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IVIG & Intralipid Therapy in IVF: Interpreting Natural Killer Cell Activity for Diagnosis and Treatment
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There is little doubt that there is an ever growing recognition and acceptance of the fact that uterine immunologic dysfunction can lead to “unexplained” infertility, implantation dysfunction, unexplained IVF failure, recurrent pregnancy loss (RPL), and even placental insufficiency. Although there are many autoimmune and alloimmune factors that contribute to such implantation dysfunction, in the final analysis it is the activation of uterine natural killer cells (NKa) (and possibly cytotoxic-T cells) with the release of toxic cytokines that so damage the “root system” (trophoblast) of the embryo that the pregnancy is either immediately rejected, or placentation is compromised, causing pregnancy loss.
There are several methods whereby NKa can be assessed in the laboratory. While methods such as immunohistochemical assessment of uterine NK cells and/or TH-1 and TH-2 cytokines have been used, the gold standard remains the so called K-562 target cell test. In this test, NK cells isolated from the blood through flow Cytometry are incubated with specific target cells and thereupon, NK cell killing is measured. It is important to bear in mind that measurement of NK cell blood concentration has little or no value in assessing NKa.
Currently, probably less than a half dozen Reproductive Immunology Laboratories in the U.S.A are capable of performing the K-562 Target cell test reliably. Both immunoglobulin-G (IVIG) and Intralipid (IL) can successfully down-regulate NKa in the clinical setting.
Presently, virtually all these laboratories compare NK cell activity before and after exposure to IVIG and/or IL. In my opinion, this does not make sense, since neither IVIG nor IL can immediately lower activation of already activated NK cells. The way these therapies achieve such NK cell down-regulation is based upon the way in which they are formed.
This is how it happens: So called “progenitor NK cells” reach the uterus early in the menstrual cycle where, under the effect of estrogen, they undergo proliferation. These “progenitor NK cells” are NOT the ones that influence implantation. This role is effected through their “offspring”, i.e., “functional NK cells” which they propagate after being exposed to progesterone. This is produced after natural or induced ovulation, or following progesterone hormone therapy.
Thereupon it takes approximately 5-7 days for these “progenitors” to spawn a sufficient number of “functional NK cells” at the implantation site to influence orderly implantation. It is by no coincidence that this aligns with the time that the embryo implants into the uterine lining (endometrium).
Neither IVIG nor IL is capable of significantly suppressing already activated “functional NK cells.” For this to happen, the IL/IVIG must influence “progenitor (parent) NK cell” activity. Thus it should be infused several days prior to ovulation or progesterone administration so that the down-regulated “progenitor NK cells” will propagate a sufficient number of normally regulated “functional NK cells” to be present at the implantation site 7 days later.
Even though most Reproductive Immunology Reference Laboratories still report NK cell activity (NKa) before and after IVIG or Intralipid is added to a specimen of activated NK cells, there is in my opinion no value in trying to assess the therapeutic potential of IVIG or IL therapy in this way. Moreover, such information can be misleading. Similarly, there is no real benefit in trying to assess the clinical effect of IL/IVIG immunotherapy by measuring NK cell activity in a woman’s blood sooner than 2 weeks after its administration. Even then, the value of such retesting is probably questionable.
In my opinion, it is very regrettable and unfortunate that so many patients are denied the ability to go from “infertility to family” simply because (for whatever reason) so many reproductive specialists refuse to address the role of immunologic factors in the genesis of intractable reproductive dysfunction. Hopefully this will change …and the sooner the better.
59 Responses to “IVIG & Intralipid Therapy in IVF: Interpreting Natural Killer Cell Activity for Diagnosis and Treatment”
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Ask Our DoctorsA Question
Dear Dr. Sher,
I am 34 years old, I have two healthy young boys (2,5)concieved naturally in the first cycle trying. Now I am desperate to get a girl. We have tried 3 PGD with GSN24 technology which led us to 5 HB of great quality. We tested for Antiphospolipids, LupusAnticoagulant. After another failed cycle with perfect embryos we did a NK test, which said 8% out of 29%- so I don’t have elevated NKC. Despite that we did a 3rd cycle and I recieved Intralipids 2 days after ET. I never got pregenant. During a Hysteroscopy the RE found a small septum in my uterus. Does that explain the failures? Since I have 6 embryos left frozen I am thinking of giving it one last shot. What do you think? Thank you for your answer,
Glory
In my opinion, the septum in your uterus will not prejudice you getting pregnant. Trying to remove it is not a good idea because the scarring that can cause could be problematic.
