Intrallipid/IVIG

Paula

2 Posts
Reply Posted on: Dec 29, 2014 at 7:21pm
Dr. Braverman,

Hello, I am 12 weeks and 2 days pregnant at age 47 with donor embryos. I had failed IVF treatments due to Immune issues never being testeed. I had the following issues:

MTHFR
PA1
APA
Antiphospholipid Syndryome

I was finally dignosed by immune doctore and with their protocol of Sythroid, Folgard, Baby Apsiran, Clexane, Estrogen/Progesterone, Prenatal Vitamin and Intrallipid, I became pregnant with donor embryos. I mainly had implantation failure. The Repro Immunologist wanted to give me IVIG, but due to the cost I insisted on Intrallipid. The intrallipid solved my NK issues, my Cytokines are fine, but it did not solve my T reg issue. My Treg CD4/CD25/Fox3+ was .6 a month prior to embryo transfer, .6 a month to two months after embryo transfer and at 12 weeks .5 the doctor says it is critical now to have IVIG, what is your perspective. Also note Anitphospholipid Syndrome is Negative, and one more negative test and they want me off clexane. Would you also keep on Clexane through pregranncy since I have MTHFR.

thank you

P
Paula Simeone

Dr. Braverman

2026 Posts
RE: Intrallipid/IVIG Posted on: Dec 31, 2014 at 12:24pm
You should not treat immune results before you have a diagnosis for why you are getting some abnormalities. How were cytokines tested i.e. ratios or serum , which ones were elevated? The T regs alone give you no information., what do they think the problem is with the T regs? I would continue the clexane in my patients but I can not comment on your case as I dont have your full history and you must of course follow the advice of your doctor. If you are 12 weeks at this point you are most likely fine , but I would certainly discuss strongly with your doctors to not stop the clexane.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Paula

2 Posts
Reply RE: Intrallipid/IVIG Posted on: Jan 1, 2015 at 11:11am
Dr. Braverman,

In response to your comments, My Cytokines and NKS before and after Intrallipid are:

Before Intrallipid prior to embryo transfer:

NK Assay
50:1 21.9
25:1 10.6
12.5:1 4.2

%CD3 70.9
%CD19 7.2
%CD56CD16 21.4
%CD19CD5 4.1
%CD3+CD56+NK! 3.3

TH1/TH2 Ratio:
TNF-a-il 10 (CD3+cD4+) 21.0
IFN g -il 10 (CD3=CD4=) 16.3

T Reg .6


After Intrallipid prior to embryo transfer:

NK Assay
50:1 6.7
25:1 3.7
12.5:1 2.6

%CD3 83.2
%CD19 4.3
%CD56CD16 3.8
%CD19CD5 9.5
%CD3+CD56+NK! 1.2

TH1/TH2 Ratio:
TNF-a-il 10 (CD3+cD4+) 14.9
IFN g -il 10 (CD3=CD4=) 7.9

T Reg .6
After Intrallipid 1 mo after embryo transfer (pregnant)

NK Assay
50:1 5.2
25:1 3.3
12.5:1 2.9

%CD3 79,2
%CD19 13.0
%CD56CD16 7.5
%CD19CD5 5.3
%CD3+CD56+NK! 2.4TH1/TH2 Ratio:
TNF-a-il 10 (CD3+cD4+) 14.3
IFN g -il 10 (CD3=CD4=) 7.7

T Reg ..6
After Intrallipid 2 mo after embryo transfer (pregnant)NK Assay
50:1 12.3
25:1 8.8
12.5:1 3.6

%CD3 83.8
%CD19 8.6
%CD56CD16 7,8
%CD19CD5 1,7
%CD3+CD56+NK! 1.1


T Reg ..5

Cytokines no longer tested per doctor after last test* Dr. states TRegs should increase by 12 weeks of pregnancy not go down.

Is IVIG critical at this point as doctor states due to low T Regs. ANA was TITER of 1:80 homogenous patern prior to embryo transfer and have not tested again.

Now looking at the other #'s and the fact that I am 13 weeks pregnant and size of baby is good is IVIG necessary?
Paula Simeone

Dr. Braverman

2026 Posts
RE: Intrallipid/IVIG Posted on: Jan 2, 2015 at 10:22am
There is not enough data here to make any recommmendations , cetainly not enough to recommend aggressive therapy with IVIG (in my opinion I dont know your whole case) . You are not measuring "cytokines" here but only cytokine ratios and only in one cell group (CD4 IL10 and INFgamma or TNF cells) there are many more to look at , and that ratio in my opinion of of little value.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.