麒麟生育论坛

标题: 多次试管失败的姐妹们，去查查免疫吧 [打印本页]

作者: nycresident 时间: 2011-1-22 00:21
标题: 多次试管失败的姐妹们，去查查免疫吧
如果你的胚胎很好，内膜很好，但是总是不着床，或者生化胎停，去查查免疫吧。

如果你要问为什么，那就先到这里恶补一下免疫不孕知识http://www.ivfbbs.com/read.php?tid=13487&page=143

哪里可以查免疫不孕相关的项目？虽然广州、上海都有得查，但是查得最全面的是深圳中山泌尿外科医院。如果姐妹们想知道，就去打梁博士的电话0755-83370927。这个医院采用的完全是美国Allen Beer实验室的检查手段和治疗方案。

哪些免疫项目会影响不孕？美国Allen Beer实验室是这样归类的http://repro-med.net/repro-med-s ... :home&Itemid=11
1. APA - 抗血小板抗体
2. ANA - 抗核抗体
3. CD56 - 免疫表型（CD-3, CD-4, CD-8, CD-19, CD-5, CD56, CD16）和NK细胞活性分析
4. TH1/TH2
5. T细胞-T调节细胞
6. 凝血
7. CD57 - 子宫内膜NK细胞
8. 其他（甲状腺抗体，抗卵巢抗体等）

什么情况下需要做免疫检查？
1. 两次流产，或两次试管失败，35岁以上；三次流产或三次试管失败，35岁以下
2. 卵巢早衰。35岁以下，可是卵巢功能很差，促排效果不好，通常促不到6个以上卵子。
3. 空囊胚
4. 不明原因不孕
5. 已知免疫问题，如ANA阳性，类风湿，红斑狼疮
6. 以前的怀孕中发现胚胎发育迟缓
7. 继发性不孕。生过一个孩子，但是想要老二确总是流产。

据Beer中心说，有免疫问题的病人，孕期黄体酮的水平会比正常孕妇低，所以黄体酮的补充要维持到16周。姐妹们如果快到停黄体酮的日期时最好先去查查黄体酮水平，不要因停针造成胎儿流产。

还有，如果姐妹们能看懂英文，不妨买一本Dr Beer出的有关免疫不孕知识的书“Is Your Body Baby Friendly"，amazon有卖http://www.amazon.com/Your-Body- ... ility/dp/0978507800

作者: nycresident 时间: 2011-1-22 00:31
先占个坑

作者: nycresident 时间: 2011-1-22 00:31
还占一个

作者: vivi 时间: 2011-1-22 19:34
明天就打电话咨询！

作者: 尼诺 时间: 2011-1-23 05:56
请问和甲状腺功能有关的两个抗体anti-TPO和anti-TG是否在免疫项目中？

作者: nycresident 时间: 2011-1-23 07:04
标题: 回 4楼(尼诺) 的帖子
免疫检查也有查TPO和TG的。但是通常都不是这个原因引起不孕，而是50%有免疫不孕问题的人抗甲状腺抗体也很高。还有卵巢早衰的人很多甲状腺抗体也高。

作者: 胖鱼儿 时间: 2011-1-23 13:01
nycresident
好贴！顶起来！
又做件好事，总是能从你这学习知识，好感谢。
我去了三院开了一些检查，，但这里没有CD方面的，好像免疫科也没有，他那里有种自然杀伤细胞检查可以测得NK细胞，你说的子宫内膜NK细胞只能在CD57内查吗？

作者: nycresident 时间: 2011-1-23 18:48
标题: 回 6楼(胖鱼儿) 的帖子
据我所知，国内的医院查NK细胞只查NK数量，不查NK活力。但是根据美国免疫不孕中心的经验，很多病人NK数量不高，可是NK活动力过强。NK活动力要用k562分析方法才能检查出来的，这个检查只有深圳中山泌尿可以查。

作者: 尼诺 时间: 2011-1-23 21:25
标题: Re:回 4楼(尼诺) 的帖子
感谢回复！这样我就放心了！

引用第5楼nycresident于2011-01-23 07:04发表的回 4楼(尼诺) 的帖子 : / Y7 B6 a8 j# {3 b4 W4 ~1 e3 a
免疫检查也有查TPO和TG的。但是通常都不是这个原因引起不孕，而是50%有免疫不孕问题的人抗甲状腺抗体也很高。还有卵巢早衰的人很多甲状腺抗体也高。

作者: jiang103 时间: 2011-1-24 09:14
我也想去查免疫，有去过深圳中山泌尿外科医院的姐妹上来说一说，需要提前几天预约？费用大概多少？过年后何时开始上班（因不在广东，希望先了解好情况再过去），谢谢！

