Two fresh DEIVF failures

Anushka

1 Posts
Reply Two fresh DEIVF failures Posted on: Oct 13, 2011 at 5:59am
Dear Dr. Braverman,
I am 46 and have two kids. Was pregnant naturally many times (last viable pregnanct in 2007, but did D&C).
I am cycling in Europe now and already had two failed donor cycles. --1 with unproven 25 year old, --2 with proven (ongoing pregnancy) 21 year old. Both times 2 blasts were transferred (1st time-early blasts, 2nd - expanding blasts).
I decided to do a full immune testing. On my Level 1 it showed only MTHFR mutations (compound heterozyg for one copy). Never knew about this and was pregnant many times. I read Dr. Beer book and asked my ob/gyn to prescribe Folgart (additional folic, B6/B12), also taking baby aspirin.
Just recently I did Level 2 testing. It showed only NKcell elevated. Dr. scale this from 0 to 5 and gave me "3" (in the middle). Here is my result:

Name Result
50:1 27.4 (elevated)
25:1 19.8 (elevated)
%CD3 81.2 Normal
%CD19 2.5 Normal
%CD56 11.6 Normal
%of CD19+cells, CD5+ 8.0 Normal

TH1:TH2 intracellular cytokine ratios
TNF-a:IL-10 (CD3+CD4+) 25.5 Normal
TFN-g:IL-10 (CD3+CD4+) 13.7 Normal

He suggests two intralipids a week apart and retest again. One infusion is very costly for me now $700 plus testing. Intralipids med costs only about $70, and a nurse or doctor can administer. But I need a prescription from the US doctor. My ob/gyn doesn't want to order Intralipids for me. Local pharmacy doesn't take international prescriptions.
I am cycling in Europe next month and was planning to do it in their clinic, but unfortunatelly can not do 7-10 days before my transfer, because already purchased flight tickets and arrive just 2 days prior transfer. Their clinic offered me Intralipids on the day of transfer.

My question is: when do I have to do 1st infusion and next ones? Is that ok to have 1st on the day of tranfer useless?
Can any doctors in US prescribe intralipids after seeing my test result from Rosalind Franklin Univ in Chicago?

I am running of time now and getting worry...

According to my protocol I will start Prednisone 10 mg daily 10 days before transfer and 15mg from ET.
Also Lovenox 40 mg will start 10 days before transfer. I don't know for how long after transfer.
My TSH, ANA, APA are normal.

Thank you so much

Dr. Braverman

1998 Posts
Re: Two fresh DEIVF failures Posted on: Oct 15, 2011 at 2:00am
You really need to call me so I can get a clear picture of all the testing you have done . Your NK activity is very elevated but I would like to see other tests to understand why they are elevated. For your condition you should take the IL at least 2 weeks prior to transfer and repeat the NK activity one week after the first dose to see if the second is required. I would go higher on the prednisone as well.

I dont think a US doctor can order the intralipids but I can certainly talk to whomever is caring for you to direct them in the proper treatment. you may also need a higher dose of lovenox.

You should never fail 2 donor egg cycles. Please call my office and schedule a consultation.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.