KIR AA with donor eggs

[Serotonin]

Dear Dr. Peet!

I am writing to you because I am absolutely devastated and don’t know what to do. As you seem to be an absolute specialist, I would be so thankful to hear your opinion, because our clinic doesn’t talk about this topic and I don’t know who to ask for help/opinion.

female (me)
age: 30
AMH: 3.1 ng/ml
blood levels (TSH, FSH, etc): within healthy range at every blood test
Factor V Leiden: negative
endometrium: always thick at embryo transfer (10-14mm), triple line
hyteroscopy: everything normal
endometrial bipopsy: everything normal
laparoscopy: everything normal
BMI: 19
healthy, no smoking, no drinking, healthy lifestyle, no diseases in family

male (Partner)
age: 40
all blood tests fine
sperm concentration: 85 mio/ml
morphology: 5%
DNA fragmentation: 10%
oxidative stress: 0.73 mV/mio/ml
BMI: 21
healthy, no smoking, no drinking, healthy lifestyle, no diseases in family

I got pregnant naturally on the first try, ended in en ectopic and salpingectomy right. We did 5 rounds of IVF with my oocytes. There was always a good amount of eggs retrieved, they fertilized well but didn’t develop properly. We were left with only 1-2 blastocysts on day 6 and even then they were not expanded yet. All transfers resulted in a negative.

We then went for egg donation. We got 8 very good blastocysts (so it was definitely my oocytes) from two different donors which were all biopsied on day 3 to screen for chromosomal abnormalities on chromosome 13, 18, 21, X and Y.
We did 1 transfers with 2 good blastocysts - HCG was initially low but doubled for a few days before it started dropping again.

We now did a Kir Gene test: I am KIR AA. We didn’t do the HLA test yet, but we will soon.

So now we are very desperate what to do. We will definitely do a single transfer next time. But what else would you recommend? Our clinic doesn’t mind KIR or HLA C, they say evidence is sparse. We could chose another clinic and ask them to look for a C1 C1 donor to have the least risk. But it is so expensive and we still have 6 very good blastocysts left, I don’t want to discard them.

-Do you think that even if the donor and my partner would have a HLA C that isn’t ideal (we don’t know yet but chances that the embryo will have C1 C1 are very very low), we will have good chances with SET instead of DET?
-Should we additionally use granocyte (filgrastim)? Do you think our chances with SET+granocyte will give us the same chance as if I were KIR BB?
-Do you think we should discard the embryos and look for a C1 C1 donor in order to have the best chances?

On the one hand I think it would be best to look for a C1 C1 donor to minimize risk, no matter the HLA of me or my partner. We had so many transfers already and the thought of doing more transfers with little chance of life birth but a high chance of miscarriage is a very heavy burden I don’t know if I can handle. On the other hand, nobody knows what role KIR genes and HLA really play in implantation/miscarriage. And there are so many other factors influencing if it works or not that KIR and HLA are maybe just a very very small element in the show process. And you have to be lucky with everything.

I would be more thank thankful to hear your opinion.

Thanks in advance!

[DrPeet]

Hello,
simply forget about the immunological stuff!! We still don`t know what to look for and what to really do with any findings.
You stated: endometrial biopsy: what was examined? Plasma cells, ERA, EMMA, ALICE???
If it was a standard histological test of the tissue- it is worthless!
If not done yet:
Either Plasmacell Test
or (better)
ERA,EMMA, Alice. please check www. igenomix.com
Greetings
Dr. Peet