I only need assistance in answering Part 2 questions.Part 1 was included for background information. Please and ThankYou!

Part I – Infertility Issues
Jane sat nervously in the examination room. She had no idea what toexpect. Her husband, Brian, gave her a

reassuring smile and squeezed her hand. There was a knock on thedoor and then it opened to admit the physician.

“Hello, Jane. I’m Dr. Klein and I’ll be doing your fertilityassessment today.”

“It’s nice to finally meet you Dr. Klein. This is my husband,Brian.” The two men smiled at each other and shook hands.

Dr. Klein sat down on the stool and opened up a thick file.“Jane, I’ve looked over the medical files that you had sent over toour office and I’ve examined the preliminary blood tests you haddone at our office last week. I just need to ask you a fewquestions, and then we’ll do a quick examination to help me try toget to the cause of your fertility issues.”

“Sure, I’ll answer the best I can. Was anything missing from mymedical records?” Jane asked, concerned that she had forgotten tosend something the doctor would need. “We’ve been trying to getpregnant for two years and nothing has worked. We both want kids sobadly, and a friend recommended you, so I hope you can helpus.”

Dr. Klein smiled kindly at Jane and Brian. They were young, andthere was no obvious explanation in Jane’s file for herinfertility. Dr. Klein’s initial notes about Jane’s medical historyand recent blood tests included the following:

• 28-year-old Caucasian female.

• Diagnosed at 14 with Irritable Bowel Syndrome (IBS).

• Diagnosed with anemia in her early 20s; current hemoglobinlevels at 7 gm/dl.

• Active lifestyle until past year; used to exercise daily and runhalf marathons until recent joint pain hindered her.

• Broken wrist last year after a minor fall.

• No history or abnormal pelvic exams or PAP smears.

• Hormone levels (estrogen, progesterone, LH, and FSH) in normalranges.

• Patient reports her menstrual cycles are not very regular.

• Positive for several classes of autoantibodies.

  Looking up from his notes, Dr. Klein asked, “Jane, have you beenable to control your IBS symptoms? Do you still have bouts ofdiarrhea or constipation despite a healthy diet?”

  “I’ve never really been able to control the symptoms as much asI’d like,” Jane said. “It’s something I’ve just learned
  to live with. I’ve tried all sorts of different diets and nothingseems to help. I felt a little better on the new low carbohydratediet that people have been talking about, but it was really hard tostick to.” She looked questioningly at her husband, silentlywondering what her stomach problems could have to do with herfertility issues.

“When Good Antibodies Go Bad” by Cozine and Gripka Page 1

“One of the things we test your blood for are the presence ofautoantibodies. Recent studies indicate that women with infertilityproblems may have higher levels of autoantibodies in their blood.Your test results show that you are positive for severalautoantibodies at levels higher than we would expect in a healthyfemale.” Dr. Klein could see the obvious confusion on Jane andBrian’s faces. “Do either of you know what antibodies orautoantibodies are?”

Questions

1. Pretend you are Dr. Klein and first explain what an antibody isto Jane and Brian.

2. Relate the basic definition of an antibody to explain anautoantibody in terms Jane and Brian will be able tounderstand.

3. What are three examples of autoantibodies that can be detectedand the diseases they are associated with?

4. Given her digestive problems and the presence of autoantibodies(indicating that her condition is autoimmune), what are somepossible diseases (besides IBS) that Jane might have?

Part II – Getting the Diagnosis Right

“I don’t understand,” Jane said looking at Dr. Klein. “What doesmy immune system have to do with my infertility issues?”

“Infertility can unfortunately be a complication of severalautoimmune diseases. Given your history of gastrointestinal issuesalong with the presence of several specific autoantibodies Ibelieve you may have Celiac Disease. I would like you to see agastroenterologist to confirm the diagnosis,” Dr. Kleinexplained.

Brian interrupted, “But I thought Jane has irritable bowelsyndrome? Did the IBS cause the Celiac Disease?”

“No, I fear that Jane may have been misdiagnosed with IBS whenall along she had Celiac Disease. The two can have similarsymptoms, but there are tests that can definitively identify CeliacDisease,” Dr. Klein explained.

“If I get treated for Celiac Disease, will I be able to have ababy?” Jane asked fearfully.

Dr. Klein patted Jane’s hand, “Let’s get the test results backand make sure we understand the cause of your intestinal issues,and then we’ll concentrate on your infertility.”

“I don’t think I understand,” Jane said looking from Brian toDr. Klein. “You explained to us what an antibody is and I thoughtthey were good, so why would they cause disease? I don’t know how Icould have gotten an autoimmune disease in the first place. I’mpretty healthy. I exercise and try to eat right. What could I havedone differently?”

Questions

1. Briefly describe what Celiac Disease is.

2. How is Celiac Disease different from gluten intoleranceor sensitivity?

3. What specific autoantibodies are tested for in CeliacDisease? What other diagnostic tests will be performed onJane?

4. Suppose that Jane stopped all gluten intake before herautoantibody tests were performed. How do you think this change indiet would affect her test results and diagnosis?

5. Jane is concerned that she could have prevented herselffrom getting an autoimmune disease. What are some risk factors forautoimmune diseases in general? Looking at these risk factors,could Jane have done anything to prevent the development of herdisease?

6. What hypotheses are often used to explain thetrigger/onset of autoimmune diseases?