The New Clinic Part 4 : Uterine Natural Killer cells

Part 1 Super Fertility
Part 2 Super Fertility treatment
Part 3 The Biopsy

In addition to being investigated for having an insufficiently selective womb, last week’s biopsy was taken to determine if NK cells are elevated in my womb lining.

Natural killer cells I’m told are good, despite their name. They appear apparently in the womb at the time of implantation (which is why they do the biopsy a week after ovulation) and determine whether the womb is short on steroids to support a pregnancy. You can read more about what they do here. And there’s also a study I found interesting.

Apparently if the tissue taken from the biopsy shows that there were too many NK cells at the surface of the lining then treatment may be required to reduce the number of cells that might be impeding growth of the embryo.

Treatment in my case would be with steroids. Prednisolone I’m told reduces the amount of oxygen in the womb which subsequently reduces the amount of blood vessels. Apparently excess oxygen and blood vessels are harmful to a developing embryo and the goal is to create an oxygen free environment, more like a normal womb.

I won’t even go into the huge list of side effects from the steroid treatment: moon face, weight gain, migraines. Won’t worry about this until we get results. All are obviously worth it if we get to bring a little one home one day.

I’m meant to have blood tests for NK cells as well under investigation by a private doctor. Not the uterine kind, but the kind circulating in the blood. There seems to be some disagreement between immunological camps as to whether general blood NK cells are harmful to pregnancy. That’s a whole other issue, whether we decide to pursue that form of testing. For now we will focus on the womb lining kind.

Who knows if this will be another battle to overcome. We’ll find out in four weeks.

Have any of you been tested for uNK cells and if so what kind of results did you get?

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The New Clinic Part 3 : B is for Biopsy

Part 1 Super Fertility
Part 2 Super Fertility treatment

A continuation of my appointment on Friday.

Right, so the biopsy. The very thought of it makes my eyes roll back into my head.

The biopsy is done 7-10 days after ovulation so the lining is thicker and so they can see how the womb is responding to what should be a critical implantation phase.

The first point of the biopsy was to test NK cells in the womb, something I will go into in another post.

The second reason was because it has been proven that the very act of taking the biopsy at that critical time after ovulation can be treatment in itself. It mimics the signal of implantation to induce healing and recruit stem cells to support the embryo in a following cycle. So in short, this can actually help to keep an embryo implanted as many of you ladies in North America know as endometrial scratching / biopsies are often performed prior to an IVF cycle to increase chances of success.

I was alone for the procedure, something I don’t recommend. I knew the Hubs couldn’t make it that day and we decided it was better to get it done at the right point in my cycle that they needed to rather than wait another cycle. So I went alone.

They explained the procedure starts like a smear test. A speculum is used, the cervix is cleaned, then a catheter is inserted and some cells get sucked off the lining. Thankfully it’s not a cutting type of biopsy.

But first a scan to check how thick my lining is. They won’t perform the biopsy on anything under 7mm. I told them a scan I had two days before ovulation determined my lining was too thin at 6mm but this doctor told me not to worry, that for sure it would be over 8mm by now. So wand goes in, he scoots it around. Lining? 6mm. Thin. Too thin. Oh wait. He finds one spot that measures 6.9mm. That spot is up and over and the furthest point away deep in my uterus. It’s still too thin for his standards but he says he’ll do it considering the look of desperation on my face and that I’ve travelled over 3 hours for it. But he tells me to prepare myself because this is going to hurt.

We always get the difficult uterus on a Friday afternoon, he says. Prepare yourself.

Meanwhile he’s making small talk asking me what I do for a living as he preps the tools for the biopsy. I can barely hear the questions over my pulse in my eardrums. I’m terrified I tell him. I’ve had a horrendous HSG procedure that almost knocked me unconscious with pain. He recognises how that could be an awful experience but carries on with fixing the speculum. He then explains again showing me a what looks like a 20″ catheter how far he’s got to go to get that thing in the right place. This is where most women get their sample taken (points to area just inside opening of womb). This is where we have to go to get yours (points to uterine no mans land). This might take a while and you are going to feel it.

Thankfully I had done my research unlike prior to my HSG. I was well aware this could hurt. So I took 800mg ibuprofen about 45 mins beforehand in addition to half a Diazepam. Thought I was going in prepared. Both did nothing.

First attempt at getting the catheter in doesn’t work. My uterus is too tilted, too awkward. Can I move down a little. Can I try a tilting my pelvis. Poked and prodded but still no luck.

Ok time for the bigger speculum. We’ll be right back. Nothing like being naked from the waist down, inspection lamp pointed brightly at your crotch, your feet in stirrups when everyone evacuates the room to fetch larger tools.

Bigger speculum is right! How they got that thing in there I will never know. But that was the easy part. The next attempt at the catheter. It’s going in. And in. And in. And this I can feel. It gets progressively worse as it goes in. Eventually it reaches it’s final destination and what I can only describe as pulling begins. This must be the suctioning. See on the screen this is the catheter and this is where we’re taking the sample. No I do not want to see just get the thing done! He tells me he counts down from 10 and at each number he pulls the tissue out with a yank.

After much fussing around he’s got what he needs. Or does he. Not convinced he asks if I mind if he checks the sample before removing the speculum. There’s a chance we might have to do this again. Thankfully though upon inspection he thinks we should have enough.

I’m warned that I may spot for the rest of the day and my period will likely come a few days early and I’m sent on my way.

Consensus : Painful? Yes. Endurable? Yes. As bad as HSG? Definitely not.

“Super Fertile”?

Now that I’ve reached the end of my conventional recurrent miscarriage clinic journey and they’ve tested for everything they could, I’ve more or less come up negative for everything that could cause recurrent pregnancy loss. Our case is now “unexplained.” I guess medically speaking it’s a good thing not to have something wrong with me but strange as it sounds I want something to be identified, something to be wrong with me so it can be treated. I need answers.

The next step in my journey has lead me to a specialist Dr. Q who is so different to the other RMC’s. The primary focus is the lining of the womb. She’s told me I’m a textbook example of someone who is “super fertile.” At last, a possibility, something I can hold on to.

Click here to read about the Super Fertility Study

A normal womb will be selective when approached by fertilised embryos and may even take six months or more to choose the best quality one to implant. Apparently my womb isn’t selective enough and allows any old embryo to implant regardless of its quality or viability. A problem with the lining of the womb will cause this to happen.

The proposed treatment protocol is a course of 400mg progesterone daily started from ovulation for either a week or BFP and to continue if BFP. The good news is that the progesterone will increase the thickness of the lining of the womb which will make good embryos really work at implanting and the bad embryos won’t have a chance. The bad news is that the progesterone will make it harder to get pregnant.

But my main concern at this point is could all five of our fertilised embryos really be that poor quality? They won’t know for sure. If it’s a case of constant chromosomal abnormalities then PGD IVF might help our chances.

But Dr. Q tells me that it might not be that simple. She suspects I might have the presence of high natural killer cells in the womb which will make a nasty environment for fertilised embryos. The cells increase blood vessels and oxygenation which isn’t what you want when fertilising an embryo. Who knew? A simple biopsy will be taken after ovulation to check the levels and if they are higher than normal Prednisolone will be prescribed.

Click here to read about the endometrial natural killer cells study and recurrent miscarriage

So it’s the next piece of the puzzle. The next thing to try out. Keen to get cracking.