Are we dealing with alloimmune implantation failure?

Sue

1 Posts
Reply Posted on: Oct 20, 2013 at 3:02am
Dear Dr Braverman,
Thank you for your great, informative forum and articles which have helped me tremendously in trying to understand what might be the reason for our recurrent miscarriages. As for my medical background, please find the summary below:
Pregnancies: First pregnancy resulted in full-term baby girl, born in 2009. Second (March 2012) and fourth pregnancy (July 2013) ended at 7-8 weeks (missed miscarriages), the third pregnancy was a chemical pregnancy after our first IVF in March 2013. Results of chromosomal testing of the embryos confirmed healthy babies. I am 37, my partner is 30 years old. We live in Sydney, Australia. Pregnancy 3 and 4 were treated with 30 mg Prednisolone, 40 mg Clexane and 1200 mg Progesterone (3x400mg day).
Diagnoses: Endometriosis Stage 2 (removed as much as possible through laparoscopy in Oct 2012), mild septum (to be removed in Oct 2013), mild hormonal imbalance (low progesterone levels), immune issues (results below):
HLA-A 03, 68 (me) and 02 (him)
HLA-B 15, 27 (me) and 07, 27 (him)
HLA-C 02, 03 (me) and 01, 07 (him)
HLA-DRB1 04, 04 (me) and 01, 04 (him)
DQAlpha 0301, 0301 (me) and 01, 03 (him)
DQBeta 03, 02/03 (me) and 03, 05 (him)

LAD Test (August 2013)
T-Cells (IgM+) 3.3%
T-Cells (IgG+) 4.3%
B-Cells (IgM+) 5.1%
B-Cells (IgG+) 15.2%

TH1/Th2
TNF-a:IL-10 (CD3+CD4+) 42.4 (H)
IFN-g:IL-10 (CD3+CD4+) 10.2

NK Assay
50:1 14.9%
25:1 12.8%
12.5:1 9.5%
%CD3 83%
%CD19 6.3
%CD56 9.9%
%CD19+cells, CD5 4.9 (L)
The use of IVIG showed a reduction of more than 10% reduction in killing at each effector/target ratio.

All other tests have been ok, e.g.: normal karyotyping, no sperm DNA fragmentation, normal prolactin levels, fasting cholesterol at 3.8 mmol/L, no thyroid auto-antibodies, no sperm antibodies, no anti-nuclear antibodies, no anti-DNA , no lupus anticoagulant, no cardiolipin antibodies, no B2 Glycoprotein, no Factor V Leiden, no Prothrombin Gene Mutation, Homocysteine 6.3 umol/L, TSH = 0.65mU/L (on 06 May 13), AMH = 6.3 pmol/L, Insulin and Glucose Tolerance testing was ok also
During our first IVF, 11 eggs were retrieved (2 immature, 1 abnormal), 8 fertilised normally, 5 made it to blastocysts, 4 frozen.
My immunologist recommends following treatment for first FET: LIT Therapy (2x before FET), Intralipids (1-2 weeks prior to transfer), Dexametasone, Clexane and Progesterone.
Based on the above medical history and results, do you believe that there still is a chance for us to produce a successful pregnancy? If yes, do you agree with the overall treatment plan? If not, what would be our best alternatives?
Thank you very much for your time and effort. It’s greatly appreciated.

Dr. Braverman

2026 Posts
RE: Are we dealing with alloimmune implantation failure? Posted on: Oct 20, 2013 at 6:03pm
First of all you are missing most of the cytokine data I use to determine what is the state of your immune system. you do have a strong alloimmune component as there is minimal disparity betweeen the two of you on the class 2 HLA genes. LIT will be of little use to you , as it must use disparity on the class 3 HLA genes that you lack to develop T reg cells.
I would be happy to guide you here in a complicated case. Best would be to fill out a consult form on the website and we will get back to you , Im sure I can help you solve this issue.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.