作者: nycresident 时间: 2011-1-24 09:26
标题: 回 9楼(jiang103) 的帖子
昨天和一深圳的姐妹QQ，她和朋友刚刚去见过梁医生，全套检查要7000元。

作者: yangguangman 时间: 2011-1-24 09:57
看到这个帖子，特意注册进来。非常感谢nycresident的帖子，提供了很多免疫方面的知识。我患有桥本氏病，甲状腺抗体很高。看了楼主的帖子后去广州中山二查过，NK很高，正在用免疫球蛋白治疗，已经三个月了，还是没有怀孕，现在考虑是否去深圳再做些检查。

作者: nycresident 时间: 2011-1-24 10:18
标题: 回 11楼(yangguangman) 的帖子
免疫球蛋白能抑制NK细胞数量和活动力，但是如果你CD57也高（这个是子宫内膜的NK细胞），免疫球蛋白就不行了，还要用抑制TNF的药，如修美乐。

作者: jiang103 时间: 2011-1-24 10:22
谢谢nycresident!
这两天听一在杭州的亲戚说，杭州有一老中医可以用中药调节免疫系统，增加IVF成功率的，有知情的姐妹吗？

作者: nycresident 时间: 2011-1-24 10:44
标题: 回 13楼(jiang103) 的帖子
如果你还年轻，可以考虑中医治疗，效果比较慢。美国免疫不孕论坛里还很崇尚抗炎症食疗法（anti inflammatory diet）-不吃面食、糖、咖啡、奶制品（牛奶、酸奶等）、肉（猪、牛、鸡等）、多吃粗粮、鱼、蔬菜、水果。这种食疗法对抑制免疫很有效。因为不好的食品会加重身体负担，刺激免疫系统，让其过于活跃。

作者: jiang103 时间: 2011-1-24 11:22
标题: 回 14楼(nycresident) 的帖子
也不年轻了，过了年就快36周岁了，所以很着急呀！
你说的那些食品，除了肉外，其它的我也很少吃呀。

作者: yangguangman 时间: 2011-1-24 11:51
谢谢楼主！准备再去复查一次NK，看看经过三个月的治疗是否有所降低。如果还不行，就得去深圳了，现在很庆幸国内有能够检查的地方，非常感谢楼主的帖子，让我知道去检查这方面的问题。祝福楼主，好人好梦！

作者: success 时间: 2011-1-24 18:38
北京哪里能查呢？NK高，只有用免疫球蛋白吗？还是阿司匹林？

我卵巢早衰？应该差什么？能恢复吗？不是说早衰不可逆吗？那个医院能查呢？

作者: nycresident 时间: 2011-1-24 20:22
标题: 回 15楼(jiang103) 的帖子
吃肉就很不好了，现在的牲畜都是人工食料喂养的，很多激素啊。美国的妈妈都不给小孩和普通牛奶，而是喝有机牛奶，这种奶牛不是用人工食料喂养的。

作者: nycresident 时间: 2011-1-24 20:45

引用第17楼success于2011-01-24 18:38发表的 :3 G- n* ]" d! ]7 u* c( E
北京哪里能查呢？NK高，只有用免疫球蛋白吗？还是阿司匹林？

& W" I! Q: n1 X& K, `* D M- n我卵巢早衰？应该差什么？能恢复吗？不是说早衰不可逆吗？那个医院能查呢？

不知道北京哪里有查，听说三院、协和可以查，但是查的项目肯定和广州、深圳的不一样，我想主要是习惯性流产的检查。免疫球蛋白、强的松可以抑制免疫。阿司匹林不可以，但是它可以让血液变稀，对有血栓的病人有帮助，因为血栓会阻塞子宫血管，阻断流给胎儿的营养。很多有免疫问题的病人同时也有血栓问题（有些血栓病会遗传的），所以病人在服用免疫抑制药的同时都服用阿司匹林或打低分子肝素。

卵巢早衰不等于没有卵子了，如果你40岁以下，还是有希望的。美国有人FSH高达80-100的还能怀孕生子呢。

作者: yangguangman 时间: 2011-1-25 20:33
suceess:
北京妇产医院可以查,挂中医科

作者: nycresident 时间: 2011-1-25 20:53
标题: 回 20楼(yangguangman) 的帖子
呵呵，中医比西药还更西医化了。

作者: yangguangman 时间: 2011-1-25 21:34
我也感到很奇怪，那里的妇科都没有这项检查。

作者: hashiandfsh 时间: 2011-3-19 20:02
标题: 回楼主(nycresident) 的帖子
nycresident , 你好, 强烈请求交流. 刚查出为, POF, 然后查出ANA着丝点型抗体滴度高达1: 80 000, 正常为1:80, 和 TG-AB抗体. 我在德国, 这里的医生没有这方面的经验, 被判无法生育.