Good luck!
Geoff Sher
Dear Dr. Sher, thank you for your answer. My RE did insisted on the septum removal. I had a second Hysteroscopy to confirm that there is no scarring. I am wondering if I should take the intralipids again before a FET even though I was not able to get the NKa test that you recommend (only the % of NKC). Would it hurt to just take intralipids without testing ( I am already on BCP and started Lupron for FET in October)? How many times should I take intralipids? DId it make sence to have it only once 2 days after transfer? From what I understood it is important to have the first before the cycle. Thank you again,
Glory
I really cannot recommend IL in your situation without NK cell activity known.
Geoff Sher
And I am wondering if it possible to concieve 2 children easily and develop a NKC problem within 6 years. Have you ever had a case like that? Thank you so much!
Thank you for your answer. When is the best time in the cycle to get the K-562 test? Does it make sence to test now since I am already down regulating? How long does that test take?
Any time in the cycle4. It takes about 10 days. Contact Reprosource in Boston or Reproductive Immunology Associates in Van Nuys, CA for his testy.
Geoff Sher
Dear Dr. Sher, thank you for your answer. I got the K-562 test done (the laboratory was able to do it within one day!)and the result is 22% activity, interleukin-2 37%. The laboratory calls this average, are my NKC elevated? In case there is an alloimmune problem would IL be a solution? I never had a miscarriage, just concieved the two boys. They were pretty heavy and I went with both over due date. We never had unprotected sex, could that have caused my immune system to have a problem? thank you again.
It all depends where this test was done. I say this because that result is strange. Usually there are a series of results in dilution. You might consider calling 800-780-7437 or 702-699-7437 to arrange a video conference (or Skype) consultation (free of charge to those who reside in the United States or Canada). If need be, someone from SIRM-Patient Relations can contact you in advance of the consultation and assist you in setting this up through your computer. Such audiovisual interaction it is much more personable than a discussion by telephone. However, if you prefer the latter, this too can be arranged.
Geoff Sher
Thank you!
You are most welcome!
Geoff Sher
Dear dr. Sher,
I was given an Intralipid infusion due to immunological issues (including high level of NK cells) probably causing first MA and problems with conceiving afterwards. I got pregnant after my 1st dose of IL (combined with corticosteroid therapy and low dose Aspirin) in natural cycle. Today I started 5th week, so there is still a long journey in front of us..
I would like to ask a question about progesterone supplementation, my previous gyn/ob was planning to give me dydrogesterone tablets after getting pregnant, my current doctor is not sure about it.
What do you think about it please? Could progesterone supplementation help? Can’t it work against the Intralipid, somehow?
Thanks a lot for your answer.
Best regards.
Karla
No! If this was a natural cycle pregnancy, it is unlikely that you would need progesterone added…unless of course your blood test shows you to be deficient. And, no there is no adverse interaction between IL and progesterone therapy.
Good luck and G-d bless!
Geoff Sher
Thank you very much.
Karla
You are welcome!
Geoff Sher
Dear Dr. Sher,
I’m 39 years old and have had 7 miscarriages including 2 IVF failures, 5 natural pregnancies. My husband is 41. All of these loses have been in first trimester between 7-10 weeks. I have read that your institute specializes in recurrent miscarriage and offers immune therapies (IL/IVIG) along with IVF to treat RPL. We live in Kansas City and St. Lois has the nearest SIRM. I am interested in learning about your program and see if you can help me. Would really appreciate a response. Thanks.
Ummay
hi Ummay,
I really think I might be able to be of help to you. Call 702-280-7437 tomorrow and set up a free Skype or telephone consultation with me.
I look forward to interacting with you.
