To resume – we left us in the street, H describing his tribulations in the lab’s ‘special’ collection chamber, and me, his loving supportive wife, shrieking with laughter. Oh, and Ossa on Pelion, once H had mastered the difficulties of Unhelpful Naked Ladies and The Looming In-Laws, there were people trotting noisily about in the corridor, leading to good old ‘if I can hear them, can they hear me?’ moment. Nevertheless, H rose manfully to the occasion, and his sheepishness on rejoining me was entirely due to the fact the entire staff of the lab obviously knew where his hands had just been, and he also knew very well indeed that I would inquisitive also mirthful, because I am puerile.
So. I have here the receipts, and TheSheila’s helpful link to Explanations Of Everything Immunology in the comments of my last post, and let us see what all this expense and pother is for. (The expense! AIIIEEE!).
Item one – The consultation fee. Well, that is self-evident. Onwards.
Item two – FGA 4+6. What in the name of wonder is this? Comparing the price list with the FAQ with my own memories of Dr Expensive’s explanations, I conclude this is the Natural killer cells panel TH1/TH2 intracellular cytokine ratios. Basically, has my psychotic immune system filled my blood-stream (and hence my uterus) with Cells of Rage, dedicated to hunting down and destroying every possible trace of DNA it can’t be having with, starting with cold viruses and the like, passing into panicked reactions to random proteins in pollen and, say, kiwis, and ended up going on rampages against embryos trying to get a grip in the old ute. The science gives me brain-ache. The treatments are usually things like steroids and intralipids, or even IViG, heparin, progesterone. Anyway, it’s treatable.
Item three – LAD. Oh, this is Leukocyte antibody detection. A sample of my blood is mixed with a sample of H’s, and then they look to see if my leukocytes have gone into rabid attack mode and if so, how rabid, and why. Basically, my leukocytes are supposed to attack ‘foreign’ DNA (virus, bacteria, fungus), and ‘self-but-altered’ DNA (ie tumour cells, cancer). If my immune system can’t ‘recognise’ H’s DNA as foreign, it then assumes the embryo is ‘self-but-altered’, and kills it. The treatment is controversial and complicated, and involves inoculating me with H’s lymphocytes, in an attempt to get my body to recognise his DNA as foreign-but-benign and leave the embryo alone. If H is ‘too similar’ to me, they even use donor lymphocytes. It is thought that the first pregnancy ‘sensitizes’ the woman’s immune system, and screws up subsequent pregnancies. My first was a missed miscarriage that had to be scraped out of me, and all the rest have been early losses and ‘chemicals’, which seems to hint that my immune system has learnt since the first miscarriage to kill embryos on touch-down. But the treatment! Expensive and experimental and controversial and involving blood-products from donors! Fucking fucky fuck fuck!
Item four – DQα Genotype. Both H and are tested for this. All our cells have two ‘markers’ on their surface, which our immune systems recognise or fail to recognise, one inherited from each parent. If our embryo inherits a combination of alleles that make its markers too similar to mine, my body thinks it’s a tumour and kills it (basically, a similar result to the above via a different genetic mechanism). Treatments, again, are steroids and intralipids or IViG, Humira, or even the above LIT treatment with lymphocyte inoculation. Again, it is possible for the woman’s body to become more sensitized on subsequent pregnancies (causing earlier and earlier miscarriages, implantation failures, etc.). Or there’s always donor eggs or sperm. And the donors would also have to be tested, to make sure we aren’t wasting our time. *tears hair*.
Item five – HVS. HVS? What? Ohhh, High Vaginal Swab. Yes, I remember that. I wince every time I think of it. We’re testing for chlamydia, gonorrhea, bacterial vaginosis, and other similar STDs and infections that can create an inflamed, hostile uterine environment and damage the growing embryo. Treatment, month-long course of four different brutal antibiotics. Yay!
Item six – Semen C+S – Same test as above, only on H, and for which he battled the combined forces of bad porn, in-laws, and a possible audience. Apart from the risk of passing the infection to me (we’ve been banging sans condoms for about 15 years now. Horse has bolted), an infection could damage the quality of the sperm, anything from killing them outright to stealthily warping the DNA inside them, so they produce crappy little embryos that don’t know how to grow organs and conk out instead.
Item seven – Chlamydia, Mycoderma. This is code for more testing of the above. It is theorized that the infection could have migrated to the uterine lining and no longer be present in the vagina, or present in the vagina and uterus. So they give the lady a large padded envelope containing a small padded envelope and a plastic pot, and send her home to await her next period, and on the day of heaviest flow, they want that pot filled and, get this, FED-EXed to the lab. I am to send a pot of blood and gunk across the city by expensive courier. I am floored.
And this is not counting the repeat sample H is to give this week, for sperm-count/DNA fragmentation (which can be caused by many things other than STDs, you know, including shitty-bad luck).
On the matter of STDs and other infections, H and I have been both boring and safe in our sex-lives. I have not had sex with many people, and except for with H, I was neurotically scrupulous about condoms. H confesses to one (ONE) silly bout of unprotected sex when he was 17 (which I’ve known about since, I think, the day after it happened (and it was before we started dating)). H and I stopped using condoms when I went on the pill, by which point we were an Established Couple Very Much In Love, also we were 19 or 20. So neither of us had much chance of picking up an STD. But if one of us had, the other had pretty much no chance of not being affected. The thing is, the thorn is, the person H had unprotected sex with at 17 had prior to that had unprotected sex herself, with several people who were not exactly careful or abstemious, so there is a tiny, remote, possibility that she gave H an STD before he even so much as considered me for a kiss, let alone life-long bondage (tee-hee). And, yes, I know this incautious sexual partner of H’s rather well, and thereby know rather a lot about her sexual habits (rather than suspect, or maliciously impute).
If we do turn out to have an STD, I may have to kill her.
There is always the possibility that either H is or I am lying about how cautious and sensible we’ve been since, or how loyal. But I know me and I trust H.
And there is always the possibility that the infection I developed after my first miscarriage (post-D&C) never went away, and that was totally not down to carelessness on my behalf. There are bacteria that live naturally in the vagina that are fine where they are, but a problem if introduced into the uterus.
Which is why we agreed to do all the infection tests. Despite being as faithful and devoted and clean-living as Darby and Joan.
And now we wait for results. Well, H has to go and battle the bad porn and looming in-laws again, bless him, and then we wait.
I am in a bit of a state, mind you. As we were sitting in Dr Expensive’s office, I has being harrassed by the thought that he was taking us seriously, which meant there were serious things to do, which meant treatments and expense and bother, which meant laying my poor heart open like a laboratory specimen to That Bitch Hope, and I don’t want to hope, I don’t, I don’t, it hurts too much, I want my nice safe Bat-Cave.