question about high cytokines

mcp

8 Posts
Reply Posted on: Oct 28, 2012 at 5:01pm
For our last fresh cycle (planned FET since we used Natera/GSN testing with Day 5 biopsy) we decided to move forward with Donor Sperm as we weren't sure we could afford all of the immune treatments since my husband and I had 7 HLA matches including a 50% DQ Alpha Match as well elevated cytokines and slightly elevated NKC's.

Would you still recommend doing treatment for the elevated cytokines? If so would Dexamethasone take care of that as well as a grain-free and diary free diet, high dose of fish oil and D3 (see my previous post for doses)? Or would I need to still do an expensive treatment like Neupogen? Or Humira?

I am doing Intralipids for the slightly elevated NKC's but is there anything else I need to take into consideration since we most likely eliminated the severe HLA matching issue by using donor sperm?

Thanks!

Dr. Braverman

1998 Posts
RE: question about high cytokines Posted on: Oct 29, 2012 at 9:58am
ok why are you doing donor sperm? It is extremely rare that I have had to do this. I think you should call me . this can be successfully treated. I need to see all of your results to help you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

mcp

8 Posts
Reply RE: question about high cytokines Posted on: Oct 29, 2012 at 1:09pm
I guess that leaves the question of do I even need any sort of treatment now that we have used donor sperm? These were the abnormal results from the testing that you had ordered awhile back...

CD4+ is 56.4
My CD56+ is 15.4
CD3+/CD56+ is 3.1
TNFa is 57.1
IFN g is 30.1

DQ Alpha - 50% match
DQ Beta - 100% match
HLA-A 50% match
HLA-C 50% match
HLA-DRB1 2 matches

I guess I am not sure if I should pay for a consult if I am not going to be able to afford treatments such as Neupogen and IVIG? If you think I should consult with you again prior to my cycle I will for sure do that, I just know that we can't afford the treatments which is why we went with donor sperm.

Thanks!

Dr. Braverman

1998 Posts
RE: question about high cytokines Posted on: Nov 2, 2012 at 9:11am
Okay , I need to really think about this. The similarity in HLA genes(its not just the DQalpha but all the class 2 HLA(DQbeta and HLADRB1) cause your immune system to fail to interact with the sperm and develop T reg cells that must be at the uterine lining when the embryo reaches there. The theory is that in these cases , changing the sperm if there is no exposure of your immune system to the sperm(this does not happen when there is exposure to the embryo as most of the class 2 HLA genes are not on the embryo) may still lead to failure if not treated correctly . I would want to know the cytokines prior to the transfer regardless as this may at least be able to be treated with prednisone.

We should talk one time prior to your transfer to go over all of this.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

mcp

8 Posts
Reply RE: question about high cytokines Posted on: Nov 2, 2012 at 9:19am
Okay I will call and set up an appointment as I am set to start Dexamethasone (will switch to whatever you prescribe) in the middle of December. I am assuming it will take some time to get results back and all of that so I will try and get an appointment as soon as I can. Thanks again for all your help!!!

I hope you guys are okay with all the hurricane stuff going on!!

Dr. Braverman

1998 Posts
RE: question about high cytokines Posted on: Nov 2, 2012 at 10:48am
yes we are fine , thank you ! ok speak to you soon.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.