When we were trying to get pregnant, we did not think there would be any problem. I come from a mom who had six healthy pregnancies and had given birth to seven children with no complications. But the apple can fall far from its tree. And on my case, my husband & I found out our pregnancy journey will be a lot harder because I had APAS.
I have not heard about APAS prior to our doctor telling us to see an Immunologist for it. It was when Dra. Maria Elsa Aquino from Metrodocs Pasig, my OB Perinatologist explained two unexplained pregnancy losses is when they consider it an APAS case. I’ve read mixed reaction why a woman had to go through two unexplained losses before she is considered to have APAS. In my humble understanding, our reproductive system (with the aid of our endocrine system) is largely responsible for pregnancy and if the doctor can not see why a woman miscarries in that area, it is only when they consider other factors – like the immune system in the play.
APAS is one of the five Reproductive Immune Disorders (RID). I did not know anything about APAS then but she explained that she could not find any reason why I keep miscarrying, that we had to check if my immune system had something to do with it.
Upon her recommendation, we went to see Dra. Lara Aleta from Bloodworks Katipunan. We told her of the recurrent pregnancy losses and she was gentle but forthright in her initial assessment with me. She suspected that I was a candidate for APAS but needed to run some tests to confirm it. But since we were not ready to conceive again just yet, she said to run the test when before we got pregnant and trying to conceive again.
Five Reproductive Immune Disorders
CATEGORY I – Lymphocyte Antibody Test (LAT) or Lack of Blocking antibodies
This is when the woman’s body fail to produce blocking antibodies to stop the immune system from attacking and rejecting the fetus. This happens when the woman shares nearly the same antibodies with her partner. Normally, the father’s DNA in the embryo tells the mother’s body to set up a protective reaction around the baby. But since the mother’s body fails to produce this, the blocking effect does not happen and the baby is rejected. The treatment for this is Lymphocyte Immunization Treatment (LIT) where the father or donor’s blood is injected into the woman to prepare her body for the pregnancy.
CATEGORY II – Antiphospholipid Antibodies (APAS)
APAS is the most common abnormal immune system problem. It can prevent implantation thus preventing pregnancy in the first place. Phospholipids are like glue needed in early pregnancy. But for some woman produce APA blood-clotting antibodies that attacks the cells that builds the placenta. This increases the risk of miscarriage. This is treated with blood thinners like low-dose Aspirin and Heparin.
CATEGORY II – Antinuclear Antibodies (ANAs)
ANAs are directed against structures within the cell nucleus. It can attack the fertilized egg and the cells in the womb. This prevents implantation and increase the risk of miscarriage. This is often treated with steriods like prednisone to suppress the inflammatory process.
CATEGORY IV – Antisperm Antibodies
Antisperm antibodies can cause agglutination or even prevent fertilization because it stops the sperm from penetrating through the cervical mucus. Steroids are usually given to patients for this.
CATEGORY V – Elevated Natural Killer Cells (NK Cells)
Natural Killer cells are important in the body. This makes up 50% of all the white blood cells and are needed to control rapidly dividing cells like cancer. However, some women may produce too much NK cells which will aggressively attack cells that grow and divide – which is in the case of pregnancy. So instead of the body allowing the embryo to develop, the NK cells attacks it. Possible treatments are LIT, Intravenous Immunoglobulins (IVIG), steroids and even rheumatoid arthritis drugs.
Exactly a year after we saw our Immunologist, with covid pandemic, we went back the clinic to run the tests she requested. The Medical Technician drew more than 200ml of blood from my arm to run all the tests needed and a week after, we got the results. Since it was Covid pandemic, we had the teleconsultation with Dra Aleta where she broke the news to us.
“I’m sorry to tell you dear that you have APAS” as she ran here eyes on the test results I sent to her via email. She continued, “Your LAT scores are at 0%” and further explained when she saw the blank expressions my husband& I had in our faces “your body can’t protect your baby when you’re pregnant”. “And your Vitamin D level are low even though you’re already taking Vitamin D supplements right now”