treatment dilemma for immunological pxs
2 Replies
hopefully trying - April 24

I am on BCP right now and scheduled to begin IVF # 2 with a microdose lupron flare protocol (lupron on May 6 and follistim on May . Quick history: hypothyroid. Both parents and maternal grandmother hypothyroid. 68% sperm antibody result. 0 pregnancy. 3 failed IUI and 1 failed IVF (with 3 blasts transfer 1 excellent quality 2 slightly fragmented). Consistently thin endometrium.

I am in the process of getting my testing back from Millenova. Am waiting on ATA and ANA. I have not been able to get an interpretation yet (my doc is way over the fence i.e. very conservative but was willing for me to do the testing. he is not willing to do the ivig and if I could try something else more affordable it would be awesome). Some of the results are abnormal others are not. I will post what I've gotten back below in case you can help interpret. I have no idea where to go at this point. I'm trying to research and get info to advocate for myself but it's been difficult.

In range:
CD3 - 69.1
CD19 - 12.9
CD16+ - 8.8
CD16- - 5.5
IgA - 139
IgG - 907
IgM - 115
Embryotoxicity Assay: absent 0%
APA - see below. all the rest normal

Out of range:
CD4 - 54.8 high
CD8 - 14.2 low
Natural NK T:E 14.4 high
Suppression with IVIG 8.4 low
Suppression with Intralipid 9.5 low
APA - IgM PG: .203 high (range .118 - .188)
IgM PC: .162 high (range .090 - .108)

Here's my dilemma. Through his nurse, my doc has been great about being willing to consider the immunological issues. However, he has been clear about his limits i.e. he's not an immunologist and tends to wait on the scientific research. He had said because this is still outside the standard of care he has not been willing to treat with IVIG. I've been working with his nurse by providing the research and articles I come across. She discusses it with him and in their IVF conference. They agreed to the testing but he felt the interpretation was outside his area of expertise which I can totally respect. He has indicated he will work with me monitoring etc if I want to do IVIG but that he won't do it himself. For multiple reasons, if there is a more afforable alternative to IVIG, I think it would make more sense to try that for this particular cycle.


Questions: Dr. Smith on the other bb suggested that Solu-cortef/dexamethasone is a new experimental treatment that his clinic has been using. 4 out of 4 women they've used it with have acheived successful pregnancy. Since he is an embryologist and not an md he is uncomformtable suggesting doseage information. Again I totally respect that. However, if I cannot take my md the treatment protocol, I'm afraid they'll dismiss this as an option.

1) What are your thoughts about Solu-Cortef? Can you tell me what the dosage and at what point in the cycle you do Solu-cortef?
2) Have you heard of Intralipid as an alternative? What would the dosage and point in cycle used?
3) Any other ideas? advice? suggestions?






 

Barry Jacobs, M. D. - April 25

I do not use IVIG. There is onl yone group which has produced data implying any benefit. No one can duplicate their dat, therefore their data are still suspect. Since it takes 750 donors to produce serum for a single IVIG treatment, that is the risk of 750 blood transfusions for no proven benefit. I do use another steroid, besides Solucortef. I give my patients Medrol, prior to embryo transfer. I want to minimize any inflamatory response in the endometrium after retrieval. No, I know nothing of Intralipid.
Good luck.

 

hopefully trying - April 25

Once again, thank you for your time and response.

 

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