2 failed ivf , currently on 2ww after IUI - immune issues!

Peace Success Love

1 Posts
Reply Posted on: Nov 27, 2012 at 1:03pm
Dear Docter Braverman

Below is a synopsis of my immune numbers

NK
50:1 17.7 (BELIEVE THIS SHOULD BE 15?)
25:1 9.4
12:5:1 6.9
IgG 12.5 mg/ml, 50:1 5.2
IgM 12.5 mg/ml , 25:1 5.1
Interlipids 1.5mg/ml,50:1 5.6
Interlipids 1.5mg/ml, 25:1 5.3
% CD - 78.7%
%CD19 16.3% (NORMAL 2-12)
% of CD19+cells, Cd5+ 10.4% (normal 5-10%)
% Cd 56 2.8% (normal 2-12)

Myself - 0501, 0505
Husband - 0104/0105, 0505

Sperm DNA Fragmentation:
The DNA Fragmentation report was - excellent to good sperm DNA Integrity
DFI = 4.8% and HDS= 7.9%

TH1:TH2 - Preeti Madan
TNFa: Il- 10 (CD3+CD4+) 22.8 (normal - 13.2 - 3-.6)
IFN - G :Il-10 (CD3+CD4+) 15.6 (normal 5.8- 20.5)

LAD - Wife
Flowcytometry - negative
T Cells IgM + 2.1%
T Cells IgG+ 1.0%
B Cells IgM+ 11.1%
B clls IgG+ 1.0%


Positive MTHFR - C677T -1 in 1600
Normal TSH but elevated thyroid TPO and thyroglobulin antibodies, border line pre diabetes.

My current protocol is 25mg Prednisolone, 40mg Clexane, 75mg asprin, 500mg Metmorphin (does this need to increase given the prednisolone), 50mg Thyroxin (Thyroid anitobodies normal TSH), Ovacare Forte Mutlivitamins, Susten 200 mg oral progesterone which I am running out of and hence need a supplementary prescription. Also on Cyclogest at night which my body manges to hold better at night time - 200mg. Is Susten 200mg okay to use if pregnant for the first trimester?

Had 20% per 100ml Interlipids on Day 9 of my cycle and IUi on Day 14, currently on Day 28, due to test in 2 days -- urine pregnancy test

Can you advice if I need to have LIT?
How do I read my LAD results? Does my Th1;TH2 look okay? Are Nks okay - these test wer done 4 days after Interlipids were administered...do they look okay for after treatment numbers?

How long will the impact of Interlipids last?
Think I had implantation bleeding /spotting ont he 25th Nov - stopped after half hr of two occassional spotting episodes.

Is my potntial pregnancy at threat beacuse of my lad? Or any other issues.
I have increased metmorphonto 1000mg as of tonight -do u think this is okay, given allt eh mds that will increase my sugars.

is it okay to have tea, eat crisps given my immune issues? Are there any foods to avoid, my TLf Alpha is 13 pg/ml on its own, the ratios are given above? I have pain in knees and joints from before.

Please can you advice me if you feel I am on the righ course or will I need LIT?

Sry to bombard you...so many quries in my hand...would be grateful for a quick response.

Sincere thanks
Peace Success love
PSL

Dr. Braverman

2026 Posts
RE: 2 failed ivf , currently on 2ww after IUI - immune issues! Posted on: Nov 27, 2012 at 1:46pm
Based on your labs Im not sure why you are on immune suppression your cytokines are normal and NKa only mild elevation(this is very common) without your complete history I cant guide you, it is not unusual for the LAD to be negative if you have not ever made it to the third trimester of a pregnancy and if you have it is only bad if the LAD is postivie , not negative as it is with you.
If you need my assistance it would be best to call and schedule a consult so I can go over your entire history and make recommendations for you. Good Luck.!
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Shg

10 Posts
RE: 2 failed ivf , currently on 2ww after IUI - immune issues! Posted on: Nov 29, 2012 at 11:43pm
Dear Dr. Braverman

You are saying above that it is "only bad if the LAD is positive"
could you please tell us why that is and what the possible treatments could be, provided the immunes are in order and no ACA,ANA, lupus etc,
You mentioned somewhere else that it could be infections? What infections orher then clamidya, ureaplasma, mycoplasma could that be?
Could Neupogen help? Or is there no hope at all?


Regards
Lucky ( i hope :) )

Dr. Braverman

2026 Posts
RE: 2 failed ivf , currently on 2ww after IUI - immune issues! Posted on: Nov 30, 2012 at 6:18am
a positive LAD means you may have made antibodies against your husbands genetics which could in turn attack the pregnancy. This would have to be confirmed with a Luminex HLA antibody test. If that was negative then the positive could be a false positive and mean infeciton or immune complexes.

I think you could consider nuepogen in your case.

I would be happy to assist you , feel free to call my office and they can schedule a consult for you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Shg

10 Posts
RE: 2 failed ivf , currently on 2ww after IUI - immune issues! Posted on: Dec 4, 2012 at 11:47am
Thank you Dr.Braberman. Much appreciated!

Have you had success in similar cases with Neupogen - i mean anti HLAantibodies but normal immune results in a non pregnant state - mine were do e at RFU - i'm based in Europe. Would donor sperm be an option?
really sorry for pestering you but I've had 6 ivf ( and 1 iui) failures sofar with 15 perfect embryos ( one of them with Neupogen but i took a low dose and my WBC did not rise propely ) and except for endometriosis we don't have any apparent issues.... My husband has 2 kids from a previous marriage.
I've tried prednisolone, IVIG (no IL as NKa is increased with IL) hcg washes, hcg booster shots, antibiotics, double interval transfer, letrozole during stimulation, long term downregulation, different drugs and protocols and NOTHING! Nk bopsy was also normal!

For my next go the plan was to have my endometriosis lasered off and we'll start neupogen on cd1 at 150mg/kg , mild dose stimulation, we'll try hcg wash again, letrosole during stims ( i'm also a resonably high responder even on 150-225 iu) hcg boister shots and i'll also try intavenous atosiban to deal with any possible uterine contractions affecting implantation..
Have i even got a realistic chance or should i start looking for a surrogate/ donor sperm?

Thank you again
lucky

Dr. Braverman

2026 Posts
RE: 2 failed ivf , currently on 2ww after IUI - immune issues! Posted on: Dec 4, 2012 at 1:42pm
you really need to call me so we can discuss your case in detail , this is not the forum for this. I would be happy to help you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.