AI treatment options for high risk patient.

Zebedee

2 Posts
Reply Posted on: Oct 5, 2012 at 2:27pm
Hi Dr Braverman

As you can see from my signature we've been on the fertility treatment road for quite some time. We were originally diagnosed as 'unexplained' and i went on to get pregnant via iui, unfortunately i had a missed miscarriage at 10 weeks the fetal age was 8+6. I got pregnant again on my third iui and the only support medication i had was progesterone suppositories. My pregnancy was uneventful and my son was born in June 2009, however, shortly after birth it became apparant that he was struggling to breath - he was later diagnosed with a long segment tracheal stenosis, complete ring trachea and bronchi suis. He underwent several surgeries but unfortunately died at one month old. We had a genetic assessment carried out and all results were normal, they had thought perhaps q22 deletion syndrome (DiGeorges Syndrome), so all was congenital.

We started to try again and had no sucess with 4 subsequent iuis and 1 ivf, at that stage i underwent some initial autoimmune testing and discovered that i tested positive for Anti thyroidperoxidase antibodies and anti thyroglobulin antibodies plus i was borderline for ANA too. I was referred to an endocrinologist who diagnosed me with autoimmune thyroiditis (Hashimoto's disease) and am on eltroxin ever since. I did a FET with 2 excellent blastocysts with prednisilone but again it was a negative result.

At this point we changed clinic to the one clinic in Ireland that has a reputation for dealing with AI issues. I had the full 'Chicago bloods' done and had raised natural killer cells but responded well to intralipids in the test tube. Tnf ratio was normal. I also discovered at this stage that i have a low amh - it was 4.2 when i was 36 and its 0.6 now. I finally got pregnant on my 4th attempt using the short protocol with aspirin, clexane, progesterone, prednisilone and intralipids. again an uneventful pregnancy and my 2nd son was born in November 2011. At birth it was discovered that he had an isolated cleft of the soft palate, which has since been repaired. It is assumed that my use of prednisilone (25mcg) during the first trimester contributed to his condition. Again genetic assessments were carried out and no chromosonal defects were found.I went on to do another ivf in August of this year on the same protocol minus the prednisilone and it was unsucessful.

I guess my question is would you recommend any alternative immune therapies that i could use that do not carry the same sort of risks as prednisilone does, as i'm obviously predisposed to some sort of congenital defects? Just to note although my amh is very low, on each ivf i have achieved blastocyst stage - ivf # 1 - 4 blasts, ivf # 3 & 4 2 each, ivf # 5 1 blast. I have looked at the use of other steroids such as dexamethasone and it doesn't appear to carry the same risk although it has its own issues. Or would Neupogen be an option for me?

I'd really appreciate your thoughts on the matter.

Thanks

Zeb
Me: 38
AI thyroiditis
low amh 0.6
Him: 39
all ok
TTC 5yrs for # 1 & 1.5yr for #2
10 tsi = bfn
IUI #1 = bfp mc may 08
IUI #3 = bfp Sept 08
ds born June 09 full term - died July 09 exactly one month old - congenital issues
Oct 09 - iui 4-7 all bfn's
Diagnosed with AI thryoiditis
IVF #1 May 2010
Chem pg
IVF #2 Sept 2010
Steroids
aspirin
clexane & thyroid meds - BFN!!
Ivf #3 Dec 2010
mf protocol
full immunes
bfn.
IVF #4 feb/mar
short protocol
full immunes-OTD 18th Mar
BFP! Hcg 258 10dp5dt
1
467 14dp5dt. Scan at 7+1 - 1 gorgeous healthy bean!
IVF#5 Aug 12
sp
full immunes
1 blast transferred. BFN

Dr. Braverman

2026 Posts
RE: AI treatment options for high risk patient. Posted on: Oct 5, 2012 at 2:37pm
I do think it is possible to have alternate therapies in order to avoid the cleft palate again. I would need to know all the abnormalites in your immune profle and your history to determine what else could be used, but Im sure I can find something . Best would be to call me for a consulation so I can guide you on this.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Zebedee

2 Posts
Reply RE: AI treatment options for high risk patient. Posted on: Oct 5, 2012 at 2:45pm
Thanks Dr Braverman

I'll get hold of all of my results and call your office next week.

Thanks again.
Me: 38
AI thyroiditis
low amh 0.6
Him: 39
all ok
TTC 5yrs for # 1 & 1.5yr for #2
10 tsi = bfn
IUI #1 = bfp mc may 08
IUI #3 = bfp Sept 08
ds born June 09 full term - died July 09 exactly one month old - congenital issues
Oct 09 - iui 4-7 all bfn's
Diagnosed with AI thryoiditis
IVF #1 May 2010
Chem pg
IVF #2 Sept 2010
Steroids
aspirin
clexane & thyroid meds - BFN!!
Ivf #3 Dec 2010
mf protocol
full immunes
bfn.
IVF #4 feb/mar
short protocol
full immunes-OTD 18th Mar
BFP! Hcg 258 10dp5dt
1
467 14dp5dt. Scan at 7+1 - 1 gorgeous healthy bean!
IVF#5 Aug 12
sp
full immunes
1 blast transferred. BFN