QuestionHi Dr. Ramirez,
I am writing from New Mexico! I am the patient that asked about heparin a few weeks ago. I am very worried about some results that came back last week. I had my first trimester screening - I was exactly 12 weeks on the day the Nuchal and bloodwork were done.
The nuchal came back normal. The only number I remember them telling me was 1.6, which they said was very good.
However, the bloodwork came back abnormal a week later and I was told that the combination "score" made our screen positive. The ratio they gave us was 1/140. To me, this seems like pretty good odds that everything is OK, but why do they call this "screen positive?"
My first question to you is...does maternal age play a part in the results? I have read many things online that say yes, it does. The reason I am asking is because I believe that they used MY actual age of 36, instead of my DONOR'S age of 28. (We did IVF, using donor eggs).
My other question is...does IVF (using donor eggs) with ICSI skew any of the bloodtest results? I have read studies that say it could. Would me being on high doses of estrogen patches and progesterone in oil injections skew the PAPP-A or Hcg results? Also, I am still on heparin (my hematologist does not want me off of it just yet). Does that make any difference?
Thanks for any thoughts you have about this! I wish I would have known how upset this test was going to make me - I may have refused it. Does my ratio result sound like something you would worry about enough to request an amnio?
Heidi
AnswerHello Heidi from the U.S.,
The blood testing that you did is called a triple screen, and by itself is not sensitive enough to make a diagnosis. However, in combination with the nuchal translucency ultrasound, it is pretty good at detecting abnormalities. You have a dilemma because one screened positive and the other screened negative. I think the nuchal translucency is more sensitive than the triple screen, meaning that it is better at detecting abnormalities. I think that you need to talk with your Ob doc and request consultation with a Perinatologist, who is a subspecialist in Obstetrics. They can give you a better indication as to whether you should do the amniocentesis.
Make sure to let them know that it was donor eggs because that make a HUGE difference in terms of genetic risks. The higher the age of the eggs, the higher the risk of genetic abnormalities. With the negative nuchal test, I am not sure that I would feel strongly that you need the amniocentesis, but the other aspect you have to consider is how do you feel about not knowing for sure? Ultimately, the decision is yours, and I think that statistically things are on your side, but can your feel comfortable with not knowing for sure? Amnio is a simple and safe procedure.
Good luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereybayivf.
