IVF and Pre-e and HELLP

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Re: IVF and Pre-e and HELLP

Post by CptSpacely » Mon Jan 27, 2014 12:13 am

Mari2013 wrote: Sometimes I think we delve deeper into the details of these issues than our doctors.


I definitely think you're right about that--not that our doctors would admit it. :roll: And it makes sense when you think about it. A doctor, whether he/she is a "specialist", is really required to be a generalist in their area of medicine. They can't possibly have time to study in detail every facet of medical research that is applicable to every single patient that they encounter and have time to care for the patients themselves. Your MFM may be a specialist in hyptertensive disorders of pregancy, for example, but not necessarily be up on the research concerning the link between IVF and PE--I mean, there have to be hundreds of things that influence a predisposition to PE. Whether or not the doctor is fully abreast of all the recent research or not, I expect that he/she is going to answer your questions based upon their own personal experience with the disease, and their experience is by definition going to be limited. Not to mention that it's somewhat rare (at least in my experience :D ) to encounter a doctor that actually acknowledges the limits of his/her own knowledge. Anyway, this has been an interesting topic, and I'm glad you brought it up. I wish you the best in TTC your next child, and I'll be interested to learn how your next pregnancy turns out--so keep us posted!

Re: IVF and Pre-e and HELLP

Post by Mari2013 » Sat Jan 25, 2014 03:48 am

Caryn, I don't think you missed anything. Maybe he was just not aware? He didn't frame his answer as if it were based on recent research. Sometimes I think we delve deeper into the details of these issues than our doctors.

Re: IVF and Pre-e and HELLP

Post by caryn » Sat Jan 25, 2014 01:42 am

So I am really interested in the link between the IVF itself, without multiples, and pre-e. Just by instinct, not knowing about any of these studies, I asked my MFM about a possible link between the IVF and HELLP. He was adament that there was no link. I am really interested to read that my instincts were probably correct.


I wonder if he's seen some new stuff at conferences that I've missed? I haven't been to one since last March. This is a fascinating area of research where there are a lot of people trying to figure out what's going on, and I certainly may have missed something. It has so many applications for infertility and miscarriage and preeclampsia and HELLP and those are responsible for so much mayhem that this is a huge focus of public health work...

Re: IVF and Pre-e and HELLP

Post by caryn » Sat Jan 25, 2014 01:35 am

What's odd is that even traditional IVF causes the maternal immune system to respond differently. I can only speculate that it has something to do with the way that the embryos are cultured in the laboratory.


It might, or it might have to do with some signaling we're just learning about, epigenetic chromosome inactivation that happens during the transit through the Fallopian tubes. There are so many differences in the early environment - and of course what's happening inside after conception and before implantation is very difficult to study! - and while those differences don't seem to cause problems most of the time, they might contribute to a higher rate of preeclampsia.

I think your intuitions about an immune response to a foreign egg are probably onto something. :) Ordinarily the maternal side of the placenta is mostly maternal genome, the fetal side is mostly paternal (because the maternal genes are silenced epigenetically) and then there's the fetus which is half maternal and half paternal. With egg donation you'd have the maternal side of the placenta be host-maternal genome, the fetal side be paternal, and the fetus would be half donor-maternal genome. So three parents. It just *has* to get immunologically messy...

Re: IVF and Pre-e and HELLP

Post by Mari2013 » Thu Jan 23, 2014 09:46 am

I am going to check out the new links, thanks for sharing.

Both my pregnancies were with single babies and we did an elective single frozen embryo transfer for the second. So I am really interested in the link between the IVF itself, without multiples, and pre-e. Just by instinct, not knowing about any of these studies, I asked my MFM about a possible link between the IVF and HELLP. He was adament that there was no link. I am really interested to read that my instincts were probably correct.