不知道你在哪里. 你可以告诉我你的电话号码, 我可以个你打电话.

作者: hashiandfsh 时间: 2011-3-22 16:20
[quote]引用第13楼jiang103于2011-01-24 10:22发表的 :
谢谢nycresident!
这两天听一在杭州的亲戚说，杭州有一老中医可以用中药调节免疫系统，增加IVF成功率的，有知情的姐妹吗？

请问, 你打听到了这个老中医吗

作者: lanhua 时间: 2011-3-25 17:20
很开心今天看到你好孕的消息，恭喜楼主，我好久没上来啦。借你的好运，希望有一天我能如你这般修得正果。

作者: emme 时间: 2011-4-20 18:55
学习了

作者: 招龙仔 时间: 2011-4-21 10:33
建了一个免疫好孕群，欢迎大家加入互相交流，早日怀上自己的宝宝159035805

作者: zym1207 时间: 2011-4-23 11:47
第一次做试管需要查吗

作者: adafa35 时间: 2011-4-25 15:35
不错，顶一次

作者: sss 时间: 2011-4-26 11:55
我移值了4次，都没有成功，去查了封闭抗体，有点问题，后来吃了3个月的中药，又做了宫腔镜检查，一个月后自己怀孕了，所以大家一定要有信心哦，好运总会降临的

作者: lucky2010 时间: 2011-4-26 12:24
SSS 你没有注射淋巴细胞只是吃中药吗中药吃的是什么配方呀宫腔镜有处理什么吗

作者: hjqpj6789 时间: 2011-4-26 22:22
不只济南哪家医院查的准啊？

作者: sss 时间: 2011-4-28 09:55
我没有注射淋巴细胞，因为值不算太低，所以就吃中药就可以了，我是在浙江省中医院找叶平医生看的，宫腔镜只是查了一下，是正常的不需要治疗，但做宫腔镜有保养子宫的作用，所以应该也有些好处。我平常还有YJ不准的问题，也是吃了中药调理了一下，希望你们也好孕！

作者: 生儿育女 时间: 2011-5-10 13:35
顶一下，有在北京查的姐妹吗？
能介绍一下情况吗？
我准备8月份以后进周。
希望能排查的都查一下，检查的麻烦相比试管的麻烦来说简直小case了。
这个帖我一定会顶下去的，很感谢楼主分享。

作者: 好孕兔兔2010 时间: 2011-5-13 09:15
标题: 回楼主(nycresident) 的帖子
楼主，我想请教一下如果试管曾经宫外孕，而且血值也有翻倍，手术前的血值是18,000左右，还用查免疫吗？

作者: czdfnhaodd20 时间: 2011-6-8 06:16

引用第30楼sss于2011-04-26 11:55发表的 :
9 V4 L9 i6 Q8 s$ U. L* X我移值了4次，都没有成功，去查了封闭抗体，有点问题，后来吃了3个月的中药，又做了宫腔镜检查，一个月后自己怀孕了，所以大家一定要有信心哦，好运总会降临的

一个月后自己怀孕了，
这不都瞎扯蛋吗？

请版主调查，谢谢

作者: lucky2010 时间: 2011-6-8 11:22
楼上的你忙什么呢整天忙着调查我们论坛里的黑幕？
你是要一个个免疫的贴找过去，然后揪出什么嫌疑犯是吧。
那你自己干嘛发了两个贴都要找北京、北医三院的免疫治疗呢？

知道你在等你宝宝的帖子里曾经问过梁医生免疫问题，因为她没第一时间回复你，你就质问人家什么意思。你这样的态度，谁看了都害怕。

作者: czdfnhaodd20 时间: 2011-6-8 13:47

引用第37楼lucky2010于2011-06-08 11:22发表的  :
  I: ]. w& c! F楼上的你忙什么呢整天忙着调查我们论坛里的黑幕？; z$ W' [  l& k9 L9 d  g
你是要一个个免疫的贴找过去，然后揪出什么嫌疑犯是吧。
9 D/ c  `: g8 f5 x那你自己干嘛发了两个贴都要找北京、北医三院的免疫治疗呢？* \  t1 _3 Z  ]
! P/ |) H% q8 z# ~6 S5 F
知道你在等你宝宝的帖子里曾经问过梁医生免疫问题，因为她没第一时间回复你，你就质问人家什么意思。你这样的态度，谁看了都害怕。

