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. After all they say, an apple does not fall far from its tree. But after two pregnancy losses in 2019, we found out our pregnancy journey will be a lot harder.
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 is to consider an APAS case and may need tests to confirm it. APAS is one of the 5 reproductive immune disorders. We were old that it could be the cause of my recurrent miscarriages. I’ve read mixed reactions why women had to go through two unexplained losses before she is tested for 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 was told that even if I get pregnant easily but my body can not seem to get the pregnancy to progress.
I first got pregnant in March 2019, shortly after my husband & I decided we start to try to conceive (TTC). The first pregnancy was a brief one. It ended in spotting that eventually led to bleeding at 5weeks and 6days. I bled despite bedrest and “pampakapit medications”. The second pregnancy happened on July 2019. We were to allow my uterus to rest and reset for 3 months after the miscarriage before trying to get pregnant again. So on the 3rd month, we TTC again and found out we were pregnant the following month. We thought and felt in our hearts that it was the pregnancy and baby meant for us but God had other plans. The second pregnancy 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. One of first appointment with her, 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 showing 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 tests before we try to get pregnant again or as soon as we find out I am pregnant.
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 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 in November 2021, my Husband & I decided to TTC again. But since we were afraid to lose another pregnancy, with prayers and a lot of discussion, we decided we get all the tests requested done. We went back to Bloodworks Katipunan to run the all the tests needed to see what was wrong with my body.
The tests included 4 of the 5 Reproductive Immune Disorders, Thyriod Panel, Vitamin D levels and blood chemistry. We spent 33,000 PHP to get all the tests done. We had it done at Bloodworks Katipunan. The Medical Technician drew more than 200ml of blood from my arm to run all the tests needed. 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.
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 ideally done prior to pregnancy. It helps prepare the woman’s body for the pregnancy. The target is to get the LAT scores up to Above Average before given we’re given the GO signal to TTC. A male donor is required for the treatment. It could be the woman’s husband or any male donor that is not blood-related to the woman. Before the LIT treatment starts, the donor will be tested for blood donor screening. A blood donor screening is a mandatory screening to ensure safety of the recipient from infectious diseases. The donor is tested for Hepatitis B & C, Malaria, HIV and Shyphillis. It costs 5,700PHP for donor screening & blood testing (chemistry).
Once my husband was cleared to become my donor for the treatment, we scheduled our first LIT session. We had LIT every 3 weeks. We would go to the clinic around 7-8AM in the morning for the medical technicians to draw blood from my husband (donor) and we go back around 10-11AM for the actual treatment or session with Dr. Aleta. Each session costs 17,500 PHP, which already includes the doctor’s professional fee. The treatment is done until the desired LAT scores is achieved and also in the first trimester in the pregnancy help the body protect the developing fetus and not reject it.
I had a total of four LIT sessions before we were given the go signal to TTC. I remember how nervous I was when we were told my LAT scores were promising. I did ask Dr. Aleta what would happen if I don’t get pregnant after several tries. And we were told to TTC for the next three months and if I don’t get pregnant, we would go back for a LIT booster session to keep my LAT scores up.
It was a lot of information to absorb in one sitting. But what I appreciated about Dr. Lara was how gentle she was in answering all our questions.
Our first LIT session in November 2020 at Bloodworks Katipunan. 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 more fit than I was and a few of them a bit on the heavier side. Some looked like they’ve been in the clinic a couple of times already, and some, like me, had cluelessness plastered in the faces. It just goes to show that RID’s and APAS is not selective of age or physical built. I did not think I would have any fertility problems. But I found myself in a small community of women who (may) had multiple losses and/or struggled with fertility for so long but are holding on to a thin thread of hope that God will bless and answer the longing for child.