Kwak-Kim Follow Up Appointment

Le sigh. 

Here were her findings:

-Elevated homocysteine - It's 8.5, she wants it under 8.  She has switched my methylfolate to a prescription supplement of Metanx.

-Elevated PAI-1 activity - Mine is in the mid 20s, and she would like to see it in the low teens.  She has stressed the importance of a low carb diet and I should continue the Metformin.

-Elevated Natural Killer Cell activity - This was a bummer.  She recommended Prednisone and IVIG treatments.  She is recommending at least 5 which would be approximately 30K.  That my friends is not happening. You have to draw a line somewhere. She agreed she would still monitor me using Prednisone. I inquired of intralipids (much cheaper than IVIG) and she does not prescribe, but my doctor does.  

-Elevated EOSIN% (white blood cell) - Mine is a 6.5 and it should be between 1-2. This is bothering me.  It could be inflammation, but there has to be a cause. In most cases elevated EOSIN% means parasites, eczema

I am thinking our plan will be to follow her immune protocol minus the IVIG and inquire of my RE regarding prescribing intralipids. Luckily for me she does prescribe them and worked at SHER for a bit, so she does believe in immune protocols.  

From what I understand I do not have the NKC's that effect implantation, but I do have the activity that causes later miscarriages and issues with the placenta causing IGUR and 2nd trimester miscarriages. 

She also suggested transferring 2 embryos instead of 1.  I found this surprising considering the other issues we are working with. 

My AMH, which has never been tested is a 1.95 which she said is okay. I did not test positive for any auto immune disorders. I also did not test positive for any other thrombophilias.  My Vitamin D levels are finally in an okay range, and I will drop my dose to 3,000 units and 2,000 units when pregnant.  

She believes that the PAI and homocysteine can be in acceptable ranges with a low carb diet and Metanx in two cycles.  So she would be comfortable with a transfer occurring in March. 

She wants another ultrasound and endometrial biopsy done 5-7 days after this month's ovulation. 

My plan - meet with my RE to discuss Dr. Kwak-Kim's findings, inquire of her thoughts on the intralipids and then having the ultrasound and endometrial biopsy done by Dr. Kwak-Kim. 

Again, its just a lot.