labs

aurora

2 Posts
Reply Posted on: Jul 17, 2012 at 8:56pm
Dr. B

I am an old patient of yours. Unfortunately not a succes story. 4 IVF cycles failed, one of which was with a frozen embryo. One of these cycles was with you through SIRM with an IVIG, lovenox protocol back in 2007.

I am now 40 yrs old, remarried and thought to give it one more try seeing there is a lot of improvement in the immunologic area. I will be seeing you in August for a consultation but wanted to ask you your opinion about the following. I have just completed my immune workup with Beer center and was recommended LIT, which I am already scheduled for BEFORE I will see you. I wanted you opinion in reference to my workup and my chances to conceive this time since I have already tried IVIG and lovenox with your cycle in 2007. What new treatment/ if any do you think I should try?


Trombophilia tests:

Leiden Factor V negative
Prothrombine Gene negative
MTHFR mutation MTHFR A homozygous
>
> PAI-4G/5G positive for one copy of the 4G variant Additionally, in the note
for this variant it says I am heterozygous for the 4Gvariant in the PAI-1
serpine gene.
>
> FactorXIII-V34L: heterozygous positive for for the V34L variant in the Factor
XIII gene. Additionally, the note says I have one copy of the V34L variant

Homeostatic Assesment (HOMA) index Serotonine 104 normal I also have anemia: low RBC (3.3), low hemoglobin (11.5) , low HCT (33.8) and high MCH 35.0, high limphocites 48.1 and low WBC 4.3 vitamin D was also out of range: low: 23 In conclusion, should I go ahead with the LIT recommended because of the LAD? Thank you very much.

Dr. Braverman

2005 Posts
RE: labs Posted on: Jul 18, 2012 at 6:01am
I would not go for LIT yet. The LAD only tests for the presence of anti HLA antibodies whcih can only be made by women who have made it to the third trimester of their pregnancies. So it is EXPECTED to be low in those that have never been there, it is NOT an abnormal result. The problem is that LIT will get you to produce anti HLA antibodies , these are antibodies that will attack the embryo with the hope that your body makes the antidote i.e. anit - anit HLA antibodies better known as protective or blocking antibodies. There is no test for that YET(Im working on it) . They use another LAD test to judgle success of the treatment , but again all that will show is that you made the anti HLA antibodie and studies have shown that it is not true that all will then go on to make the "protective" antibodies. You could then be stuck with the "bad" ones without the "good' ones.
Hence come see me there is a lot new , and hold off on the LIT for now.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

louisa

9 Posts
RE: labs Posted on: Jul 18, 2012 at 9:11am
Apologies for jumping in but I found this interesting.

If someone has HAD lit in the past and developed 'bad' antibodies as you say, instead of the helpful ones, do you have treatments to counteract this situation?
Does Neupogen/IVIg/Intralipids etc overcome if this is the problem?

Thanks Dr Braverman

Dr. Braverman

2005 Posts
RE: labs Posted on: Jul 18, 2012 at 9:35am
yes both would help . IVIG "is" simply pooled "protective" antibody. This is why it works so well in patients with postive HLA antiobodies that are getting Kidney transplants, as these same anti HLA antibodies would otherwise attack the kidney transplant. This is why transplant failure is higher in women with complicated pregnancy history because in this group are women that have made anti HLA without making the protective antibody , and why this group does so much better with IVIG.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

louisa

9 Posts
RE: labs Posted on: Jul 18, 2012 at 9:47am
I undserstand that a lot better now, thank you so much.

When you say 'both' would help -
do you mean the Neupogen and IVIg would help or Intralpid and IVIg ?

Could you explain in what other way Neupogen/Intralipids also overcome too many 'bad' antibodies possibly from LIT?

Thank you
Louisa

Dr. Braverman

2005 Posts
RE: labs Posted on: Jul 18, 2012 at 9:54am
neupogen and IVIG , intralipids will not help .
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

louisa

9 Posts
RE: labs Posted on: Jul 18, 2012 at 9:58am
thank you for your time :)

- sorry again aurora for jumping in to your query!

Dr. Braverman

2005 Posts
RE: labs Posted on: Jul 18, 2012 at 9:58am
ITs an open forum all are always welcome to join in.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

aurora

2 Posts
Reply RE: labs Posted on: Jul 18, 2012 at 3:05pm
Dr. Braverman,

Thank you very much.The other test you are referring to is HLA DQ alfa matches? Would that be a case where LIT would be more beneficial than harmful?

Dr. Braverman

2005 Posts
RE: labs Posted on: Jul 18, 2012 at 3:26pm
It wouldnt work in cases of identical matches as you would not even generate the anti HLA as his HLA would not look foreign.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.