Pls Tell Me About RPL Testing

mtlaurel · July 2012

Having never actually gotten pregnant (beyond this c/p), I'm surprised my RE wants me to get an RPL panel done.

We removed my eggs from the equation this time, and while I don't think our donor had a great cycle relative to previous ones, I happen to know that it worked for the other recipient couple. And, I know that we both transferred 2 of the exact same quality and cell-size embryos on d3. (I met other recipient on another board - clinic did not disclose this info).

I have in my head that my DH's DNA is screwed up. Maybe that's just my defense mechanism kicking in. Obviously, it could just as likely be an issue with me, but my lining is always very good, my E and P levels always good, etc. So, can someone please point me towards some resources to help me understand RPL testing? Thanks

reb259 · July 2012

mtlaurel:

Having never actually gotten pregnant (beyond this c/p), I'm surprised my RE wants me to get an RPL panel done.

We removed my eggs from the equation this time, and while I don't think our donor had a great cycle relative to previous ones, I happen to know that it worked for the other recipient couple. And, I know that we both transferred 2 of the exact same quality and cell-size embryos on d3. (I met other recipient on another board - clinic did not disclose this info).

I have in my head that my DH's DNA is screwed up. Maybe that's just my defense mechanism kicking in. Obviously, it could just as likely be an issue with me, but my lining is always very good, my E and P levels always good, etc. So, can someone please point me towards some resources to help me understand RPL testing? Thanks

I feel like we have an issue with H's sperm too, especially since we have now used 2 diffferent donors. Both RE's said everything is normal for him and would not recommend DNA testing as it is very controversial. I am not sure I would cycle again without having it done.

As for RPL the 2nd RE is saw did the testing before my 3rd IVF with my OE. They took like 14 vials of blood and everything came back normal. Although my body does not absorb folic acid and I have to take extra. Sorry I can't be more of a help...I am sure someone on here will.

Again, so sorry about this cycle!

Edwina.McDunnough · July 2012

Not RPL per se, but https://www.scsadiagnostics.com does dna frag testing on the sperm. C.ornell seems to be big on this. It's controversial if you are borderline, but it can also give you peace of mind. Posts on this are on the blog LINKS page.

RPL panels are broad, and what I'm finding is that one lab's panel differs from another, so not all RPL testing is equal. At Dr B we're getting a full immune panel for both of us, karyrotyping for the mister; and thrombophilia for me. I can't get them to give me a full list of the tests, though.

If you want the list of tests I had done with SIRM last year I can dig it up. It's not comprehensive, but we wanted to work within what my insurance covered, and the idea was that if any red flags came from the short list we'd pursue further testing (which we did not at the time).

I hope you are able to get some answers. HUGS !!

mtlaurel · July 2012

Thanks, reb and E. Yes, we intend to do the sperm DNA fragmentation test, even though the 3 REs we've seen all discounted it. I just can't see investing any more $ in cycling without doing that.

Here's the list of RPL testing our current RE ordered for me. I'm guessing it's the "short list." I understand the value of getting more testing, but I'm having a hard time wrapping my mind around this line of testing when we've never even gotten to blast stage for transfer...

Anticardiolipin Ab IgG & IGM

Antithyroglobin Ab

B2 Glycoprotein 1 Ab (IgG & IgM)

Factor 11, DNA Analysis

Factor V Leiden Mutation Analysis

Homocysteine

MTHFR

PTT Activated

T-4 Free

Thyroid Peroxidase Antibodies

Antithrombin 111 Activity

Lupus Anticoagulant Comp

Plasminogen Activator Inhibitor (PAI - 1)

Protein C Activity w. reflex

Protein S Activity w/ reflex

Edwina.McDunnough · July 2012

The DNA frag testing is relatively inexpensive. I'm thinking less than $500, a lot of it's the shipping. The clinic ran a SA on the sample to ensure there were viable sperm in there, but you can actually just ship it straight to the lab too.