请版主调查，谢谢

作者: 下一站的幸福 时间: 2011-6-9 11:04
我也是ANA1：100阳性，干燥综合症，到底这种病对试管有没有影响，说法不一，治疗不一，就没有好的医生对我们有帮助吗？我也在网上咨询过梁燕，他给我的答复也是不需要注射白蛋白，只服用强地松与阿丝匹林，到底怎么办？有那个姐妹给于指导？

作者: lucky2010 时间: 2011-6-9 16:34
下一站的幸福，你看过等你宝宝的帖子吗？她也是干燥综合症，如果我没记错的话。在DR.BEER的书中有一章节是关于抗核抗体阳性的。有抗核抗体阳性，提示你可能有自身性免疫系统的问题。但你要综合其他免疫不孕的检查结果，才能知道是否治疗，如何治疗。

作者: nycresident 时间: 2011-6-10 02:25
标题: 回 39楼(下一站的幸福) 的帖子
美国另一个免疫实验室（RIA）的医生有建议，ANA高的吃强的松就可以了，只有NK高的才要打免疫球蛋白。

作者: nycresident 时间: 2011-6-10 22:57
发些帖子给懂英文的看看了

vesnaMay 16 2011, 01:30 PM
Doctors please help me
I am currently 5 weeks and 5 days pregnant.I am on lovenox,prednisone 30 mg and IVI-g
*
I have immune issue elevated nk and elevated cytokine level.
My first results BEFORE IVI-G
NK 50:1= 24.5
TNF ALFA =47.7

1.FIRST IVI-G
After IVI-g on 04/18/2011 my results are
NK 50:1=14.8
TNF ALFA=37.9
We were so happy because level dropped
I had transfer on 04/25 and I get pregnant

2.SECOND IVI-G
On 05/04/2011 I had one more IVI-g
Results from that infusion came today but elevated
NK 50:1=31
TNF ALFA 49.5

3.THIRD IVI-G after one week
05/11/2011 results for couple of days

Doctors ,as you can see my levels are rise from the moment I get pregnant.My immune doctor
gave me aggressive IVI-g protocol.I don't have last blood results,they said for
couple of days.Levels from today are after second ivi-g,and they are elevated.Is it normal to be elevated after pregnancy?
I am so scared,I am crying ,please tell me are they gonna kill my baby?
My beta is doubling very nice,we saw sac and yolk sac last week.US for heartbeat
in Wednesday.
I guess levels are little bit lower because I had the third ivi-g after only one
week.
Please help me do I have chance for this for baby
vesna
Geoffrey Sher, MDMay 16 2011, 04:39 PM
Stay the course with the IVIG. Ignore the NKa as there is usually a lag in response anyway. I presume you are taking steroids too along with heparin.

Hopefully all will be well. Please keep me in the loop.

Geoff Sher
vesnaMay 16 2011, 04:46 PM
Thank you my dear Dr.Sher
I am taking prednisone 3 times per day 10 mg,lovenox 2 times, ivi-g
I will know more in Wednesday.
Hug
Vesna
Geoffrey Sher, MDMay 16 2011, 07:57 PM
How much IVIG are you getting. I used to prescribe 40G per infusion at least! Now I have completely supplanted the IVIG with Intralipid.

Good luck!

Geoff Sher
vesnaMay 17 2011, 05:08 AM
[quote name='Geoffrey Sher, MD' date='May 16 2011, 07:57 PM' post='174944']
How much IVIG are you getting. I used to prescribe 40G per infusion at least! Now I have completely supplanted the IVIG with Intralipid.

Good luck!

Geoff Sher
[/quote]
Dear doctor,
I am taking 400mg IVI-G.I am praying that last dose lowered my level.
Tomorrow is big day for us
Thank you for your answer and care
vesna
Geoffrey Sher, MDMay 17 2011, 10:27 AM
The dosage needed is 40 Grams per infusion. 400mg is really completely inadequate.

Geoff Sher
vesnaMay 17 2011, 11:01 AM
[quote name='Geoffrey Sher, MD' date='May 17 2011, 10:27 AM' post='174977']
The dosage needed is 40 Grams per infusion. 400mg is really completely inadequate.

Geoff Sher
[/quote]

Thank you for you answer dear Dr.Sher
Maybe ,I am wrong,I have to check tomorrow
hugs
vesna
Geoffrey Sher, MDMay 17 2011, 03:33 PM
I think you should!