Geoff Sher
Hello Dr. Sher,
I have had three miscarriages in a row since the birth of my son 2 years ago. I am 31 years old and have had all testing for genetic problems, hormone problems, blood clotting, and everything is normal. First missed miscarriage was at 15 weeks heart beat stopped, second was a chemical pregnancy, third ended 12 weeks heart beat stopped.
My question is, is it possible the bacterial infection I had when my son was born is causing an abnormal reaction of the nk cells?
Hi Haley,
If the inflammation damaged your uterine lining making it unable to thicken properly in response to estrogen, then yes this could be a factor. However, there are other equally plausible explanations.I suggest you call 702-892-9696 ans set up a consultation with me so we can discuss in depth.
Geoff Sher
Dear Dr. Sher,
at the moment I begun 14th week of pregnancy. Till now I got 4 infusions of Intralipid : before ovulation, at positive pregnancy test and then every 3rd week (7th and 10th).
I have one more dose planned for next week (still 14th week). Yesterday I was told by my gyn/ob that I should see also infectologist, because of probable CMV reactivation and poitive IgM toxoplasma test (which I was told can be flase positive due to polyclonal activation by CMV). I will have controll test in 2 weeks. Could the Intralipid be a problem for me?
Next week I will have also new immunological test fot NK cells, in case there are ok,this should be my last Intralipid. I wanted to ask, wheter NK cell cannot be activated later again (when the effect of last infusion will be gone) and do some harm to my baby in the later stages of pregancy?
Thanks a lot for your answers.
Best regards,
Reneé
I do not think you need follow-up NKa testing. However, the Intralipid will NOT compromise or effect management of CMV or Toxoplasmosis.
Good luck!
Geoff Sher
Dear Dr. Sher,
I suffered 4 miscarriages between 7-9 weeks. I´m 38. I have been with heparine and baby aspirin but it didn´t work. On my last pregnancy I did the NK assay and here are my results. Do you think I´m good candidate for IVIG treatment?
CD3: 73%
CD56(NKH-1): 15%
CD16+ CD3-: 12%
CD3+ CD56+: 4%
CD3- CD56+ CD16+: 10%
CD3- CD56+ CD16-: 1%
CD3- CD56- CD16+: 2%
Thank you so much from Spain
Carolina
You have not had adequate immunologic evaluation done. Your blood needs to be tested for 1. Natural Killer cell activity by the K-562 target cell test; 2.Antiphospholipid antibody profile (APA) , antithyroglobulin and antimicrosomal antibodies, and for DQalpha/HLA. Your husband’s blood should be assessed for DQa/HLA matching with you. There are very few reproductive immunology reference labs in this country that can do some of these important tests adequately. I refer to Reproductive Immunology Associates in Van Nuys, CA or to Reprosource in Boston, MA.
Please go to http://www.IVFauthority.com and when you get to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
“Recurrent Pregnancy Loss”
“Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
“Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
“Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
“IVF success: Factors that influence outcome”
Consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
Geoff Sher
Dear Dr. Sher,
thank you very much for your answer.
I forgot to mention that I am getting also methylprednisolone 4 mg per day,which is planned till the end of 2nd trimester because I am ANA positive.
Shouldn’t I rather quit it or cut it to half dose at least, while the CMV reactivation is present,or can I continue in the treatment with no fear?
Thanks for a response.
Best regards,
Reneé
This is something you should discuss with your personal RE.
Geoff Sher
Dr Sher,
You kindly answered a question that I had posed about laparoscopy with endo and you referred me to to some articles, this being one of them.
You highly recommend that patients with endometriosis be tested for immunological factors including the NK cells.
Should I be tested for anything else?
Also, I know there is an NK blood test and NK uterine test, which should I have done?
Finally, is there any reputable European lab that carries out these tests. I believe that somewhere a long time ago I hear of one in the UK.
Many thanks as usual for all of your time and care.
I prefer the blood test but in Europe, there is no place to do the K-562 target cell test so I would do the uterine biopsy for cytokines.
Good luck!
Geoff Sher
Hi Dr. Sher,
I have just gone through my second failed IVF attempt.
Each time I have gotten 3 eggs and done a 3 day transfer of 3 embryos, a 4 cell, 8 cell and 10 cell, all grade 1 both times.
