dexamethasone & intralipids

sophie

12 Posts
Reply Posted on: Jun 27, 2012 at 4:50am
Hi Dr. Braverman,

I understand (from your site) that intralipids are used only to supress NK cells, and that if one does not have elavated NK cells, that intralipids may possibly interfere with implantation. I have borderline elevated NK cells and had my first ever ectopic (of 7 pregnancied) after an intralipids infusion. Could the intralipids have caused my ectopic by oversupressing my immune system?

Also, could you briefly explain specifically what steroids like dexamethsone are intended to treat?


Thank you so much for taking the time to answer our questions!
Sophie

Dr. Braverman

1998 Posts
RE: dexamethasone & intralipids Posted on: Jun 27, 2012 at 5:49am
No intralipids are not the cause of ectopic pregnancies, it is however true that patients with immune issues who are unable to implant in the uterine cavity have an easier time implanting in the fallopian tubes as they dont have the same immune surviellance.

Dexamethasone is used by many progrmas to "assist" the immune system by suppression to help implant the embryo and there is also data that it helps increase beta HCG production that is a secondary assist in implantation. The doses used are quite small and not meant to treat any underlying immune issues.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

sophie

12 Posts
Reply RE: dexamethasone & intralipids Posted on: Jun 27, 2012 at 7:29am
Thanks very much for your reply!

To clarify about the ectopic question-- I understand that ectopics are not caused by intralipids, but I think what you are saying is that in a situation where immune issues are present, an ectopic could occur because the immune environment in the tube is more conducive to implantation than the uterus.

I am extrapoliating from other info on your site regarding studies that show reduced implantation rates when intralipids are used in women who do not have immune issues (I guess, specifically that they don't have elevated NK cells). It makes sense to me that if I use intralipids and I don't have a significant elevation in NK activity, the intralipids might reduce uterine receptivity thereby leaving a viable embryo no other suitable environment in which to implant, other than a tube. Does this scenario make sense to you as one possible explanation for an ectopic in a patient with no prior history of tubal issues (but with six prior losses)?

I also see that you prefer using prednisone to dex. You said dexamethasone is used to help the embryo to implant but is not used to treat any underlying immune issues. Is the same true for prednisone?

Again, thank you for your time! It is much appreciated.
Sophie

Dr. Braverman

1998 Posts
RE: dexamethasone & intralipids Posted on: Jul 2, 2012 at 7:40pm
No its only true that an overactive immune system that would lead to failure to implant or early miscarraige are not complete in the tube so when there is a coincidental pregancy that lands in the tube (usually an anatomic issue) it has a better chance of progrressing in the tube than in the uterus,because of the lack of immne survielllance in the tube..
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

sophie

12 Posts
Reply RE: dexamethasone & intralipids Posted on: Jul 3, 2012 at 6:15am
Thanks very much. I am 43, and pretty much out of time, but it helps at least to know that I did not cause the ectopic by using intralipids.

I am DPO 10 today (low stim TI with trigger) with HPTs still positive, so we'll see. The ectopic was 2 cycles ago and on the right side. I had only one follicle this time, and on the right. Heavy odds, but hoping for the best. I contacted your office last week regarding the pregnancy package, if I get lucky, you may be hearing from me soon.

No need to reply-- just wanted to say thank you for the time you spend answering questions.

nicolettc

15 Posts
RE: dexamethasone & intralipids Posted on: Jul 17, 2012 at 10:22pm
Dear Dr Braverman,

Does Prednisolone do exactly the same thing?
Do you treat your patients with Dexamethasone or Prednisolone?
Could you please explain how could Dexamethasone technically assist with HCG production (i.e. mechanism)?

A wealth of knowledge on this forum, thanks to you.

My sincere thanks
Nicole

Dr. Braverman

1998 Posts
RE: dexamethasone & intralipids Posted on: Jul 18, 2012 at 5:55am
No the intralipids did not cause the ectopic, the implantation in the tube many times will advance further than it would in the uterine cavity becuase the immune system does not police it as well.
Dex has mostly the same properties as pred but it crosses the placenta more readily so that is why pred is our first choice for longer treatment cycles.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.