Donor Egg cycle with elevated NK cells

[zelda81]

I'm starting my 4th round of IVF, first time with donor eggs. I have had two biopsies previously which has found elevated NK cells (10% the first time then 33% a year later). I also had a natural pregnancy which resulted in early miscarriage a few years ago.
In my 3rd IVF cycle I was prescribed Prednisolone but it was still unsuccessful.

Now we are in Covid times I am faced with a difficult decision. The clinic have stopped prescribing Prednisolone due to the impact to the immune system and risk of then getting Covid - but they have told me that they will prescribe it to me if I am willing to shield for 12 weeks while I am taking it.

This has prompted me to look a bit closer at the pros and cons of Prednisolone and has left me with a tough decision.

As much as there is a positive link between prednisolone and improving implantation / reducing risk of miscarriage, there are also articles indicating that taking it could adversely impact the development of the placenta - which could lead to birth defects, pre-term birth, cleft pallet or miscarriage later on in the pregnancy.

What I've not been able to find in order to weigh this up properly is any information about the link between prednisolone and using donor eggs.
If I have elevated NK cells is the risk of my body rejecting the embryo even higher when using a donor egg?

If anyone has any experience of this I would be grateful for some advice.

Thanks

[VioletCreams]

Hi

I hope that I’m not too late in getting back to you about this. I had elevated nk cells (think it was around 6%) so was on pred & clexane for my cycles.

The first cycle was with my own eggs and ended up being a chemical pregnancy but this was the first time I was pregnant in 5 ivf cycles so took it as a good sign. I then used pred & clexane for my donor cycle and I now have an almost 3 year old.

You do need to take a higher dose of folic acid 5mg which is prescribed from your gp as there is meant to be a higher risk of cleft palates as you say. I never knew anything about placental problems or late miscarriage being an adverse affect of the steroids. I did have a pre-term birth (just at 36 weeks) but that was due to having pre-eclampsia. One advantage of steroids is it apparently masks morning sickness so I never suffered from that all.

I’m not sure if having nk cells would be a higher chance of rejecting a donor embryo as I think regardless of where it came from it is seen as a ‘foreign object’ and would likely reject it even if it was your own.

With regard to pred lowering your immunity I was hospitalised at 33 weeks due to pre-eclampsia and given 2 steroid injections to mature the baby’s lungs. I then developed pneumonia and was seriously ill and on oxygen for over a week and was having iv antibiotics 5 times a day (2 different types). Just to let you know this isn’t very common, apparently I was only the second person they had in that this happened to and the previous person was quite a few years earlier. I’m not saying that to alarm you just that there is so much unknown about Covid-19 and I can see their reluctance in prescribing it for you. I guess if you are happy to shield for 12 weeks then go for it but what will happen to your scans? I had my viability scan at 7.5 weeks will that mean you won’t have one? Also what about your hcg pregnancy blood test (if they do that)?

I hope that this has helped you (even a little). Good luck in whatever you decide to do xx

[zelda81]

Thank you @VioletCreams for responding to this. It’s really helpful, and not too late as we still have time to make the decision. I think we’ve decided to try without the prednisolone this time. I’m hoping we might get some frozen embryos and if I miscarry we should have the option to try again.

I’ve read that pre-eclampsia is sometimes a risk with donor conception, regardless of NK cells. Sorry you had so many complications but congratulations on having your 3 year old now.

[Linda2018]

ARGC does tests for NKs and gives regular infusions (IVIGs) up until week 24 so that NKs do not become an issue.