I am 35 years old and have been diagnosed with moderate endometriosis, hypothyroidism and DOR. My Doctor also mentioned something about him suspecting my immune system has attacked my ovaries. No male factor issues.
I asked him about autoimmune implantation failure and he said and I quote “it is a scientific fairy tale.”
I really need some advise.
Please help!
Thank You,
Jennifer
P.S I live in Toronto, Canada
I respectfully completely disagree with your doctor’s statement. In fact he argues against himself when he says that “your immune system has attacked your ovaries”. If anything is unlikely it is that. 30% of women with enmdometriosis and 50% who have hypothyroidism (which in women is due to an autoimmune cause in most cases) have an immunologic implantation dysfunction. Since both could well apply in your case, I think it is more likely than not that this is precisely your problem. The DOR only makes it more urgent that you conceive before time runs out completely for you.
Please go to http://www.IVFauthority.com . When you get to home page, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
8. “IVF success: Factors that influence outcome”
9. “Staggered IVF”
10.“Embryo Banking”
11.”Thyroid autoimmune disease and IVF”
12. “Endometriosis”
Consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
Geoff Sher
In the absence of known autoimmune disease, what criteria do you use to decide to test for autoimmune abnormalities
1.A family history of autoimmune disease (e.g. Hashimoto’s autoimmune hypothyroidism; Graves, hyperthyroidism; Rheumatoid Arthritis; Lupus erythematosus etc).
2. Unexplained infertility
3. Unexplained IVF failure (especially following the transfer of quality blastocysts or chromosomally normal embryos)
4. Recurrent pregnancy loss (RPL)
5. Repeated “chemical Pregnancies”
Geoff Sher
800-780-7437
4.
I am 36 years old and have been trying to concieve for 6 years. I live in kansas city and have been seeing a re here in town. I also see a reproductive specialist in Chicago. I have had had 5 unsuccessful IUI attempts and 1 unsussesful IVF attempt. I have endometriosis. The specialist in Chicago found that i have hashimotos disease, and tested positive for prothrombin gene, factor xiii, b-fibrinogen, hpa-1,pai-1,and mthr. She also said that I have elevated cd19+b, She has recommend IVIG but my RE here strongly disagrees. What do you think?
You are a sitting duck for autoimmune implantation dysfunction. One third of women with Endometriosis and 50% who have Hashimoto’s autoimmune thyroiditis have have activated uterine Natural Killer Cells (NKa) that will reject the implanting embryo, often so early that you will not even know that it was happening. Please go to http://www.IVFauthority.com . When you get to home page, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
2. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
3. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
4.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
Consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
Geoff Sher
Hi Dr Sher,
we’ve just finished a consult with the beer center and are struggling with the decision of ivig vs intralipid. They are saying that ivig is shown to recude TH1 activity and there is no such proof that intralipids does, but from my research, it seems that both can do the same thing (but sometimes
some people respond better to one or the other) we are concerned about putting blood products from so many different people in us if intralipid basically does the same thing (and is 8X cheaper)
our results
tnf-alpha :IL-10 (CD3+cd4+) 53.5
IFN-g:IL-10 (CD3+CD4+) 29.9
I should note that we are very early in pregnancy already when the blood was drawn from the test in case that skewes things but with our history of m/c we want to cover our bases. and we started dexamethosone, did an intralipid, and started progesterone after we have the blood drawn for the tests.
Treg was all good
nk 50:1 was 16% (a bit high)
cd56cd16 was 9.7 (good)
also we have read that both progesterone and prednisone can be helpful in reducing the tnf alpha and wondered what your take on that is.
further info we are homozygous c677t. heterozygous Factor XIII gene mutation and homozygous PAI-1 4G/5G so needless to saw we are on BA, fragmin for that.
thanks for your time!
I was among the 1st to use IVIG in IVF and I can tell you that I have totally supplanted this with IL and our results speak volumes. IL does exactly the same as IVIG.
Good luck!
