Yesterday was my follow up with Dr. Kwak-Kim. She had asked my husband to come with for this appt since I went alone to the first one and cried a bunch. Not because he wasn't there, but because of a huge mix of fear and relief that I'm not crazy. Our appt was set for 9, so we left about 1.5 hours before. Our area has gotten a lot of heavy rain and I wanted to allow a bit more time to get there than the hour it took me the last time. Well, I still had to call and tell them we'd be late by about 15 minutes.
When we got there, we were taken back to the conference room almost immediately, save for time for a bathroom stop (hey, it was a long car ride!) As soon as we were in the room, DH starts making jokes. He has such a great way of cutting the tension. I'm thankful for him. Dr. Kwak Kim came in and began talking about my results.
I have a positive result for antiphospholipid antibody, high TSH level, high testosterone and DHEAs, high NK cells, high TH1/TH2 cells, High PAI-1 level, and a lower end of normal vitamin d level. So what does this all mean? It means that I have an genetic tendency towards blood clotting, not an actual clotting disorder, though I do have heterozygous mutations for a few of them. In my mind, I equate that to having sludgy blood-which makes sense why I have the restricted flow we saw on the ultrasound. It also means that my immune system is somewhat dysfunctional. The NK cells job is to get rid of invaders they don't know, which could be our embryos. Her big concern were the high PAI-1 level and the high DHEA. I reminded her that when the labs were drawn, I was taking supplemental DHEA and have since stopped. Apparently I was over supplementing myself so hopefully that will straighten out.
So what do we do about it? She started me on Synthoid for my TSH level. Apparently I'm still in normal range, but just a bit higher than she'd like to see for us trying to have a baby. I will get that level checked every 2 weeks. She also started me on Metformin to help the PAI-1 level come down. She said it should come right down pairing Met with exercise and a low carb diet, as well as losing weight/reducing my BMI. She also wants me to take vitamin d, fish oil and changed me to a prescription prenatal vitamin. When it's time for our IVF cycle, she will also have me on prednisone to combat the NK cells. She'll monitor that level and if it's still not low enough, we will do IVIG infusions. I will also be on lovenox during the cycle.
It's been a lot to take in. I didn't expect her to find so much. I'm sure I'm not repeating it back the way she did. It feels good to have a plan again. Trying to cycle in June is going to cut things too close, so I also called and rescheduled for the July cycle. When I called the RE, I was told he wants to see me when he's back in the country. I am afraid he wont let me cycle there since I keep changing my mind and because I'm seeing the RI. You never know, maybe he's taking an ego hit because Im pulling in another specialist. The logical side of my brain says he just wants to see me because my CD3 labs are so off. Either way, it'll be okay.
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