Re: IVF and Pre-e and HELLP

Post by CptSpacely » Thu Jan 23, 2014 04:31 am

sam10 wrote:One of the risks with any ART including IVF is the risks of mulitples, which then in turn also increases the risk of PE/HELLP (especially for those who had PE/HELLP in a previous pregnancy). More placenta means more risk.
For those who do IVF and are already at higher risk for PE due to a previous PE pregnancy it is usually recommended to do a single-egg-transfer.


I believe that most of these studies try to adjust for number of embryos in order to account for the added risk of multiple gestation, but since I've never read any of the full-text articles, I'm not sure how they accomplish that. We did an eSET using fresh donor eggs + ICSI to conceive my son, and I still managed to develop severe PE with just the one embryo.

caryn wrote:A couple new studies I haven't discussed in the research write-ups:

http://www.ncbi.nlm.nih.gov/pubmed/24175873
http://www.ncbi.nlm.nih.gov/pubmed/24029471
http://www.ncbi.nlm.nih.gov/pubmed/23375143

This is very poorly understood - researchers start saying things about Tregs that go right over my head when I ask about it, and I think it's partly because they're not sure yet, either, what might be going on, so they can't teach it to me yet - and so I would definitely as your RE and your MFMs to talk about this to you.


Thanks for these additional links! The second article you linked to is very interesting to me--I just wish I had a better understanding of it! As I mentioned above, we used an egg donor to conceive, and I've always felt instinctively that my complete lack of genetic ties to the embryo must have been a contributing factor in my PE. If I'm understanding that abstract, it sounds like my instinct is correct, and that donor egg IVF does result in the maternal immune system behaving differently than in a natural conception. What's odd is that even traditional IVF causes the maternal immune system to respond differently. I can only speculate that it has something to do with the way that the embryos are cultured in the laboratory.

I did speak to my RE about this just last week. We're currently planning on doing an FET this spring with one of the embryos we have left over. He said that the embryos have "the same genes" that my body has already dealt with in my last pregnancy, so it should "recognize" them, and the pregnancy should progress normally this time. :roll: I must confess that I'm skeptical. I'm just keeping my fingers crossed that the spiral artery remodeling that is discussed so often on these forums is sufficient to help the placenta implant more efficiently on my next go around.

Re: IVF and Pre-e and HELLP

Post by caryn » Thu Jan 23, 2014 02:22 am

A couple new studies I haven't discussed in the research write-ups:

http://www.ncbi.nlm.nih.gov/pubmed/24175873
http://www.ncbi.nlm.nih.gov/pubmed/24029471
http://www.ncbi.nlm.nih.gov/pubmed/23375143

This is very poorly understood - researchers start saying things about Tregs that go right over my head when I ask about it, and I think it's partly because they're not sure yet, either, what might be going on, so they can't teach it to me yet - and so I would definitely ask your RE and your MFMs to talk about this to you.

Re: IVF and Pre-e and HELLP

Post by sam10 » Thu Jan 23, 2014 11:16 am

One of the risks with any ART including IVF is the risks of mulitples, which then in turn also increases the risk of PE/HELLP (especially for those who had PE/HELLP in a previous pregnancy). More placenta means more risk.
For those who do IVF and are already at higher risk for PE due to a previous PE pregnancy it is usually recommended to do a single-egg-transfer.

Re: IVF and Pre-e and HELLP

Post by Mari2013 » Wed Jan 22, 2014 07:07 am

CptSpacely wrote:I'm new here, but I'm interested in this subject since I also have to use IVF to conceive. I found links to the studies you're referring to towards the bottom of Caryn's post here:
https://www.preeclampsia.org/forum/viewtopic.php?f=28&t=26469

BTW - I'm very sorry for your loss.


Thank you for finding the link! Happy to see your son is doing well and good luck with TTC

Re: IVF and Pre-e and HELLP

Post by CptSpacely » Wed Jan 22, 2014 12:20 am

I'm new here, but I'm interested in this subject since I also have to use IVF to conceive. I found links to the studies you're referring to towards the bottom of Caryn's post here:
https://www.preeclampsia.org/forum/viewtopic.php?f=28&t=26469

BTW - I'm very sorry for your loss.

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