CARE Fertility Bulletin Board

smiles123 · 03 Dec 2010

After receiving results from our Level 1 & 2 tests, the following is the report
I have been shown to have elevated TH1 and TH2 levels and is PAI-1 homozygous. Both me and my DH share one DQ Alpha gene and both are a C4/M2 carrier.
Can someone explain the meanings of:
1. Elevated TH1 & TH2 level
2. PAI-1 homozygous
3. Both of us sharing one DQ Alpha gene
4. Both of us being C4/M2 Carrier

I have been prescribed aspirin, steroids, intralipid and clexane. Do these have any side effects?

Yellow38 · 03 Apr 2011

Hello,

I did some investigations after I had my L1&2's done and made some notes to help me understand what the tests were and the implications of the results. I have copied below the ones relating to your conditions...

The only one I don't recognise is number 4 on your list though - this may be karyotype results, but I am not certain.

In terms of treatment, I believe the steroids and intralipd will be for the elevated TH1/TH2 & the 25% DQ alpha - both of these will dumb down your immune system, and the aspirin and clexane will be for the PAI which is a thrombophilia issue - so the aspirin & clexane basically act as blood thinners/regulators.

I have taken all of the drugs you list and the worst one I find is the steroids - you need to try and take them in the morning otherwise I found the interfere with your sleep plus they made my chest a bit spotty, but to be honest nothing you shouldn't be able to handle. Hope this helps!

Test L2, 1 Results Range & Interpretation (TH1:TH2)
Cytokine ratio (TH1:TH2) test
What is the cytokine ratio test?
This is a blood test done by various labs in the US including RFU Chicago. It is a measure of the ratio of pro-inflammatory cytokines (chemical messengers) to anti-inflammatory cytokines in CD3+CD4+ white cells (cells which make a lot of cytokines) in the blood. Higher ratios have been shown to be associated with a lower chance of live birth and are common in many inflammatory conditions (e.g., Crohns, IBS, arthritis, asthma), in cases where there is a DQalpha match and/or elevated NK activity. They may also be elevated under chronic stress or when you have an infection.

Please explain my cytokine ratio test results?
There will usually be two ratios
TNFalpha to Interleukin 10; and
Interferon gamma to Interleukin 10

e.g., TNF-a:IL10 (CD3+CD4+) 38.3
IFN-g:IL10 (CD3+CD4+) 10.9

The TNFalpha ratio is usually seen as more important for fertility and at RFU Chicago anything over 30.6 is elevated. Values over 40 are fairly high. Values over 50 are very high.

PAI-1 polymorphism is also very common - about 20% of the population are homozygous 4G/4G and about 30% are heterozygous 4G/5G (the rest of the population are negative i.e., 5G/5G. The PAI-1 mutations are more common in ladies with PCOS.

Test L2, 1 Results Range & Interpretation HLA DQ Alpha (female) & HLA DQ Alpha (male))
DQ Alpha Genotype (DQa) test
What is the HLA-DQa test?
The surface of our cells are covered in proteins which are used to communicate with other cells in the body. Patterns of proteins are called â€˜markersâ€™ and the DQalpha (DQa or DQA1) marker is one of these. Everyone has two DQa markers (which are expressed on most of their body cells). One is always derived from your mother and one from your father. So any embryos produced from your eggs will have one of your DQa markers and one from your partner/sperm donor. You are born with your markers and they never change. Consequently, you will never need to have your DQa markers retested.
How do I understand my DQa results?
Step 1: translate the DQa numbers into allele numbers using this list from pg 302 of Dr Beerâ€™s book (we do this because the body tends to treat markers on the same allele as being almost identical):

0101, 0104, 0105 = 1.1
0102 = 1.2
0103 = 1.3
0201 = 2.1
0301, 0302, 0303 = 3.1
0501, 0503, 0504, 0505 = 4.1
0401 = 4.2
0601 = 4.3

Example results:
DQ Alpha Genotype
Patient 0201, 0505 This is (2.1), (4.1)
Partner 0201, 0103 This is (2.1), (1.3)
Step 2: work out what embryo combinations you can make with your allele numbers and your partnerâ€™s allele numbers â€“ drawing a three x three box grid might help but basically you need to work out the four different combinations you can make if you take each of your two numbers and combine it with each of his, like this (by convention, the lower number is always written first):

(2.1) (4.1) (patient)
2.1 (2.1, 2.1) (2.1, 4.1) match
1.3 (1.3, 2.1) (1.3, 4.1)
(partner )

Step 3: how many combinations match your numbers exactly? In this example, the mother is (2.1, 4.1) and because the father has (2.1, something), there is only 1 combination which matches the mother.

The theory is that if the embryo is an exact match for the host mother (regardless whether own egg or donor egg), it is more likely to be seen as â€˜altered selfâ€™ and trigger an unhelpful over-aggressive immune response. If you have one possible match in four, that means that, on average, for every four good embryos you make as a couple, one of them (25%) will match you and be at increased risk of triggering an immune response. If you have two matches in four, the risk will be 50%. If you have four embryo matches in four, all your embryos could trigger an immune response (100%), if your body fails recognise the embryo as â€˜foreignâ€™ and â€˜benignâ€™ rather than â€˜altered selfâ€™.

Examples:
If you work out the 4x4 grid for this combination, it will give you 1 match (25%)
(1.1, 2.1)husband, (1.1, 3.1)wife

The grid for this will give you 2 matches (50%)
(1.1,2.1)husband, (1.1,2.1)wife

The grid for this will give you 4 matches (100%)
(1.1,1.1)husband, (1.1,1.1)wife

A matched embryo will not necessarily always trigger an aggressive response, but the theory is that it is more likely to, if the motherâ€™s body fails to distinguish it properly from â€˜selfâ€™.

Poobear · 08 Feb 2012

Hi Smiles123 ,
Im currently waiting for my Immune level 1 resutls to be explained. Amoung other things my OH has been diagnosed as a C4/M2 carrier. As this is a new test i cant find anything on it anywhere, have you managed to find out what it relates to yet ?

Thanks

silverbirch · 01 Nov 2010

Hi - I had fairly similar results, took the medication and now have a 6mth old baby, so hope it goes well for you x

I didn't find too many side effects from the medication - the reflux in pregnancy was worse than anything else I found!