Recombinant stim meds better than urinary for RPL patients?

Posted By Braverman IVF & Reproductive Immunology || 2-Dec-2010

New studies have found that the immune suppression necessary for implantation is acheived with greater success with recombinant stimulation medications such as gonal F, follistim, luveris, and ovidrel in comparison to urinary derived stim meds such as repronex, menopur, and HCG. Although no studies have been done to determine if this is significant enough to cause failure in routine IVF cycles(I doubt it is ) however in patients with immune related pregnancy loss who need every bit of help they can get, it would make sense to avoid the urinary and stay with the recombinant meds follistim , gonal f, luveris, and ovidrel.

In the same light the use of vaginal progesterone , although perfect for initiating luteal changes in the endometrium almost 100% of the times, does not raise serum(blood) levels of progesterone and there are clearly functions of serum(in the blood) progesterone in recruiting "friendly" immune cells from the blood stream to the uterine lining and helping to prevent differentiation of "friendly" immune cells that are found in the blood stream to the "toxic' forms. Again this is clearly not an issue with routine IVF(as we have great success with vaginal progesterone(crinone, endometrin) but in patients with immune issues it is becomming our practice to only use IM progesterone on our most difficult cases as this is the only one of the therapies that we use that will raise blood progesterone levels. .

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