APAS and Fertility Disorders

As of March 2014

Preg Belly FB

Being diagnosed with Antiphospholipid Antibody Syndrome or APAS is devastating, confusing and scary. Knowing that you cannot have a “normal” pregnancy is unnerving.

When I learned that I had APAS, I wanted to know more and more about it but it has always been a hush-hush topic. After all, no one would probably be proud to announce to the whole world that they are having troubles getting pregnant.

The world of reproductive-immunological disorder is so quiet. I have never heard about these things before. I know that people only have a hard time getting pregnant when they have PCOS (polycystic ovarian syndrome) or the husband has a low sperm count. But your immune system countering your pregnancy?! That is unheard of. Well, at least, by me.

So I would like to discuss again the different types of reproductive-immunological disorders to help all those who are in the same boat as I was when I first discovered the syndrome.

When I was doing my research around two years ago, I stumbled upon this site>>. It has provided me with the information I needed to  understand my condition.

To quote from Reproductive Immunology Associates, one in every 200 couples are too genetically similar to achieve a successful pregnancy. They are saying that one among 200 couples will experience two or more recurrent miscarriages. That is way higher than the incidence of parents giving birth to children with Down Syndrome (1 in every 800) and children with Rare Disorder (1 in every 20,000). I am comparing this to the latter because I have also been involved with PWD causes and this number has struck me as very alarming.These are the causes of miscarriages as per the website:
Cause Percent
Infection   1%
Anatomy abnormal   5-10%
Progesterone level low   20%
Chromosome abnormal    
   Primary miscarrier (no live births)   7%
Immune Mechanisms 50%
 
Unknown   15%

Based on the table, the figure for immune mechanisms is quite high. My OB, Dra. Valerie Guinto, and my immunologist, Dra. Carol 
Gloria, mentioned five repro-immunological disorders.
Contrary to what many people believe in, APAS is not the only repro-immuno disorder out there. In fact, APAS is only one of the five immune disorders that cause recurrent miscarriages in women. I think the term was just generalized because the other categories don’t have the acronyms to encapsulate the condition.
Here are the five repro-immuno disorders:

CATEGORY 1. The couple’s tissue is too compatible; the woman’s body considers her placenta foreign with her immune system activating against the baby.

According to the website,

Early in pregnancy, the mother’s immune system receives signals from the tiny fetus. Many of the signals are hormonal, but others come directly from genetic messages that the father has contributed. Some of the messages involve the tissue type, also known as the human leukocyte antigens (HLA) and the white blood cell (leukocyte) type. HLA are expressed on white blood cells. They are unique to each individual and allow the body to identify anything foreign to it such as infections, cancers, transplanted organs and fetuses. One half of the fetus’s HLA type is contributed by mother and the other half by father. When a woman becomes pregnant, her body’s immune system usually recognizes the father’s HLA as different from her own, and the white blood cells in her uterus produce protective, blocking antibodies. These antibodies coat the baby’s cells and protect the fetus from mother’s killer cells.

If the father’s HLA is too similar to mother’s, her cells may not recognize differences that are vital to the production of blocking antibodies.
 
APAS
http://www.rialab.com/miscarriages_prevented.php
 
Per my understanding, when the wife’s HLA is “too compatible” with the husband, the body does not produce the blocking antibodies that it needs to protect the baby, thus a miscarriage takes place.

CATEGORY 2. Blood clotting problems like antiphospholipid antibody syndrome or APAS. This I think is the most common; I am positive for this also.

Phospholipid molecules are normal components of all cell membranes. Some also have glue like properties and allow cells to fuse. Antibodies to phospholipid molecules can, therefore, cause problems.
Specifically, they can damage the inside of the blood vessel wall. This allows blood cells to stick to the site of the injury and cause blood clots. Antibodies to phospholipid molecules can, therefore, interfere with the development of the placenta. With each pregnancy loss, there is a 10% chance that the mother will develop an antibody to a phospholipid molecule.
Most women with antiphospholipid antibodies are not sick. However, some have underlying autoimmune tendencies and should be appropriately evaluated. Women with underlying autoimmune diseases may have antiphospholipid antibodies even before they ever become pregnant. (Rialab)
 
In simple terms, there is a problem with the way your blood clots making your blood “too thick” that the nutrients and oxygen needed for the baby’s growth are blocked.

CATEGORY 3. Anti-nuclear antibodies. There seems to be an immune reaction to the baby. When the baby develops as a cell, it contains a nucleus. The nucleus is the ” brain ” of the cell. It contains the information that regulates the function of the cell. Some people have antibodies to different nuclear components.
CATEGORY 4. The couple produces antibodies to sperm which immobilize and destroy them on contact.

CATEGORY 5. Certain white blood cells are over active like the NKs or natural killer cells.  Later in my work-up, I was also tested positive for this. See this excerpt from www.miscarriage.about.com —

Despite the strange sounding name, natural killer cells are not a bad thing to have — on the contrary. NK cells play a vital role in the functioning of the immune system. They help the body fight off tumors and destroy cells that are infected by viruses.
Because of the finding of elevated NK cells in some women who have had miscarriages, some researchers have speculated that NK cells could also be responsible for a woman’s body terminating a pregnancy. Not everyone agrees, however, that the finding of elevated NK cells in women with recurrent miscarriages means that the NK cells themselves are the cause of the miscarriages. There are other reasons why the NK cells could be elevated.There is a lot of evidence that NK cells are elevated in women who have had recurrent miscarriages, but not so much evidence that the NK cells themselves are the actual cause of the recurrent miscarriages. Researchers are looking at whether treatments to reduce the levels of NK cells reduces the risk of miscarriage.

Read more here>>.

So there you go, I hope that in some way, I was able to help provide more information on this condition and hopefully, will be able to guide our partners, our family, our friends about our case.
 
Babydust to you, love!
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3 Responses to “APAS and Fertility Disorders

  • Hi Balot!

    Was there any progress after this? What treatment did you take and which is successful?

    • balotdelrosario
      6 months ago

      Hi Licca, I was treated with LIT prior to pregnancy and was put on aspirin, heparin, IVIG (once when I was on my 7th week) and monthly intralipid until Month 8. These treatments depend on how your body respond so my treatment plan may not be the same as yours. Others respond greatly with several intralipid sessions. Your OB and immunologist will determine what course to take based on the fetal growth.

      I was blessed by God with a bouncing baby boy and he is already turning one tomorrow. I pray that God grants you your heart’s desires, too! Babydust sis!

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