Using Neupogen for Leukocyte Antibody Detection (LADs)

MPB

1 Posts
Reply Posted on: Jan 28, 2013 at 5:05am
Hi Dr Braverman,

I would really appreciate your thoughts on my situation. I am based in Melbourne, Australia so don't have as many options to treatments that are readily available in US.

I have just done a full Immune panel in US. It came back with the following:

  • Tested moderately positive to two types of APAs. These are:
    Antiphosphatidylserine IgG (Class II s-u) [Levels: 61]
    Antiphosphatidylinositol IgG (Class II d,e,t) [Levels: 65]


  • Low T-regs [Levels: 0.5%]
  • Low Blocking Antibodies (LADs)
    [B-cells] IgM+ [Levels: 1.0%]
    [B-cells] IgG+ [Levels: 6.4%]


  • High ANA [Levels: 1:1280 speckled]

What would you suggest is the best way for treatment? I have been suggested:

  • LIT and then use IVIG

    • Get LIT treatment in Sydney
    • Use IVIg prior to transfer
    • Test cytokines every 4-5 weeks to see if further IVIg is required
    • Possibly also add Dexamethasone/Prednisolone to this treatment

  • Neupogen and IVIg

    • Take Neupogen a week before stims
    • Test cytokine levels 1-2 weeks after using Neupogen
    • If cytokine levels are fine, add IVIg prior to transfer, then test cytokines every 4-5 weeks to see if further IVIg is required
    • If cytokine levels are too suppressed, don't use IVIg - just continue with Neupogen and see how we go
    • NO Dexamethasone/Prednisolone to this treatment as it would over suppress me


I would appreciate it if you could provide your suggestions. Thanks.

Cheers,
MPB
TC #1 since April 2010
Me: 31 DH:31
Chemical Pregnancy: 12/10/11
Ectopic Pregnancy: 03/01/12 (Right tube removed partially)
IVF (ICSI) Stim #1: March 2012
Long Down Reg (10 follicles
18 eggs retrieved
7 fertilised
ET x 1 5dt
No frosties) - BFN
NKC and Positive ANA detected: To be treated with Clexane
Dexamethasone & Intralipid
IVF (HA-ICSI) Stim #2: June 2012
Long Down Reg
Colorado Protocol (8 follicles
16 eggs retrieved
8 fertilised
ET x 1 5dt
No frosties) - BFN
Taking a 4 month break to treat Positive ANA and Anti ds-DNA with anti-malarials. Next cycle: January 2013 (New Year
New Hope
New Dreams)

Dr. Braverman

2026 Posts
RE: Using Neupogen for Leukocyte Antibody Detection (LADs) Posted on: Jan 28, 2013 at 7:19am
You have quite a bit of information here, not sure why you have the recomendations that you take IVIG and or neupogen. I think you should call my office and they can arrange a SKYPE cosult, I have doctors in Austalia that I can work with if you require a course of therapy and I would guide it. But right now the therapy seems kind of abstract.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.