When we were trying to get pregnant, I did not think we would have any problem. After all I have a mom who had six healthy pregnancies and had given birth to seven children with no complications. But after 2 pregnancy losses in 2019, we found out our pregnancy journey will be a lot harder because I had APAS, a reproductive immune disorder after fetal development and pregnancy sucess.

READ: Miscarriage | Losing & Gaining Our Angels

I have not heard about APAS prior to our doctor telling us to see an Immunologist for it. It was after, Dra. Maria Elsa Aquino from Metrodocs Pasig, my OB Perinatologist explained that two unexplained pregnancy losses could be considered an APAS case. APAS is one of the 5 reproductive immune disorders that may have caused my recurrent miscarriages. I’ve read mixed reaction why a woman had to go through two unexplained losses before she is considered to have APAS. But 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 in play – like the immune system.

APAS is one of the five Reproductive Immune Disorders (RID). I did not know anything about it then but she explained that she could not find any reason why I keep miscarrying. She said, I get pregnant easily but my body can not seem to get the pregnancy progress. I first got pregnant in March 2019, shortly after my husband & I decided we wanted to get pregnant. It was a brief pregnancy ending in spotting that eventually bleeding at 5weeks and 6days. I bled despite bedrest ang “pampakapit medications”. The second pregnancy happened on July 2019, 4months after the first miscarriage when the doctor said it was already safe to TCC again. It ended with a sudden loss of fetal heartbeat at 11weeks. Since my OB could not see anything wrong from any clinical results she was looking at she recommended 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. I’ve read about her in an FB APAS group that I joined into. 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 showimg symptoms of sluggish blood circulation 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.


Bloodworks Katipunan

Exactly a year after we saw our Immunologist, my Husband & I wanted to TTC again. But since we were afraid to lose another baby, with prayers and a lot of discussion, we decided we get all the test requested done. We went back to Bloodworks Katipunan to run the all the tests needed to see what was wrong with my body and why I kept on miscarrying before we get pregnant again.

The Medical Technician drew more than 200ml of blood from my arm to run all the tests needed. The tests included 4 of the 5 Reproductive Immune Disorders, Thyriod Panel, Vitamin D levels and blood chemistry. We waited a week after to get the results and 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 explained that even though I was taking Aspirin already, my blood clotting time just hit the normal range. So if Aspirin is taken off, my clotting time would be below normal. She continued, “And your LAT scores are both 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”. Since the womans body supposedly builds blocking antibodies to protect the growing fetus, mine does not. So in the event I get sick or my immune system thinks the fetus is a foreign body, it may attack it and it can protect it. “And your Vitamin D level are low even though you’re already taking Vitamin D supplements right now” Vitamin D’s helps keep our immune system healthy and helps protect it from repiratory infections, which explains I kept on having flu nearly once every month before my first miscarriage.

I was the first to break the silence asking her “What’s the game plan doc?”

To which she replied “You’re on Apsirin na, we will keep you on that” it will help the blood thin and in the event I get pregnant, it will help nourish the fetus. And she added “We also need to start LIT. We will start with three sessions first and see if your LAT scores will improve and see from there if dadagdagan pa.” LIT, Lymphocyte Immunization Treatment is when a male blood donor’s (Husband) white blood cell components is injected subcutaneously (under the skin) of the woman’s arm to prepare the woman’s body for pregnancy.

LIT was developed to help prepare the immune system for pregnancy, so that instead of the immune system attacking the embryo or foetus, it can help acclimatise the prospective mother’s body to the foreign cells. It is thought that LIT helps to develop a tolerance to the prospective father’s cells in preparation for pregnancy so that the immune system may accept the pregnancy, rather than reject it.

https://www.fertility-academy.co.uk/blog/lymphocyte-immunization-therapy-lit-recurrent-miscarriage/

LIT is supposedly done prior to pregnancy. The target is to get the LAT scores uo to Above Average before given the GO signal to TTC. LIT is done every 3 weeks, until the desired LAT scores is achieved and also in the first trimester in the pregnancy help the body protect the develooing fetus and not reject it.

She also said to increase my Vit D dose from 2000IU to 5000IU to increase Vitamin D levels in my body to help have healthy immune system. I took Vit D alongside Prenatal meds, CoQ-10 supplement, Vit C with Zinc.

It was a lot of information to absorb in one sitting. But she was gentle in answering all the questions we were asking and providing us with information needed to get the treatment going.

We went back to Bloodworks Katipunan and had our first LIT session in November 2020. I would be lying if I would say, we went in prepared. I sat in the waiting area seeing ladies older and even younger than me. Some of them thinner and fit than I was, a few of them a bit on the heavier side. Some looked like they’ve been in the clinic a couole of times already, and some, like me, had cluelessness plastered in the faces.

I did not think I would have any fertility problems. But I found myself researching and reading all about APAS and the reproductive immune disorders as I battle with my thoughts of why my own body kept rejecting my own babies.