Liver Biopsy

[kfreitas]

I am 41 year old women. Was recently getting tested for an upcoming IVF cycle when the doctor or lab accidentally ran a test for AMA M2 which came out positive. I requested another, positive again. I was diagnosed with Hashimotos Hypothyroidism and Endometroiosis. Also psoriasis. I have been doing the HCG protocol since Januray (homeopathic) and recently lost 80 lbs. Doctor referred me to a GI speicliast after 2 positive M2 results, Did an ultrasound, liver is normal, mild changes to gall bladder (should be expected with rapid weightloss) - my liver enzymes and all other tests came back on the liver panel, except AMA and ANA. GI suggesting a liver biospy this friday. I feel very reserved as I believe both positive antibody tests are related to autoimmune disease, not liver disease. Would you advise moving forward with IVF without doing a liver biopsy first?

[Thomas D Schiano, MD]

i dont really consider this AMA as (+) and if the liver chemistry tests are normal, I personally dont think a liver biosy is necessary

[kfreitas]

Thank you for your response Dr Schiano! The titer was 1:40 for the ANA and the "smooth muscle IgG with reflex to the titer F-actin IgG was 6 (range 0-19) The AMA M2 Result was 25.1 and the range is 0-20 however 20.1-24.9 shows equivocal. 25 units or greater is positive.  My alpha1-Antitrypsin was 138 (range 75-200). I forgot to mention in my first post that I am gluten intolerant. not sure if that's relevant or not, but thought I would mention (the IgG made me think of it)

[Thomas D Schiano, MD]

the AMA can be a false (+) which can be seen in the setting of other autoimmune conditions.  It would be good to know what the titer is.  Even if you had PBC i wouldnt dissuade you from pursuing IVF, thus i am not sure how a liver biopsy would change things.  PBC can have very spotty changes on biopsy.