Here's my short, not necessarily RPL :

NKa
3 hour glucose tolerance
DQ-Alpha
Phosphatidlserine (IGG)
Phosphatidlserine (IGM)
Activated Protein C Resistance
Plasminogen ACT INH-1 ACTIVITY
Lupus Anticoagulant
Protein C Activity
Protein S Activitiy
Antithrombin III Activity
Anti-Cariolipin AB (IGA)
Anti-Cariolipin AB (IGG)
Anti-Cariolipin AB (IGM)
Fasting Plasma Homocysteine, Cardiac
MTHFR
Factor V (Leiden)
Prothrombin 20210 Mutation
Beta-2 Glycoprotein I AB (IGM)

Beta-2 Glycoprotein I AB (IGG)

Mrs.McIrish · July 2012

I can't help with the question but I am glad you are doing this. My mind immediately jumped to a possible sperm issue for you and Reb. Hope you are holding up as well as you can right now.

theworms · July 2012

I would definitely have DH's sperm tested.

I had RPL testing w/ RE and it was about 20 vials of blood on a fasting stomach. I don't remember all the tests it included but there were clotting tests and some immune tests.

I also had Dr. B immune panel run as well.

I think it's important to get as much info as possible before moving on.

GL cutie

lynn0926 · July 2012

I can't be of any help, but I have been following your blog and thinking about you. I hope you can get some answers soon and have a very successful cycle next time around. Huge hugs!

Mitzi Bishi · July 2012

I think it's great your doc is being proactive and investigative. I'm thoroughly impressed.

It's so easy (especially with MFI) to simply "blame" the sperm and thus chalk all of those missed pregnancies as "sometimes these things just happen." Essentially with MFI you have an impaired chance at even getting pregnant, so it's extra harsh to then just wait and see if you're also prone to miscarriages.

I haven't had anything other than a genetic assessment done, which honestly I don't know what all that entailed.

The other one you might consider at least inquiring about is something Edwina tipped me off on, called the e.tegrity test. We've gone back and forth on it / if we should have it done. The company is US based, which is a big reason as to why we haven't. It costs about $700. I did write them to see if they could do it (basically a uterine biopsy to see if your lining attracts the embryo), but the email they sent me looked quite unprofessional (think green calligraphic font with grammar errors). From everything I read the "cure" if there is an issue is then intralipids.

I hope you get some answers!

Edwina.McDunnough · July 2012

Mitzi Bishi:
The other one you might consider at least inquiring about is something Edwina tipped me off on, called the e.tegrity test. We've gone back and forth on it / if we should have it done. The company is US based, which is a big reason as to why we haven't. It costs about $700. I did write them to see if they could do it (basically a uterine biopsy to see if your lining attracts the embryo), but the email they sent me looked quite unprofessional (think green calligraphic font with grammar errors). From everything I read the "cure" if there is an issue is then intralipids.
I hope you get some answers!

I'm doing an EFT from the Yale guy and there is another Dr that does another endo test; someone on the boards is doing that biopsy.

https://info.med.yale.edu/obgyn/kliman/infertility/dx/diagwelcome.html

Intrallipids are cheap enough that you could just add them into your protocol. It's a catchall treatment for several issues. The EFT can indicate several concerns with several treatments. I have some reservations about it, but it's relatively inexpensive. The issue with any of these tests and angles is that there isn't necessarily a tried and true way to treat the problem. But if you're at the end of your rope and you want to explore options then many of the therapies won't necessarily hurt either.

krod2010 · July 2012

Mtlaurel...sorry to hear about your cp. I think doing the further testing would at least rule things out.

I posted yesterday about if anyone knew anything about Beta 3 Integrin which is the e-tegrity testing. My dr mentioned it to me yesterday and it is hard finding out information about it-mostly about the protocol. There is a company called Adeza in Cupertino that also does the testing.

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