting my dose of T3 in half, and re-checking the levels in 2 weeks. If need be, we may add in some T4, but at the moment, my T4 is within range.
She also said that besides the T3, everything looked really good. I asked her if that was necessarily "good news," since there's not much else to fix, and she quickly responded, "Oh, no, this is definately good. With your clotting factors, you don't WANT to have additional issues with APAs or NK Cells."
However, she said this is not a one-time only test. That things like APAs (anti-phospholipid antibodies) and NK (Natural Killer) Cells can fluctuate, and in fact, 1 of my APA tests from the hematologist came back slightly elevated in May, so already mine have shown proof of fluctuation. She said that in women with the PAI-1 mutation, and PCOS, APAs have a tendency to become elevated once a pregnancy is achieved, so we will continue to check these, along with the NK Cells.
For the moment, here is the plan she recommended:
Continue Metformin 1500mgs, and all vitamin supplementation (Neevo, B6, D3, Calcium, Omega 3s, Cod Liver Oil, etc.)
Decrease T3 dose from 15 mcgs 2 x day, to 7.5 mcgs 2 x day
Do NOT take Zithromax/Macrobid (she thinks if we continue to "flush out" the endometrium, I'll see an end to the brown bleeding!!)
Increase Lovenox to 2 x day starting on CD 6 (or last day of period)
If possible, go back to Chicago for an u/s on CD 10/11 to check blood flow to implantation zone on increased Lovenox
Prometrium/Endometrin starting 2dpo to a -hpt or AF
This cycle, since my thyroid is out of whack, she suggested I do NOT TTC, and that's actually fine by me. I'd rather not waste my Lovenox, anyway. She does want me to take the Prometrium/Endometrin, though, to help with the brown bleeding for next cycle.
We will also continue to check NK Cells and APAs at various times throughout the cycle, and if necessary, we may need to add Prednisone or IVIg to the mix. I'm hoping we won't need that, but, I just went back to look at my charts and see where I was in my cycle for the 3 different APA panels I've had done... all 3 were post-Peak. So, there may a change if I get it done pre-Peak.
I feel like I have been elevated (no pun intended) to a whole new level of infertility. It really stinks!! Whereas before the majority of my readers could relate to exactly what I was going through, now I feel like only Reproductive Immunologists and a small handful of women even know what the heck I'm talking about anymore!! I'm scared to death to go through IVIg, not because I'm nervous about the treatment itself, but because I only "know" 1 woman online who has done it. I don't feel the strength of support behind me anymore, like I always have in the past. Don't get me wrong, I definately still feel the moral, spiritual, and emotional support... but it's like I'm venturing into unknown territory, where no woman (here in blogland, anyway) has gone before.
But, I'm jumping the gun. I may not need IVIg. Please pray that I won't.
I will hear from the Dr. again on the 16th, when the lab processes my Ovarian Assessment b/w, which I had done on CD 4. Oh, and I asked about ATAs (anti-thyroid antibodies) and she said I just had this test in June 2009, and those don't tend to fluctuate so quickly, and they looked fine.
In the meantime, I am weaning off of Hydrocort (I forgot to tell Dr. Kwak this, but she didn't bring up the Hydrocort, either, so I don't think she thinks it's crucial that I stay on it). Dr. Kwak is drafting a letter to Dr. G-T (my NaPro Dr) right now, with copies of all the lab results and her recommendations. It should work out perfectly, because I have an in-office visit with Dr. G-T next Monday!
Things are progressing. Now I need to figure out if another trip to Chicago is in the cards or not... I think maybe it's a good idea. I don't just want to "guess" that 80 mgs of Lovenox is doing the trick, ya know? Then again, Dr. Kwak said if I can't make it out again, that based on my weight, she has seen that 80 mgs MOST OFTEN will work. Hmmm... decisions, decisions. Would you fly out for another looksy at the blood flow??