Neuprogen or Intrallipids or both?


2 Posts
Reply Posted on: Mar 10, 2013 at 5:05am
Hi Dr Braverman,
This site is great and thanks for giving the opportunity to ask questions.
I have had 4 failed ivfs. I have low amh (4.9 when last tested a year ago). Before my 4th ivf I had a laporoscopy during which they removed moderate endometriosis and a cyst.
For my 4th ivf I was on neuprogen from just before transfer and had intrallipids on the day of egg collection. I'd 3 grade 1 embryos put back (2 with 8 cells and 1 with 6).
I am missing the 3 KIR receptors and MTHFR (C677T and A1298C) are mt/nt heterozygous and PAI -1 4G/5G is 5G/5G.
My chicago bloods which were done following my first failed ivf (before the endometriosis was removed) revealed the following results with high cytokines and NK cells lowered with intrallipids:NK AssayName Result Limits All Units in %50:1 20.5 10-4025:1 11.5 5-3012.5:1 6.5 3-20IgG conc 12.5 50:1** 10.6IgG conc12.5 25:1** 8.3IgG conc 6.25 50:1** 11.9IgG conc 6.25 25:1** 8.5%CD3 77.8 60-85%CD19 4.6 2-12%CD56 17.9 2-12%of CD19+ cells CD5+ 13.0 5-10Notes: **>10% reduction in killing at each effector/target ratioNK Assay with IntrallipidName Result50:1 w/intrallipid 1.5mg/ml 12.025:1 w/intrallipid 1.5mg/ml 7.8TH1:TH2 intracellular cytokine ratiosName Result Limits Units in ratioTNF-a:IL-10 (CD3+CD4+) 32.5 13.2-30.6IFN-g:IL-10 (CD3+CD4+) 25.2 5.8-20.5
I am about to start on my 5th ivf which will probably be my last own egg ivf. My consultant says that I should use both neuprogen and intrallipids, this time with neuprogen from day 1 of my cycle. But the immunologist I saw said I should use one or the other. Which do you think is better? And if I am to use neuprogen do you recommend it from day 1 or from egg collection?
Sorry for such a long post and many thanks in advance.

Dr. Braverman

2026 Posts
RE: Neuprogen or Intrallipids or both? Posted on: Mar 10, 2013 at 7:52am
I do not know your case as well as your doctors so of course I must alway have you defer to their recommendations. with my patients and similar situations with low AMH I do have them start from Day 1. There are many others issues however that may need to be addressed, I would be happy to consult with you prior to your last IVF if you wish, if you would like my help simply email my office ([email protected]) and they will be happy to assist you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.