IVF with IVIG or Neupogen?

hbfab

3 Posts
Reply Posted on: Sep 21, 2013 at 5:50am
Dr. Braverman,
I had 4 fresh IVF and 1 FT between 2008-2011 all failed and I am 38 year old. After multiple IVF failure, my OB told me it's my egg quality. I finally went to a reproductive immunologist in Chicago and was told that I have immunology issue with high NK and TH1/Th2. I have been on IVIG (CD 6-10), Lovenox, letrozole (4 cycles), metformin, baby aspirin, fish oil, progesterone and estradiol patch for 7 months since 02-13, and the most recent lab after IVIG are:

50:1 - 20.5
CD 56 - 10.9
TNF - 40.3
IFN - 23.6

These numbers varied during my 7 months treatment with IVIG, sometimes they are under control, sometimes they are not.

Because of my age, I feel like I have to something or nothing will happen, although my OB is not very supportive for me to do another IVF as he said the sucess rate for a women after 4 IVF failure is very low, he had suggested me using donor egg. I did not want to go that route so I asked OB if I can try another IVF. He okayed it but suggested adding the Neupogen. He said IVIG is not working for me and he really considered it as a "fraud" not approved by FDA, and that there is no scientific eveidence that it's working for IVF implantation failure. He said Neupogen is quite new in IVF as well, but there were some clinical trials in Europe and showed that it may be useful in women experienced implantation failure. He said I can choose between IVIG or Neupogen, either way he will put me in a low dose stimulation to try to get better quality egg. I related this information to my reproductive immunologist in Chicago and she is opposed to using Neupogen and said it has not been proved to be safe for both mum and the baby.

I need a third opinion on this and I am glad that I found your website! My OB gave me two options (the low dose stimulation with menopur and gainirelix is the same for both):

1.IVIG+Frozen transfer (I proposed the FT thinking I want to have the NK and Th1/Th2 under control first before transfer; OB is not in favor of it but okayed it.)
2. Menopur+fresh transfer.

My recent AMH is 3.6 and FSH is 8.7. Currently my insurance will cover the IVIG for upto 18 months and I have not checked the Neupogen, but according to my OB, it's usually not covered.

May I have your opinion on my situation, Dr. Braverman? I am afraid that I make a wrong decision and cause another failure.....

I appreciate any advice that you can provide. Thank you!

Dr. Braverman

2026 Posts
RE: IVF with IVIG or Neupogen? Posted on: Sep 21, 2013 at 6:13am
I think you first need to have a diagnosis. Right now you are treating symptoms i.e. elevated NK and TNF. Understanding the reasons why these are elevated by help you to better answer the quesitons of how to modify your treatment. Certainly this can and most likely is sitll and embryo quality issue, but you do have some immune findings that dictate you get a diagnosis and adjust treatment so that if you make a good embryo you increae the chances for a successful implantation.
I would need to see your full history and order our complete immune profile in order to help you.
If you would like my assistance please fill out a consult form on my website and we will be in touch.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.