Elevated cytokines and intrahepatic cholestasis of pregnancy


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Reply Elevated cytokines and intrahepatic cholestasis of pregnancy Posted on: Aug 15, 2011 at 4:20pm
Dr Braverman,

I have a long story of IF covering 10 years.
3 1st trimester miscarriages, 9 failed embryo transfers, 4 different IVF clinics, then diagnosed with huge uterine septum.
Successful pg after uterine septum repair in which I also took baby aspirin and oral IVIg on my own initiative. Around week 36 I developed itchy hands and feet for which I was not tested until week 40. At week 40 doctor wanted to induce me due to gestational diabetes, but I agreed as I was concerned about the itchy hands and feet which three separate doctors in the group did not take as a serious symptom.

Trying for --2, miscarriage --4 last February (1st trimester). Current RE referred me to AEBCenter for testing.
APA+, ATA+, MTHFR - both mutations, Factor XIII+, elevated TNF-alpha cytokines, elevated but within normal ranges fasting insulin/fasting glucose ratio.
Recommendations: Humira, Metformin, IVIg, Lovenox, baby aspirin.

Retested after first month and levels went from 36 to 37 so will repeat Humira.

My questions for you are:
1. does Humira interfere with menstrual cycle? I have not had a period for eight weeks and wondering if Humira could have an impact.

2. what is the mechanism, or reason, for possible relationship between elevated cytokines and intrahepatic cholestasis of pregnancy? If there is a relationship, do you think the Humira would decrease the chances of developing chlestasis again during another pregnancy?

I've read on your site that you also recommend DHA and vitamin D levels to help with this so I have also added those elements.

Thank you.

Dr. Braverman

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Re: Elevated cytokines and intrahepatic cholestasis of pregn Posted on: Aug 15, 2011 at 6:23pm
No Humira should not affect your getting your perioid. The cytokines are elevated but not so much that I would worry about ICP, but yes anything that lowers TNF will reduce the risk as the inflammatory process cuased by elevated levels of TNF is a primary etiological agent in ICP.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.