Humira

Confused

4 Posts
Reply Posted on: Dec 18, 2015 at 4:43am
Dear Dr Braverman,


Five years ago, we had ICSI (low motility) and were lucky enough to have a son first time. I have never got pregnant naturally. Since then we have had one failed FET (2013), and two more failed fresh ICSI cycles.


Before I did the 2014 cycle I decided to do the immune tests in case there was a problem, and got a TNFa:IL-10 ratio of 39.4 in April 2014, and slightly elevated killer cells. I took two doses of Humira and this took the TNFa ratio down to 35.2 in August 2014. I then took another two doses (the clinic doesn't test after this as they only give you 4 doses max), and did ICSI. (I also took clexane and steroids for the NK cells).I got a chemical pregnancy at the end of October, with bleeding and a negative test six days after the postive one. I tested the TNFa again 5 days after the bleeding began and got a ratio of 40.5.


I have since done another ICSI - the TNFa tested in March this year (so 7 months after taking humira) came back as within range at 29. I therefore just had intralipids, clexane and steroids in the cycle in July - it failed.


I am now doing another ICSI and the TNFa ratio has just come in as higher than ever at 50.5 and humira is being recommended again. Not only am I frightened of this drug because of the potential risks, but looking at the results the previous time I took it, I'm not convinced it worked that well. What do you think? The ratio is even higher now so it has further to go down to normal levels.


What do you think of following an anti-inflammatory diet - no sugar, gluten or dairy, no red meat and so on? Have you had any patients where this has helped in a big way? I have been taking high omega 3s - but does this make TNFa worse?


As an alternative to humira, my clinic are suggesting I do two intralipids instead of just one - but I see from elsewhere on your board that these don't reduce cytokines?


I am also considering Trevor Wing's Chinese mushroom regime to get the cytokines down. I am frankly feeling like if I don't take humira then there's no chance of the ICSI working, but I don't want to become seriously ill because I took it.


Thank you for your help and sorry to ask so many questions! It's very kind of you to offer this service - I have tried to get advice or a second opinion elsewhere but have failed.


Thanks again.

Dr. Braverman

2026 Posts
RE: Humira Posted on: Dec 18, 2015 at 6:25am
You are confused because your clinic is confused. The TNF ratio is a "ratio" i.e. the TNF could be normal and it could be the IL10 that is low. I would never use Humira without serum cytokine testing to see the true TNF levels. Changing therapies based on outcomes rather than based on complete immune evuation should not be considered. Many clinics without strong backround in immunology use these old ratios that ultmitaley yeild little insight into your issues and the tretments become purely speculative. I would be happy to help you first get a correct diagnose and agree I would not use Humira without more justification.
Braverman Medical Team
Braverman Reproductive Immunology P.C.

Confused

4 Posts
Reply RE: Humira Posted on: Dec 18, 2015 at 7:49am
Thanks for your speedy response, Dr Braverman.