Hail Mary, Full of Grace…

I’m practically grinding my teeth right now. I don’t know what possessed me, but I decided that I needed to look for scholarly articles about “pregnancy outcomes in women with positive anti-nuclear antibodies”, because ever since my first miscarriage I’ve felt that everything traces back to my fickle (auto)immune system and I cannot stand the thought that I would have to fail another IUI or have another miscarriage before anyone will treat my issue–the treatment is corticosteroids, which are immunosuppressant drugs, and docs do not prescribe them lightly, however, due to my autoimmune issues I’ve taken boatloads of steroids so I’m not your average girl.

Let me back up to say, that I tested negative for anti-nuclear antibodies (ANA’s) in November of 2012. But I tested HIGH POSITIVE with a ratio of 1:160 post-miscarriage in February 2013 (just over a year later), and I had elevated liver enzymes (which is related). A couple months post-miscarriage my ANA’s fell to 1:80, which is still positive (and really, once you’re positive, having a lower number doesn’t mean much). Then, I went on to have a ‘chemical pregnancy’ (early miscarriage). I am 100% sure that my immune system “picked off” my first pregnancy–the evidence points to it–but I can’t prove it because my (former) stupid OB didn’t have me “test the products of conception”. Since the chemical pregnancy I have been ttc for 6 months and 5 of those cycles have been medicated–3 of them are IUI’s with injectables (though this third one doesn’t count yet because I’m in the middle of it now). It’s quite suspicious that I haven’t conceived by now, in my opinion, given our heroic efforts and the fact that we conceived twice naturally. What I’m pointing at is this: antibodies get ‘smarter’ and ‘faster’ each time they are exposed to a “pathogen”–you know, like when you build up immunity by being exposed, like chicken pox, and each time you’re exposed your immunity grows stronger. Well, I believe that my anti-nuclear antibodies are getting more keen to my pregnancies, and “picking them off” before they can even implant. It explains my pattern.

And guys, I just can’t bear the thought of losing another pregnancy–another baby. I can’t bear the thought that I might fail IUI #3 and waste more time and have to pay for MORE expensive tests at an RE’s office and be shoved toward IVF, when I could simply take 10mg of prednisolone and baby aspirin (I’d prefer Levonox as a prophylactic, but the baby aspirin should work with ANA’s). It simply drives me mad to think there’s something else to be done that isn’t being done.

And I really feel like my angels (particularly my Mom) were gently pushing me to look for scholarly articles on pubmed today, so that I can show them to Dr. Angel and make a case for the prednisolone. I hesitantly suggested it a week ago, and he said he’d consult with his RE, but he hasn’t had a chance. Plus, this RE doesn’t know me so even if he’s aware of the connection between implantation failure, miscarriage, and positive ANA’s…he may tell Dr. Angel it’s not a necessity. But what I’m seeing is that it most certainly IS a necessity. I’m going to post the abstracts from the articles I looked at. And I want you to tell me what you would do if you were me? Would you move heaven and earth to make sure you had the damn steroids? Cuz I feel prepared to do that. In fact, I think I’ve said it before: there’s nothing I WON’T do to have a baby. There’s nothing I WON’T do to protect my baby…from myself. And really, 10mg of prednisolone is child’s play compared to the Remicade I was on, so what’s the harm? I can’t keep doing this. I PRAY Dr. Angel looks at these abstracts and agrees to give me prednisolone. I really feel like this might be the magic ingredient for me and I feel like I have everything to gain and nothing to lose by taking it. I didn’t properly cite these (like, for you aspiring professors out there).

So, here’s the abstracts if you’re interested–this first one even suggests that my poor ovarian response may be linked with having ANA’s:

Immunol Invest. 2012;41(5):458-68. doi: 10.3109/08820139.2012.660266. Epub  2012 Mar 19.

Antinuclear antibodies predicts a poor IVF-ET outcome: impaired egg and embryo development and reduced pregnancy rate.