Geoff Sher

作者: lisa2015 时间: 2011-6-12 10:53
我也是移植5次都没着床，进周2次，2次都腹水，5次都是做冻胚，有2次做过孵化，1次做过囊胚。现在还有8个冻胚在医院。最进一次是2011-5-26号移植，6-9号查血只有0.2，还是没成。
以前总觉得是运气问题，可运气和概率不可能总不降临到我这，因为看边上的病友还是容易的。所以这次回来就狂查资料，昨天才刚刚发现这个网站，觉得找到支撑。

我也想去查查免疫，上海是在上海红房子医院查的吗？有在那里查的JM吗？查之前要准备什么？要月经干净去，还是月经第几天去好，有要求吗？是夫妻双方查，还是就女方查就行呢？全套的费用要多少？请知情的JM回复哦，急等！！

作者: 下一站的幸福 时间: 2011-6-12 14:34
NK我好象没有查。我查的抗心磷。红狼一套都为阴性。只有ANA1：100阳性。但我吃了一年的强地松。去查还是1：100。1：100也是阴性。也是阳性我就再这个值的低线上掉不下来。不知道怎么办在好。强地松阿司吃的太多明显感觉身体不行了。但我的主制医生也没有给我希望就说在试试吧会成功的。他对我好象也是无能为力。就让我一次次的实验。我的身体；心都在失败中被一点点的击碎。不行就代孕吧。这是我唯一的希望了？我以前有自己怀过两次。为什么试管就失败我找不到答案。也许上辈字是个坏人。这辈子被惩罚！

作者: nycresident 时间: 2011-6-13 08:59
标题: 回 44楼(下一站的幸福) 的帖子
如果你的ANA高又伴有不孕，可能还有其它免疫的问题。真正造成免疫不孕的罪魁祸首是过于活跃的NK细胞。

作者: 米饭 时间: 2011-6-13 19:25
标题: 回 45楼(nycresident) 的帖子
楼主好！觉得发现这个帖子太晚了！！！！我今年41岁了，做了3次IVF，前两次都是只有B级胚胎，未成。最近的一次刚刚做完。自然周期取出的一个卵泡，做成了A级胚胎，着床了，第11天HCG: 46，激动地哭了；第13天48，心抽搐；第15天降到了29，都快崩溃了... 在网上疯狂查，好像这个叫生化妊娠吧。我有内异，还有哮喘，所以一定有免疫紊乱的问题。想问一下楼主，NK可以在生化妊娠后检查吗？另外，我小时候得过结核，未经治疗自愈了，但是体内有陈旧性病灶，这样的情况能做免疫治疗吗？很想加楼主的QQ聊，可以吗？

作者: nycresident 时间: 2011-6-13 21:18
标题: 回 46楼(米饭) 的帖子
到专门的医院查免疫，根据结果才能定需不需要做治疗，前面的楼有说那家医院最适合做这些检查。搜搜这个论坛的免疫帖子，有些姐妹正在治疗，你和她们交流好了。

作者: 米饭 时间: 2011-6-13 21:44
谢谢楼主的回复！

作者: lucky2010 时间: 2011-6-14 15:15
下一站的幸福，我昨晚看BEER的书，ANA阳性也是可以用免疫球蛋白的，但这个前提是你要知道自己在其他免疫系统方面出了什么问题，只是说免疫球蛋白这个药是可以用的，只要你的IgA是合格的。

作者: 紫钦宝贝 时间: 2011-6-17 16:59
nycresident,我三促六移，一次胎停，一次生化，我以前一直怀疑是内膜问题，每次移植都是8C，厚度和形态都不好，现在第四次促排已经进周，突然很担心自己的免疫问题，但现在去检查已经来不及了，老公也只给我这最后一次机会，我太想成功了，我能不能自己要求医生在移前后注射免疫球蛋白，或脂肪乳剂，到底哪种效果好些？我以前的医生同意了让我注射蛋白，但他不是太支持。虽然这样会冒太大的风险，但我还是想把可能影响的因素都控制在最低范围，能给点好建议吗？谢谢

作者: nycresident 时间: 2011-6-18 01:01
标题: 回 50楼(紫钦宝贝) 的帖子
你知道免疫球蛋白这个药很贵的吗，注射一次差不多要一万元呢。这个药的风险倒是不大，看你医生怎么说，风险小也一点也便宜的多的方法就是滴脂肪乳剂+低分子肝素+强的松。形态C的内膜不行哦，排卵前可是C吗？排卵后C形态是没有关系的。

