6×RIF: high NK%&Th1, KIR-AA, gluten&dairy intolerance - ivig timing


1 Posts
Reply Posted on: Nov 7, 2012 at 4:36am
Dear Dr. Braverman,

I would like to have your suggestion mainly on timing ivig infusions in an ICSI cycle with elevated NK%, Th1 dominance and KIR-AA genotype.

I am 35, from Europe, never been pregnant. My tubes are surgically closed off because they looked like inflamed and tubal factor had been thought to be my primary infertility issue. The origin of my damaged tubes is unknown: no hidden clamydia, STDs, known uterine infections or pelvic inflammations, surgery etc.

I had 6 IVF-ICSIs with 0 beta hcg (4 fresh cycles + 2 FETs) over the last 3 years with good quality both 3 day and blasto embryos, so I am the classic RIF patient.

This summer I was diagnosed with very elevated NKs (29,7%), a strong Th1 cytokine dominance (3 out of 4 Th1/Th2 cytokine ratios were Th1-elevated) and KIR-AA genotype. HLA crossmatch is negative.
TNFa was high normal and every other cytokines were within the range, I have just imbalanced ratios.

After immune testing I started a gluten and dairy free diet and after some weeks I started to feel much more better in regard of many health issues (such as headache, hormone levels, muscle&joint tension, energy in everyday life and sports, acne). Additionally, after 2-3 months of freefrom diet I became very sensitive to some other foods as well, most gluten cross-reactive aliments, so I am actually cutting them out off my diet, too. I hope I can pull down Th1 cytokines with my diet.

Now I am preparing my first cycle with immune treatments: besides daily 10 mg of prednisone and LMWH since 1st stim day, my RE ordered the first low dose ivig infusion 1-2 days _after_ retrieval and the second one 1-2 days after ET, in the implantation window.

My questions are:1) According to the UK and US protocols Intralipid/ivig is usually given 7-10 before ET against high and active NK cells. That's why I am afraid my ivig infusions will be administered too late to be effective for NKa, won't they? But what about against the KIR-AA genotype? What do you think the best timing is when having a KIR-AA problem, too?

2) Can I have Intralipids if I am sensitive to eggs? I have a negative IgE/allergy for both egg yolk and white, but some days ago I started to react to eggs as like as to gluten. I do not know if it is white or yolk or both, but I really hope that after some time I can re-introduce eggs in my diet. But until then, can Intralipids have an adverse effect on NKa?3) I saw in many previous post you said that uterine biopsies are useful. I had 3 (on cdays 8, 13, 21) scratchy biopsies in the previous cycle of my last unsuccessful ICSI. I was wondering wether I should do them again or not if its aim is to create a little inflammation in the lining whilst I am struggleing to heal an inflammation caused by gluten - it just does not make sense to me :-) Does biopsy really suit high cytokine cases, too?I do understand that you cannot give any specific advise without a deeper knowledge of my case, but I am curious to know your opinion in general. Please let me know if you need some more info, I just tried to put a very long story of 5 years of TTC as short as possible.Your great work is so much appreciated. Best regards and thank you in advance,RB7577

Dr. Braverman

2026 Posts
RE: 6×RIF: high NK%&Th1, KIR-AA, gluten&dairy intolerance - ivig timing Posted on: Nov 7, 2012 at 6:15am
You have quite a few issues, many clinical and many laboratory. There are quite a few questions that need to be addressed in your post and this forum is not the place for this. As you know reproductive immunology has to be tailored to each case and modified as the treatment and pregnancy progresses. It would be best for you to call my office and we can schedule a SKYPE or telephone conference and I would be happy to review your entire case with you and recommend the timiing and correct treatment.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.