Literature for and against Immune treatments

Dr. Braverman

2026 Posts
Reply Literature for and against Immune treatments Posted on: Oct 12, 2010 at 5:21am
Pts have called me and asked "why do other doctors quote literature that says immune treatments dont work' or are dangerous?"

The first thing everyone has to realize is that there is literature on both sides of the argument , in fact, most of the literature today supports the diagnosis and managment of immune related causes of RPL(most of this is from journals around the world as not much research is done on this topic in the US). Most of the doctors who quote the literature against Immune related rejection and treatment do not have any background in immunology and dont have the ablity to see the flaws in these studies. Most studies against the use of IVIG or even PLI were and are flawed by many factors. The most significant is the complete lack of understanding of the many cells lines involved in immune tolerance and hence immune rejection and simply treating any one with RPL without knowing the reasons you are treating wont give you any answers as to whether therapy works. Most of the recent literature is starting to address this issue and is looking at a complete immune cell analysis and drawing much better conclusions. Certainly there is no argument the immune system is involved in pregnancy loss, and that treatments help many patients avoid miscarriage and IVF failure(just look at our list of patients that have had so many losses,some as many as 18, before we treated them and you'll understand that the treatments work. Our job is to try and shorten the list of those that need to be treated so patients who dont need the treatment dont get it. But as a last option for so many patients you just cant ignore the prescence of these treatments.
The second issue is that of PLI and the fact that it is not FDA approved due to a Lancet study in 1998. Again the world literature is already way beyond this conclusion and has showed the studies here were flawed by improper preparation of the PLI injections and loss through refrigeration of the very important receptors on the cells that were to be injected to help develop immune tolerance. But again the lack of understanding of immunology by those quoting these studies has guided many away from treatments that are now helping so many patients around the world.
Lastly is the safety of the treatments. There is abundant literature showing the safety of IVIG and large series have shown this treatment to be safe not only in pregnancy but in all other autoimmune syndromes that it has been used to treat. This is consistant with our history of no serious complications in all the years we have been treating patients.
The most important issue seems to be experience in seeing, diagnosing and treating this very complex group of patients. We rely on the great success we have had over the years as the best proof that our diagnosis and treatments are effective. Its unfortunate that many have begun treating patients for immune related pregnancy loss with limited knowledge of the field and as we have stated on this site , these are best left in the hands of those with great expereince as this still is the most important quality necessary for success.
I will gladly share the literature on these topics and any one should feel free to call me to discuss them. Our success is no coincidence , and misguided literature should not sway someone from at least exploring and understanding these issues and if they relate to thier own problems with RPL. It would have been a shame if all the people we have treated over the years avoided looking into these issues.
Braverman Medical Team
Braverman Reproductive Immunology P.C.

pkharas

0 Posts
Re: Literature for and against Immune treatments Posted on: Dec 27, 2010 at 6:56pm
pl. explain what is IVIG and PLI ?

- pkharas
p.b.kharas

Dr. Braverman

2026 Posts
Reply Re: Literature for and against Immune treatments Posted on: Dec 28, 2010 at 5:19am
These are both detailed in the website. IVIG is an antibody solution that we transfuse into our patients usually once a month for about 4 treatments. The mechanisms of action are detailed completely on the website, but their basic mode of action is to decrease the immune response against an implanting embryo.
PLI or LIT is an injection that desensitizes the mother against the fathers genetics(and hence the baby's genetics) so that the mother is better able to tolerate the embryo. It does this by generating the production in the mother of "protective" or "blocking" antibodies , that lieterally act as a shield for the embryo against the attacking cells of the mothers immune system.
Braverman Medical Team
Braverman Reproductive Immunology P.C.

pkharas

0 Posts
Re: Literature for and against Immune treatments Posted on: Dec 28, 2010 at 6:00pm
IV--iMMUNOGLOBULINS......once a month,after ET or u start much before that?
ANY ALLERGIC REACTIONS OR ANAPHYLAXIS ?
CONGRATS ! UR STUDIES R EXCELLENT & SOMETHING NEW ALWAYS.
p.b.kharas

Dr. Braverman

2026 Posts
Reply Re: Literature for and against Immune treatments Posted on: Dec 29, 2010 at 4:01am
Prior to getting IVIG you must have an IGA level to minimize the risk of allergic reaction The most common method is to give 10 days prior to ET, but the decision on doses after this is based on following the immune panel and how it responds to your doses of IVIG.
Braverman Medical Team
Braverman Reproductive Immunology P.C.

Posts
Re: Literature for and against Immune treatments Posted on: Dec 29, 2010 at 4:18am
Dr. B
Thank you for all your responses and now that you have all my records I will be calling for a phone consult this week. I also just found out that my new insurance covers IVIG therapy as long as its preapproved with a letter from a physician explaining why I need it (if that is in fact what I need). I think that because I really don't have that much trouble getting pregnant that I'm going to talk to my RE about doing just medicated IUI's for my next round, so how long in advance do you suggest getting IVIG or other treatments? I'm assuming that doing a IVIG treatment is suggested on cycle day 1 during an IUI cycle? Or a month in advance? I really can't thank you enough for all you help!

Dr. Braverman

2026 Posts
Reply Re: Literature for and against Immune treatments Posted on: Dec 30, 2010 at 8:27pm
my pleasure.
Braverman Medical Team
Braverman Reproductive Immunology P.C.