作者: 紫钦宝贝 时间: 2011-6-19 16:24
nycresident，谢谢你的回答，我排卵前的内膜有时A有时B，但每到移植前比超都是C，我知道这很不好。我也不能肯定这是不是内膜因素，我最后移植失败后，我们这移后十天查血，也就是移植第十三天我去比超时内膜是7B，医生说没有想象的好也没有想象的差。主要是我都移植过六次，我不想再赌，老公也给我最后一次机会，感觉压力还是很大，这个我自己可以好好调节，放松心态去做这最后一次。有滴脂肪乳剂这种治疗的详细方法吗？哪些医院会有这些药，我应该什么时候治疗这个呢？

作者: 紫钦宝贝 时间: 2011-6-20 17:44
nycresident，我看脂肪乳剂分长、中、短链的脂肪乳剂；且其主要成分有分别从大豆油、椰子油、橄榄油、鱼油中提取的，或四者混合按比例提取而合成的制剂，不知道临床控制NK是用的哪种？？？还有这个是不是在移植前两周静脉滴注呢？鲜胚周期也可以用吗？肝素和强的松是跟脂肪乳剂一起使用的吗？是不是使用肝素一般就不用阿司匹林了？我现在已经降调第八针了，再等五天就要开始促排了。不知道有用没用，我都想试试。

作者: nycresident 时间: 2011-6-20 22:14
标题: 回 53楼(紫钦宝贝) 的帖子
脂肪乳剂是大豆提炼的那种，英文名intralipid，一定要认准了。
用法： 20%的脂肪乳剂100ml，与400ml生理盐水混合，通过静脉滴注

移植前7-10天滴注一次，好孕后再滴注一次。
肝素是移植后开始打，普通肝素要天天打，低分子肝素好像是一星期打两针，这个具体要问问医生
强的松是促排的时候就开始吃，一直吃到12周。

上面是我从一个试管医生的博客里看来的。

脂肪乳剂治疗免疫最近两年才在美国开始，主要是芝加哥的一个免疫医生提出的，Beer中心不用脂肪乳剂。在做NK毒性分析时，芝加哥的实验室会给出加入脂肪乳剂和IVIg对NK后，50:1和25:1的结果降低程度。

作者: nycresident 时间: 2011-6-21 02:32
patient question:
Doctors- I’ve had 3 m/c’s this year all around 7-8 weeks. The 1st was a natural pregnancy. My prog was very low and I had a lot of bleeding early on. The D&C result was “normal male” but I’m convinced the m/c was due to the fact that I wasn’t on any prog support or lovenox.

M/c’s 2 and 3 were SET IVF cycles and the D&C report came back as normal “female” for each which I've been told by several sources (including Dr. F and my own RE) that this is an inconclusive result.

My question is regarding my pregnancy with my son. In that pregnancy, I transferred 3 embryos and got pg with all 3. All 3 implanted and at 7 weeks I had 2 h/b’s and 1 gestational sac. By 8 weeks, I only had one h/b.

Don’t the losses during my son’s pg point to chromosomal abnormalities vs immune issues? If it were it immune issues, wouldn’t I have lost all 3?

Thank you for your help.

Dr' s answer
Even though your progesterone was low at the time of the loss, I think that was more likely due to the fact that the pregnbancy was not attaching properly, rather than being due to an inherrent luteal defect. ..i.e. the result, rather than the cause of the problem.

In fact in your case, it is in my opinion quite probable that you have an immunologic implantation problem...probably alloimmune in origin (see my articles on "immunologic implantation dysfunction"..." and on "Recurrent Pregnancy Loss" at www.IVFauthority.com). I invite you to call 800-780-7437 and set up a telephone conference with me to discuss this , if you wish.

作者: 紫钦宝贝 时间: 2011-6-22 12:45
nycresident，真是太感谢了，这么详细的方案，我准备采用，不管有没有效，这样心里也踏实些。我过两天就要促排了，我到医院去问问我的医生有没有这方面的药，虽然他不太支持，但他会配合的，为了这最后的希望。

作者: liguangui 时间: 2011-6-22 13:16
标题: Re:曾经的免疫老大难，今日的快乐妈妈！祝福我们，祝福大家！
intralipid治疗高NK毒性的效果还没完全明确（尽管我们的实验数据显示其可显著抑制NK毒性，但药效似乎不及IVIG）。另外，作为高脂含量的生物制剂（肉眼观察可见高浓缩样乳液），可能会对病人特别是有血脂病的病人产生较严重的副作用。

作者: nycresident 时间: 2011-6-23 19:32
Beer派别的免疫医生是不推荐脂肪乳剂，可是使用脂肪乳剂的医生则觉得它比免疫球蛋白便宜安全，SIRM这家医院已经给免疫不孕病人用了好几年的脂肪乳剂了，说效果比期望的要好。以前10多年他们都是用IVIg的，现在已经不用了。

Immunologic Treatment

INTRALIPID 20% - FINALLY AN EFFECTIVE, SAFE AND LOW COST ALTERNATIVE TO IVIG THERAPY
SIRM physicians have long advocated aggressive treatment of immunologic implantation dysfunction in women undergoing IVF. In cases where there has been Natural Killer Cell activation (Nka) (as evidenced by an abnormal K562 target cell test) we have championed the use of IVIG to down-regulate (deactivate) the Nka. In this manner, many women who otherwise might not have achieved success with IVF have gone from infertility to family.