Geoff Sher
Dr Sher
thanks for your reply. do you put any stock on the tnf alpha results? we are freaking out a bit as our re-test showed them higher 59.3 (2 weeks after an IL) we did another IL this am before seeing the results. our NK results are pretty good considering at 16% (we didn’t retest those)
how much should we worry about tnf alpha? we are at 7 weeks right now (had a good Us yesterday)
should we switch to IVIG instead and how soon can we do an IVIG after doing an IL?
thanks so much!
Dear Dr Sher,
Must intralipid infusion always be accompanied by prednisone to be effective? What is the relationship? Would the protocol be different if one is already 5-6 weeks pregnant?
thanks kindly, d.
Not necessarily prednisone but yes…a corticosteroid (dexamethasone, prednisone or prednisilone). I prescribe the steroids until the 9th week and then tail them off.
Geoff Sher
Dear Dr Sher
I am from the UK and have undergone quite a few IVF/ICSI cycles because of my husbands sperm quality, all with varying degrees of success, but none leading to a full term pregnancy, most lost between 6-9wks.
For my next frozen embryo transfer I want to add in immunotherapy, however my consultant is pretty small minded about this and has refused to prescribe Intralipids, although she is ‘happy’ for me to take them along side my transfer.
I had planned to take them 7 days before transfer and combine with prednisolone and asprin, plus progesterone for luteal support.
I am now having problems finding someone to prescribe the intralipids, my GP knows nothing about them and the clinics that might are very very expensive, I did however find a midwife who is experienced in administering them.
Any tips on who or where to get a prescription from in the UK?
Thank you
Regards
I really wish I could help but unfortunately aside fromm telling you that there areb those in the UK that embrace immunotherapy. I know that Dr Taranisi in London does and that a physician in CARE group, does too.
Good luck!
Geoff Sher
Hi Dr. Sher,
I have recently had a failed IVF cycle, and had blood work done to check for antibodies. Apparently my husband is positive. My doc says he’ll put me on ASA, Heparin, Intralipids and Crinone (I didn’t respond to the PIO). I do have Hypothyroidism, and have been on Synthroid for 15 years. Here’s the concern…the Intralipids are on back order, so is there something else that could be used to get the same result? Also, is it necessary to be put on Lupron and Estrace (the nurse told me that was the usual prcedure)? Thanks for your help!!
The only alternative is IVIG and this is a blood product, associated with unpleasant side effects in 1:4 cases and ism about 25 times more expensive. I used IVIG before IL was known to be effective.
Good luck!
Geoff Sher
Hello Dr. Sher,
While searching the net for the answer of my 4 first trimester losses, i came across your website. Perhaps I also have an immunologic cause of these losses.
I am 40 years old and married for 6 years residing in India. My first pregnancy was a blighted ovum while in 2nd & 4th cardiac activity was seen at 5 wks and then lost at 6 weeks. The 3rd pregnancy was 13 weeks when heart beat was lost but the baby boy had encephalocoele.
My RE is persistent that I should do a course of ATT although there is no evidence to suggest this. My cycles are regular with good endometrial lining at ovulation. HSG and sonograms are also normal.
What do you suggest? Do you think I might have endometrial TB or immunological recurrent pregnancy loss?
Sabita
Hi Sabita,
I fully agree with you on this. Please go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
1. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
2. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
3. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
4.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
5. “IVF success: Factors that influence outcome”
6. “Recurrent Pregnancy Loss (RPL)”
Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.
Geoff Sher
Also I conceived naturally each time but had difficulty conceiving with a 16 month period of infertility between 3rd and 4th. In addition, my brother has sarcoidosis who was misdiagnosed with TB to start with!
Sabita
Copy!
Geoff Sher
I have had 2 back to back miscarriages, so my RE tested my NKa 3 mos ago and it was elevated. Therefore, he told me he wanted to start intralipids as soon as I got pregnant . In reading this blog, it sounds like you recommend doing prior to ovulation I am in a quandry whether there is any benefit of doing it now. Is there any harmful side effects? I understand that you need a good immune system to support implanation as well.
