NK Cells & Immune Testing - Biopsy v's Blood Tests?

[PaulaDag]

Hi All,

I am looking to book in for NK cells and immune testing as a next step on my fertility journey.

There seems to be two ways of testing - by blood tests and by uterine biopsy. I get contradictory information on it from the internet, my IVF consultant and the offices of Dr Quenby and Dr Shetata - these are the two I am looking to book with.

I've heard great reviews on both Dr's but want some more guidance on what you think is more reliable testing for this?

Dr Quenby does biopsy and no blood tests and her admin clinic said the biopsies are more evidence based if you are having the NK cells test for fertility, as the result can be different to the blood test.

And Dr Shetata office says the blood tests we do are far more reliable than the uterine biopsies and that they have been working with the lab for years to create the tests.

My IVF clinic don't really approve of this immunology testing but yet have an add on for it for £450 which is a biopsy at the NHS hospital attached to the clinic (its both NHS & private).

Any thoughts or recommendations? Do I need to have both tests done for peace of mind?

So confused on which to do but want to make the right decision and not think after I wished I'd checked both to be sure... 😭

xx

[Millbanks]

Hi Paula. So when I had my ERA biopsy done I asked whether it was worth me having the NK cells done too. My consultant basically poo poo-ed it and said it was a waste of money so I didn't bother. Since then I have found out (well realised) that my mum has an autoimmune disease and as such it's a marker that I might also have something up with my immune system. I mentioned this to my consultant at our last review and she said it would be a good idea to get my immune panel done (which includes NK cells but blood rather than uterine). I reminded her what she'd told me about the uterine NK biopsy and she said that as there is autoimmune disease on my mum's side, it would be worth checking. She also said that the bloods are different to the uterine tests and in her opinion the bloods are better in her opinion (although she didn't expand on that). This probably doesn't help you but thought I would let you know anyway! xx

[PaulaDag in reply to Millbanks]

Hi Millbanks,

This is really helpful, thanks. It sounds as if the blood and biopsy tests are different and so can't really be compared.

My consultant is pretty much the same as you and poo poo-ed NK cells. Although mine went as far as poo poo-ing the ERA as well, saying I've had 4 natural miscarriages so implantation is not a problem by NK or ERA...🤔I thought ERA was about their transfer window during IVF not natural conception and that NK cells attack so could implant and then let go... confusing. Anyway I digress.

Re your immune panel testing, it sounds as if the bloods include more tests than just NK cells? And perhaps the uterine biopsy only tests NK cells. Would you mind telling me who you are having you immune panel testing with and what tests they include roughly?

It seems as if we all get differing advise on whether bloods or biopsy is best. No wonder we never know what decisions to make huh

xx

[Millbanks in reply to PaulaDag]

I think if you've had implantation previously then ERA isn't necessary for you. I've never had a proper BFP so there's definitely something going on there - and the ERA showed 24 hours out timing wise - so that was relevant for us. Yes it is only for FETs. The NK assay also tests for high levels of Cytokines (which are cells of the immune system that can attack other cells) - there are a couple of other tests that they do too but I can't remember all of them - if you google Chicago test then it should explain it better than I can! My clinic is doing the bloods but sends them off to Chicago for the actual testing. I think most clinics do the same.

As far as I understood the immune panel is more thorough than the uterine test - and if you have high levels in your blood the chances are that they will filter through to the uterus, although not necessarily the other way round.

YES!! There is so much conflicting evidence it's almost impossible to know what to do for the best. But I like to do a lot of reading and make up my own mind as to what makes sense to me - it doesn't mean it's right... xxx

[Millbanks in reply to Millbanks]

Just read: Cytokines are a category of signaling molecules that mediate and regulate immunity, inflammation and hematopoiesis.

[PaulaDag in reply to Millbanks]

Hi Millbanks, I don't know why I thought natural implantation was irrelevant as ERA is about looking at implantation window for FET...but consultant did say the same that ERA won't be needed as I had 4 natural implantations pre IVF. So ERA isn't a thing for fresh transfers at all? There is so much i don't know 😭

I'll make enquires re Chicago testing then as I have been looking at booking Dr Shetata in Epsom and he doesn't do the Chicago test. Is yours being done by your IVF clinic? I'll check to see if mine offer this.

xxx

[Millbanks in reply to PaulaDag]

Yes exactly. It’s only relevant when your doing a frozen transfer. When you are doing fresh your body naturally produces the progesterone needed and they go based on the embryo rather than progesterone hours.

Well my clinic takes the bloods then sends them off for analysis at another clinic so do ask. They might not call them the Chicago bloods but rather just immunology xx

[Hidden]

Hi there. I did my nk biopsy but the sample wasnt good enough and i wasted 8 weeks waiting for that result. I was fuming to say the least. The consultant i did that privately with (bmi) said uterine is better than blood test. It was so painful though and im traumatised! So now that my round has failed and no one seems to prescribe autoimmune protocol without testing (so unfair after 4 failed transfers and known autoimmune condition Hashimotos) im looking in to it again.

Again not helpful ! What does your clinic say? X x x

[PaulaDag in reply to Hidden]

Hi Mimisami,

That is a disgrace and I would be fuming as well. I had the endo scratch and that was painful enough!

My Ivf clinic says biopsy is best too and more evidence based but it does seem as if it is not as wide a testing as the bloods..maybe biopsy is only nk cells and bloods is more inclusive and other immune checks. Is that your understanding? Do you know what was/would have been tested for your uterine biopsy? xx

[Hidden in reply to PaulaDag]

Hey. Not sure to be honest. They didnt give me much info. To be honest i wanted to just know if NK cells are elevated to find answers. And i read alot that with hashimotos the chances are that they are elevated. I hope to find q consultant/ clinic who wants to dig in to this a bit further.

[sazzle2680]

I had both the NK and cytokine bloods done. Again like everyone else, I’ve had contradictory info from consultants from my clinic in Spain and here in the UK.

I have hashimotos too - both NK and cytokines in my blood were very high. For me it stood to reason that if it was high in my blood (which would circulate through a placenta) then I’d want to treat it. The treatment was the same regardless if it’s uterine or blood diagnosed.

If it hadn’t shown in my blood then I probably would have gone on to have the biopsy just to be absolutely sure that it didn’t need treatment.

These are all difficult and costly decisions. Good luck xx

[PaulaDag in reply to sazzle2680]

Hi,

Really helpful info, thank you.

Am i correct in saying that the cytokines only get checked by the bloods and probably not by uterine biopsy? I'm getting the impression from research that the biopsy is limited to NK cells only.

xx

[Millbanks in reply to PaulaDag]

Yes!

[sazzle2680 in reply to PaulaDag]

Yeah that’s correct.x