Abstract

To investigate the impact of anti-nuclear antibodies (ANAs) on the outcome of in vitro fertilization-embryo transfer (IVF-ET), 66 (96 cycles) infertile women positive for anti-nuclear antibodies (ANA+ group), and 233(285 cycles) infertile women negative for ANAs (ANA- group) were enrolled. The clinical characteristics and IVF outcome were compared between the two groups. In the ANA+ group, the proportion of MII oocytes and two-pronuclear zygotes (2PN), cleavage rate, number of available embryos and proportion of available embryos, number of high-quality embryos and proportion of high-quality embryos were significantly lower than those in the ANA- group. In addition, the pregnancy rate and implantation rate in patients positive for ANA was markedly lower than the ANA- patients (28.1% vs 46.4%, 15% vs 25.7%, respectively). Thus, our findings suggest that the presence of ANAs significantly interfere with the oocyte and embryo development, as well as reduce implantation and pregnancy rate in patients undergoing IVF treatment.

J Reprod Med. 2005 Jun;50(6):383-8.

Results of prednisolone given to improve the outcome of in vitro fertilization-embryo transfer in women with antinuclear antibodies.

Abstract

OBJECTIVE:

To evaluate the association of antinuclear antibodies (ANA) with outcome of in vitro fertilization-embryo transfer (IVF-ET) as well as the effect of short-term immunosuppression with prednisolone on implantation, clinical pregnancy and live birth rates following IVF-ET.

STUDY DESIGN:

The study group consisted of 120 women, 22-42 years old, in whom IVF-ET was performed and whose ANA could be measured. Prednisolone (15-60 mg/d for 5 days) was administered starting 1 day after oocyte retrieval to some women with or without ANA, without randomization. The 223 IVF-ET cycles were divided into prednisolone-nontreated ANA-negative cycles, prednisolone-treated ANA-negative cycles, prednisolone-nontreated ANA-positive cycles and prednisolone-treated ANA-positive cycles. Retrospective analysis of rates of implantation, clinical pregnancy, and live birth were evaluated in the four groups.

RESULTS:

Overall, ANA positivity was noted in 20.0% of subjects (24/120) and 25.1% of cycles (56/223). Implantation and clinical pregnancy rates in the prednisolone-nontreated ANA-positive group were 0% (0/41 transplanted embryos) and 0% (0/15 cycles), significantly lower than in the other groups. The live birth rate in this group was significantly lower than in the prednisolone-nontreated ANA-negative group and non-significantly tended to be lower than in the other 2

CONCLUSION:

Implantation, clinical pregnancy and live birth rates following IVF-ET were low when ANA was detected. Implantation and clinical pregnancy rates were improved significantly by prednisolone, but the live birth rate was not.

Fertil Steril. 1998 Dec;70(6):1044-8.

Prednisolone plus low-dose aspirin improves the implantation rate in women with autoimmune conditions who are undergoing in vitro fertilization.

Abstract

OBJECTIVE:

To evaluate the effect of prednisolone plus low-dose aspirin (PSL/LDA) in women with autoimmune conditions who were enrolled in an IVF-ET program.

DESIGN:

A retrospective clinical study.

SETTING:

In vitro fertilization unit, Niigata University Hospital, Niigata, Japan.

PATIENT(S):

Three hundred seven women who underwent IVF-ET between January 1996 and December 1997.

INTERVENTION(S):

Prednisolone (10 mg/d) and aspirin (81 mg/d) were administered to the women with autoantibodies who chose to participate.

MAIN OUTCOME MEASURE(S):

Pregnancy and implantation rates with IVF-ET.

RESULT(S):

Women undergoing IVF who had positive antinuclear antibodies, with or without antiphospholipid antibodies, had significantly lower pregnancy and implantation rates than did women without autoantibodies (14.8% versus 21.7% and 6.8% versus 10.4%, respectively). The administration of PSL/LDA to women with antinuclear antibodies significantly improved the outcome of IVF-ET (40.6% pregnancy rate and 20.3% implantation rate).

CONCLUSION(S):

A high proportion of women who are undergoing IVF-ET have autoantibodies, which are associated with poor IVF outcomes. The administration of PSL/LDA to these women may improve their implantation rate.