Well, I finally had out follow up-
here is what he had to say! ( below)
I was surprised to learn my NK cells had gone to normal, which is great news! (not mentioned in recap)
anyway- I really hope these meds work!
Hi Megan , here is a summary of our findings and our plan for treatment
1. You have a high level of antibodies against your husbands HLA genes and these are complement fixing so we know they cause damage to the pregnancy and may explain your 19 week loss.
2. You have a HY restricting allele the DRB3 and this causes you to make antibodies against any male pregnancy and if fact when the immune rejection for the male becomes strong enough most of your pregnancies will be rejected , all of this starts usually after a full term male pregnancy has occurred.
3. You have a combination of HLA genes that predisposes the embryo to making low levels of HLA G , a molecule the embryo must make to HELP create immune tolerance for your husbands genetics which obviously is not working
4. You have significant uterine artery flow issues
5. You do not have enough differences with your husband on certain HLA genes that are necessary to create immune tolerance toward all of his genetics.
To treat this we recommend
1. Prednisone to decrease the production of the anti HLA antibodies that you have (you should start at 40mg , 20mg twice per day) we discussed IVIG as well but this is very expensive , however we will try and order it to see if it is covered but I would doubt it.
2. Neupogen for the HLA matching issues and to help develop tolerance toward your husband genetics. It is important to have relations as often as you can while on the neupogen.
3. Lovenox to improve the uterine artery blood flow and to prevent the activation of complement caused to your complement fixing HLA antibodies that is the root of the problem with these types of antibodies.
The nurses will call you to go over injection teaching.
You must reorder the HLA antibodies and Treg cells with each pregnancy test as well as an heparin anti XA level that we will be sure you get scripts for , you need a CBC with each pregnancy test as well.
Jeffrey Braverman MD FACOG
Braverman Reproductive Immunology