Failed FET using same immune protocol as successful IVF

kdb

4 Posts
Reply Posted on: Sep 23, 2012 at 1:54pm
Hi Dr Braverman

Thank you for making yourself available via this excellent forum.

In November 2010 my first IVF cycle was successful using a combination of Prednisolone (25mg), Clexane (20mg/40mg), Aspirin (75mg), progesterone-in-oil (50mg) and Intralipids to treat my NK, cytokines and anti-thyroid antibodies.

Sadly we have just had a failed FET cycle with two excellent quality blastocysts (better quality than my IVF cycle) using an almost identical immune protocol (100mg of progesterone-in-oil this time). In addition I had an endometrial biopsy/scratch performed.

I have mild PCOS, Hashimoto's Disease and am Heterozygous MTHFR. I take 50mcg Thyroxine and 3 x 500mg Metformin daily.

It has been suggested that perhaps in my FET I was *over* suppressed and next time should try 10-15mg Prednisolone instead of 25mg.

(And I notice you mention some research on this:
http://www.preventmiscarriage.com/Discussion-Forum/Whats-new-in-Reproductive-Immunology/Lack-of-inflammation-may-lead-to-IMPLANTATION-fa.aspx)

The key differences in my immune test results from the two cycles are:

IVF 2010 FET 2012
NK 50:1 13.3 19.6
NK 25:1 7.5 17.6
TNFa 29.9 28.1

The NK seems to be more stubborn now, and doesn't reduce much with IVIg in the test tube.

Would you agree with the approach of a lower dose of Prednisolone, combined with intralipids as before?

Would there be any benefit in having two intralipids prior to embryo transfer, rather than just the one?

Many thanks for your advice
kdb

---

Full results...

>> IVF 2010

NK Assay (% killed) panel
50:1 = 13.3 10-40%
25:1 = 7.5 5-30%
12.5:1 = 4.5 3-20%

IgG conc 12.5 50:1** = 9.1%
IgG conc 12.5 25:1** = 7.8%
IgG conc 6.25 50:1** = 7.4%
IgG conc 6.25 25:1** = 5.5%

% CD3+ = 89.3%* 60–85%
% CD19+ = 2.8% 2–12%
% CD56+ = 5.7% 2–12%
% of CD19+ cells, CD5+ = 10.7%* 5–10%

TNF-a : IL-10 (CD3+CD4+) = 29.9 13.2-30.6
IFN-g : IL-10 (CD3+CD4+) = 19.3 5.8-20.5


>> FET 2012

NK Assay (% killed) panel
50:1 = 19.6 10-40%
25:1 = 17.6 5-30%
12.5:1 = 9.2 3-20%

IgG conc 12.5 50:1** = 19.6%
IgG conc 12.5 25:1** = 12.1%
IgG conc 6.25 50:1** = 19.8%
IgG conc 6.25 25:1** = 14.2%

% CD3+ = 89.6%* 60–85%
% CD19+ = 3.1% 2–12%
% CD56+ = 6.4% 2–12%
% of CD19+ cells, CD5+ = 3.2%* 5–10%

TNF-a : IL-10 (CD3+CD4+) = 28.1
IFN-g : IL-10 (CD3+CD4+) = 18.1

Dr. Braverman

2026 Posts
RE: Failed FET using same immune protocol as successful IVF Posted on: Sep 23, 2012 at 8:45pm
I dont use the IVIG in the lab test , I dont beleive it is accurate. The NK cells do not seem that high. I would have to do a full analysis of your case to give you a consult , it really requires a full history which is not the purpose of this forum I would be happy to assist you if you wish . Please feel free to call my office to schedule a consultation. I agree that oversuppression could be another cause of the problem.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.