5 Posts
Reply Posted on: Dec 4, 2014 at 1:45pm
I have completed the majority of the testing you list on your website (everything except for the HLA phenotyping) and all has come back completely normal except for the following:

TNF-a:IL-10 (CD3+/"CD4+") = 31.8(Very Slightly Elevated)

CD3-/56+ (Total NK Cells) = 5.5 (Low)

CD3-/56+/16+ (16+ NK Cells) = 4.4 (Low)

CD19+/5+ (Cytotoxic B Cells) = 4.9 (High)

The other RIP results are as follows:

CD3+ = 75.1 (Normal)
CD3+/4+ = 40.8 (Normal)
CD3+/8+ = 26 (Normal)
CD3+/56+ = 5.6 (Normal)
CD+/HLA-DR+ = 3.2 (Normal)
CD3+/25+ = 6.3 (Normal)
CD19+ = 15.9 (Normal)
CD3+/4+/25h/127lo/FoxP3+(TReg) = 3.6 (Normal)

Natural Killer Cells Functional Test = All below 9

IFNg:IL-10 (CD3+/"CD4"+) = 7.4 (Normal)

(CD3+/"CD4+")/TNF-a = 68 (Normal)

(CD3+/"CD4+")/IFNg = 15.8 (Normal)

(CD3+/"CD4+")/IL-10 = 2.1 (Normal)

All blood clotting, ANA panels, etc. have been normal.

We have had 2 children before (non eventful, normal pregnancies). We are cycling for gender selection. I have had one chemical pregnancy of a not so great quality embryo so my doctor suggested further immune testing. However, everything has been within range except for the few items listed at the top.

I have noticed that the TNF-a is only slightly elevated, but the IFN-g is in the lower end of the normal range. You have mentioned before that you don't like the IFN-g to be below 5. Will treating the TNF-a cause the IFN-g to potentially go too low?

We have had a 10 minute consult before and you mentioned i should try a transfer with a more robust embryo. You felt that my history and test results didn't indicate I had immune issues. However, I don't have a ton of embryos remaining, so I was hoping I could get your feedback on the cytokine level above. Would prednisone be beneficial in this case or more harmful?

Dr. Braverman

2026 Posts
RE: TNF-A Posted on: Dec 7, 2014 at 7:35pm
Your analysis is a little to simplistic, you dont alter just one cytokine you manipulate the entire immune system , prior to recommending a therapy , you have to have a diagnosis, looking at just CD4 TNF and INF gamma is not enough to see the complete picture . Although you have had some of our panel to date , completing it would give us the picture we need to decide the best option for you. The "normal" levels from the lab are very different than our ranges as we compare our pateint population to each other and have far more data for comparison purposes. The normal diagnosis are for reference only and need to be interpreted by an RI that has expereince looking at these labs.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.