Respectfully, if you start too late it will have no value. Please go to the home page of http://www.IVFauthority.com. When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
1. “Recurrent Pregnancy Loss (RPL)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
4. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
8. “IVF success: Factors that influence outcome”
Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Geoff Sher
Dr. Sher,
I am a 28 year old woman that had a previous untreated chlamydial infection for a year before getting treatment about 13 years ago. I believed for a long time that tubal occlusion from this infection was the sole reason I couldn’t conceive. I had both tubes removed last year due to hydrosalpinges. I had my first IVF cycle last month and it was a failure with 2 beautiful blastocysts transferred and it just doesn’t make sense considering the doctor gave me a 75% chance. I ended up doing some research and found that the presence of antichlamydial antibodies such as Anti-CHSP60 could be destroying the embryo’s before they get a chance to implant. I was wondering if this type of antibody is something you could treat for with intraveneous immunoblobulin, intralipids, or a heparin/aspirin regimen or am I barking up the wrong tree with this? I’m just not sure how to even test for this anti-body and what treatment would be effective for it. I just know that something is wrong and my body rejected those embryos. The last thing I want to do is do a frozen embryo transfer with no immune treatment and get the same result and I do feel I will.
Corina Chacon
Frankly I do not believe that anti-chlamydial antibodies are the cause .Before considering these antibodies, I would definitely get NK cell activity tested (the K-562 target cell test) and then antiphospholipid antibodies (APA). Contact Reproductive Immunology Associates (RIA) in Van Nuys, CA. to get the test done.
Geoff Sher
Anti-Chlamydia antibodies are not the issue. More important is to exclude an immunologic implantation dysfunction.
Please go to the home page of this blog, http://www.IVFauthority.com. When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
2. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
3. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
4.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
5. “IVF success: Factors that influence outcome”
Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Geoff Sher
Hello Dr. Sher,
I am a patient at the Montreal Reproductive Center in Quebec and am interested in doing the Natural Killer cells biopsy test. I have done the blood work and it came back normal. Is it possible to have the biopsy done in Montreal and have the sample sent to your lab for testing? Please advise how this can be done.
Thanks very much,
Sonia Leaver
It is important the NK cell activity be tested through the K-562 target cell test done at an appropriate lab. If that is normal, I see no need to do endometrial cytokine biopsies.
Geoff sher
Hello Dr. Sher,
I am currently seeing Dr. Kwak-Kim a RI in Chicago. She would like me to do IVIg with my FET cycle but my insurance denied it so I am unable to afford it.
Dr. K does not do Intraplids so it’s up to my RE to prescribe it and help me through it. He is willing to do so but is unfamiliar with the dosage and how to infuse.
Can you give any help in this area for me? I am about to start a FET cycle this next week.
What is the normal dosage for Intraplids or any info I can give to my RE to help?
My recent numbers are below too from Dr. Kwak-Kim.
NK assay:
50:1 32.1 should be 15 or less
cd56 9.9 should be 12 or less
Th1/Th2 cytokines:
TNF 44.5 should be 30.6 or less
IFN 18.9 should be 20.5 or less
Thank you for your time.
You are welcome to have your Re call me at my office in Las Vegas (702-892-9696) and I will transfer that information gladly.
Geoff Sher
Thank you very much I just passed your info on to my RE Dr. Olive and hopefully he will call you soon to go over intraplids for me.
Hello Dr Sher,
We started a donor egg cycle a month ago but we had to cancel the ET because I developed a reaction from the lupron, sensory peripheral neuropaty in my feet and legs and the Estrace and estrogen patches raised my blood pressure.
We have 7 (6 days) embryos that we are planning on transferring in a couple of months. Since I have elevated NK cells, RE suggested IVIG on FET day and two more infusions of IL every four weeks.
I am not to crazy about IVIG because of the human plasma and I’m really worried about side effects after the bad experience I had with the other medicines.
My question is: Is it really necessary to have the IVIG on the FET, how about another IL infusion? Wouldn’t it be better to have the infusion at least a week before the FET?
I forgot to add that we are gonna try a natural FET, not sure how successful it could be.
Thank you for your time
Personally, there is rarely (if ever) a need for both IVIG and IL….one or the other. Frankly, I with rare exceptions only use IL. The 1st infusion is given 10-14 days prior to ET.
Good luck!
Geoff Sher
Thank you so much for your help.
Have a blessed day!
Cilia