Interpretation of DQ Alpha Matches - updated version :)

elle822

3 Posts
Reply Posted on: Oct 10, 2013 at 3:21pm
Hi Dr. Braverman,

I'm sorry that the table of my b/w info that I created didn't show up well in the post. It looked great in the preview, but I guess the HTML code didn't work! My apologies!

Anyways, does your advice from earlier this morning change based on you being able to see my b/w?

Here is a link to my panel (with identifying info removed): http://img24.imageshack.us/img24/8685/gat5.jpg

Any other testing you'd recommend? If so, can I work with your clinic at a distance?

Thanks,
Elle



Here is my previous post from this morning:

Hi Dr. Braverman,
I'm a fan of your boards and appreciate that you take the time to answer public questions. I appreciate your opinion and would love to hear what advice you'd give our situation.

Background:
Originally sought IF treatment as a severe male-factor couple.
Everything is all clear with me, the only identified issues we have are sperm parameters and DQ-Alpha matches.
Four years of actively trying, no pregnancies. One failed IVF cycle.
My age is 28, husband is 30.

Our HLA Panels:
WifeHusbandDQ Beta03, 0603, 03HLA-A02, 0324, 26HLA-B40, 5107, 51HLA-C03, 1504, 07HLA-DRB104, 15, DRB4,
DRB5 present,
DRB3 absent04, 04, DRB4 present
DRB3 absent, DRB5 absentDQ Alpha1.2, 3.03.0, 3.0
All NK cell activity with me, the wife, is currently normal in its native state.

Questions:

In your opinion, how does the fact that my husband has the 3.0, 3.0 homozygous genotype, and the act that I also have one 3.0, impact our fertility potential?

If you were in our situation, would you proceed with another shot at IVF, or no? If so, would you include intralipids or another treatment?

My NKa cells are not yet activated, likely because we've never conceived. If we do successfully conceive with a future round of IVF, would it be more difficult to conceive again after that, thereby reducing the chance for a sibling?

Any other thoughts you can share?

Thank you,
Elle


Your response:

k let me start by sharing your question at the end of your post.

"My NKa cells are not yet activated, likely because we've never conceived. If we do successfully conceive with a future round of IVF, would it be more difficult to conceive again after that, thereby reducing the chance for a sibling?"

you are quoting a very old and outdated school of thought , that the HLA genetics dictate NKa elevations . This is not correct. First of all DQalpha alone gives you no information and by itself can not evaluate your immune issues. Please read my blog on HLA on my website. DQalpha is not present on the embryo surface so it is not avaialbe to your immune system until well into the pregnancy. Most attacks on an embryo are most likley by T cells regardless , that are present in high numbers due to a lack of development of correct numbers of T regulator cells.

I cant make out the remainder of your HLA studies from the above post (i.e. which are yours and which are your husbands they seem to have run one on top of the other and its not clear)?

There is also a great deal of information missing as this immune workup is not extensive, which you should have if you are this young and not successful.

I would be happy to assist you with this. simply fill out a consult request on my website to initiate this.

it is still possible that your main problem is the male factor, you can see that the DQalpha testing does not add anything to your diagnosis. we have had 10 couples with complete DQalpha mathcing last year all but one had a baby . (that one had egg qualty issues).

Dr. Braverman

2026 Posts
RE: Interpretation of DQ Alpha Matches - updated version :) Posted on: Oct 10, 2013 at 10:05pm
yes it does, your husband is homozygous for all of the class 2 HLA genes and I think this is the problem. This can be treated, but you may not concieve until it is . Please fill out a consult form on my website , and they will arrnage for a free 10 minute discussion with me so we can discuss this. It is one of the more difficult cases to treat and to date you have not had the correct diagnosis or treatments.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

elle822

3 Posts
Reply RE: Interpretation of DQ Alpha Matches - updated version :) Posted on: Oct 11, 2013 at 3:06pm
Thank you for sharing your expertise.

Is it more difficult to have a successful pregnancy with my husband's homozygous Class 2 genes? How often do you see the sucess of this?

Also, we can't find any "typical" treatment protocols for this kind of sitatuion. We are struggling with making our infertility-to-family decisions of if we'd like to go through everything and can afford it, so we're wondering if you'd share how you typically treat these cases.

Elle

Dr. Braverman

2026 Posts
RE: Interpretation of DQ Alpha Matches - updated version :) Posted on: Oct 12, 2013 at 6:15am
There is a lot more analysis to go though , the best thing would be to fill out a consult request on our site and we will be in touch with you. We have many cases like this and have had great success in treating them . We have to look at how storng do we beleive the cytotoxic T cell memory is for paternal genetics an if there are any ohter inflammatory conditions that need to be treated as well. . Its not one medicatio for one problem as so many overlap.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.