Intralipids & Steroids for RPL


1 Posts
Reply Posted on: Mar 1, 2017 at 11:50am
Hello Dr. Braverman,

I am a 32 year old woman with PCOS, Hashimotos with high TPO titres around 4,000, and elevated NK cell activation at 17%. I have been pregnant 3 times (2 FETs and 1 natural pregnancy). I miscarried each time between 4-6 weeks. All standard ACOG RPL testing was normal. One of these miscarriages was with a PGS tested euploid embryo. I was on a GnRH antagonist protocol which resulted in 40 eggs retrieved, 32 fertilized naturally, 19 made it to blastocyst, 10 euploid and 3 no-result. My husband and I are considering immune therapy, but are a bit confused as we are reading about many different immune protocols. One doctor recommended doing a double dose of intralipids combined with a low dose (0.5 mg) of dexamethasone saying my blood test only showed a small down regulation of NK cell activation when treated with intralipids. Why such a low dose of steroids and why even do intralipids if my blood test showed a poor response to intralipids? Much of the reading I have done says a dose of 20-25 mg of prednisolone is recommended for immune patients. Is a 20-25mg dose of steroids combined with intralipids overkill? In addition, what are your thoughts on a prophylactic dose of lovenox even in cases with normal thrombophilia panels? Any insight is appreciated!
Thank you!

Dr. Braverman

2026 Posts
RE: Intralipids & Steroids for RPL Posted on: Mar 7, 2017 at 6:09am
The mistake made by all the doctors that recommend immune therapy is they have no idea what they are treating. You do not devise a protocol based on NK cells as they are not the "cause" of pregnancy related issues by themselves. And you do not do "prophylactic" treatments. What I recommend is to get a full immune evaluation, get a correct "diagnosis" then you dont have to guess at the therapy. I do not beleive Intralipids to be of value anymore (read my blog on this) . I would suggest you fill out a consult form from my website and we can schedule a free phone or SKYPE consultation to review your case in detail. I can assist you regardless of where you live.
Braverman Medical Team
Braverman Reproductive Immunology P.C.