For us at SIRM, advocating the use of IVIG over the last decade, has come at a considerable price. Clearly, women requiring IVIG have been concerned about the cost (more than $4000 per dosage), reported side effects and, given the HIV/hepatitis scare, have been reluctant to receive a blood product. To make matters worse, under-informed critics have for unexplained reasons played on such unfounded fear often raising it to the level of alarm. The fact is that over the years we have administered IVIG to thousands of women, without a single report of viral transmission and few significant (but always transient) side effects.

About a year ago reports began to surface regarding a low cost (about ten times less than IVIG) synthetic product called Intralipid, which upon being infused more than a week prior to embryo transfer would lower Nka and further more, was virtually free of side effects.

About a year ago, we began evaluating the effect of Intralipid in patients who had activated Natural Killer cells, and for whom IVIG therapy would otherwise be indicated. Thus far we have treated more than 30 women with Nka using Intralipid 20%. More than 60% of the patients achieved viable ongoing pregnancies, showing Intralipid therapy to be at least as effective (and perhaps even more so) than IVIG. There were no significant side effects and patient tolerance of this treatment was high. We anticipate that patients receiving Intralipid will soon start reporting on their experience using Intralipid, on various discussion boards.

Against this background, SIRM physicians have collectively decided to virtually abandon further use of IVIG, in favor of Intralipid.

Below are some clinical details about Intralipid:

Intralipid (IL), is a synthetic product composed of 10% soybean oil, 1,2% egg yolk phospholipids, 2.25% glycerin and water. Based on research performed at SIRM and elsewhere, infusion of IL lowers Natural Killer cell activation (Nka) as effectively as does, intravenous gammaglobulin (IVIG.) When indicated IL (as with IVIG) is infused 7-10 days prior to ET and one more time again after a positive pregnancy in women whose Nka is due to an autoimmune causes (antiphospholipid antibodies and/or antithyroid antibodies). In cases of alloimmune implantation dysfunction (DQa and/ HLA matching between the embryo recipient and the male partner) the same applies but in this situation the infusion is repeated at 2-4 week intervals until the 24th week of pregnancy.
We have supplanted IVIG with IL therapy in a significant number of women undergoing IVF , and who had immunologic embryo implantation dysfunction. The results thus far have been excellent, way beyond our initial expectations.
At last we now have a safe and inexpensive alternative to IVIG therapy...Intralipid! What is more, IL costs about 10 times less than IVIG, is not a blood product and is without significant side effects.

作者: 紫钦宝贝 时间: 2011-7-2 16:27
nycresident，我今天促排第三天了，我去了我们这里最大的一家医院（华西医院），没有开到IVIG和低分子肝素，开的脂肪乳剂intralipid20%是250ML装的，一次是滴100ML吗？那剩下的还可以用不？我看华西医院有低分子肝素钙，没有低分子肝素，不知低分子肝素钙能不能用？谢谢nycresident！

作者: nycresident 时间: 2011-7-5 22:16
脂肪乳你要问问药店或生产商，开封了的药还能不能留，能留的话如何保存，能留多久。这个药也不贵，如果是我就丢弃剩下的。我也不知道低分子肝素和低分子肝素纳是不是一回事，你得问问医生哦。

作者: 紫钦宝贝 时间: 2011-7-6 21:33
nycresident，我今天已经滴了脂肪乳，用了3个小时，买的低分子肝素钙（速碧林），也叫低分子肝素，60多一支，买了五支，我准备移后开始注射，隔三天注一次，不知道行不行，我的医生从没这样用过药，所以他也没有好的建议。

作者: nycresident 时间: 2011-7-6 22:13
标题: 回 61楼(紫钦宝贝) 的帖子
不好意思，我又去看了看那个医生的博客，低分子肝素（Clexane 或Lovenox）是每天打一针。

作者: 紫钦宝贝 时间: 2011-7-7 18:58
嘿嘿，nycresident，我买的肝素英文名叫Low-Molecular-Weight-Heparins lnjection。0.4ML一支，4100IU抗Xa因子（WHO单位），如果我移后天天打，要打到什么时候呢？

作者: nycresident 时间: 2011-7-12 02:04
标题: 回 63楼(紫钦宝贝) 的帖子
我把整篇文章都拷下来了
IVF success rates are dependent upon the number of the mature eggs and “competent” embryos available for transfer. A woman undergoing IVF is given fertility drugs for two reasons: (1) to enhance the growth and development of her ovarian follicles in order to produce as many healthy eggs as possible and (2) to control the timing of ovulation so that the eggs can be surgically retrieved before they are ovulated. In cases where the woman has previously received fertility drugs, the subsequent treatment protocol is largely based upon her response to the most recent such treatment regime. If a woman is receiving gonadotropins for the first time, the dosage and regimen is determined by her cycle day (CD) 3 blood FSH antimullerian hormone (AMH), Inhibin-B concentrations, medical history and body type.

Controlled Ovarian Hyperstimulation (COH)

At SIRM, in most cases, the woman begins her cycle of treatment by taking birth control pills (BCP) and having an ultrasound examination to exclude ovarian cysts. The BCP therapy is continued for 10-30 days before initiating daily injections of a Gonadotropin Releasing Hormone agonist (GnRHa) such as leuprolide acetate (Lupron). Both the BCP and Lupron are administered together for an additional two or three days, whereupon the BCP is stopped. The daily Lupron injections are continued until menstruation begins about 3 to7 days after stopping the BCP. By shortening the duration of time on the BCP it is possible to accurately plan the onset of menstruation. In this way we are able to schedule each cycle of IVF to the convenience of the patient and the medical team. Additionally, the combined use of BCP and Lupron reduces the likelihood of Lupron-induced ovarian cyst formation, thereby largely avoiding the need to delay or cancel the cycle of treatment.

As soon as menstruation begins, blood is drawn and if the plasma estradiol (E2) concentration is less than 70 pg/ml, the patient is ready to initiate ovarian stimulation with gonadotropins. If the E2 level is greater than 70 pg/ml, Lupron therapy is continued at the same (or an increased) dosage for a few more days, whereupon the E2 concentration is re-measured. Subsequent failure of the E2 to fall below 70 pg/ml is an indication for a pelvic ultrasound for the detection of an ovarian cyst, the presence of which usually mandates the performance of an ovarian cyst needle aspiration.
Lupron injections are either continued at a reduced daily dosage or (as is now becoming common practice at SIRM), we stop Lupron and switch to low-dose GnRH antagonist (Ganirelix or Cetrotide). On a designated day (usually within a week and a half of the onset of menstruation), a specified regime of gonadotropins (e.g., Gonal F, Follistim, Bravelle, and Repronex) therapy is initiated. Those patients requiring heparin therapy begin this treatment on the first day of receiving gonadotropins.

In a variation on this theme, patients whom have severely diminished ovarian reserve receive intramuscular Estradiol Valerate (E2V) injections (Delestrogen) and/or vaginal estradiol suppositories for a week or longer, prior to and during gonadotropin therapy.

Those patients who have a history of a poor endometrial lining may be prescribed sildenafil (Viagra) vaginal suppositories and oral terbutaline to attempt to improve the uterine lining.
Patients who have activated natural killer cells (NKa) as measured by a K-562 target cell test receive intralipid (IL) therapy by intravenous infusion 7-14 days prior to embryo transfer.
All IVF patients receive oral corticosteroids (dexamethasone or prednisone) daily, commencing with the start of ovarian stimulation and continuing until the first blood beta-hCG test (i.e., pregnancy test). Women who have rising blood hCG levels (a positive blood pregnancy test) 9-11 days after egg retrieval continue taking corticosteroid and heparin (when applicable) beyond the ultrasound confirmation of pregnancy, which is performed at the 6-7 gestational week.

In cases where the blood pregnancy test fails to reveal an appropriate increase in the quantitative beta hCG concentration, heparin therapy is discontinued, and the corticosteroid dosage is slowly reduced over a few weeks and then stopped. Pregnant women continue corticosteroid as well as heparin treatment until the 8th-10th week of pregnancy, whereupon the heparin is abruptly discontinued and the corticosteroid is tapered off over 1-2 weeks and stopped.

Two days after the initiation of gonadotropin injections, the dosage of gonadotropins is substantially reduced, and is then maintained at this lower level until the administration of HCG. Dosage adjustments are sometimes made during the course of the cycle, based upon the patient’s response to medication.

Commencing seven days after the initiation of gonadotropin therapy, the patient undergoes serial ultrasound and plasma estradiol evaluations to monitor her ovarian response. These assessments are aimed at determining the ideal day for administering 10,000 IU of hCG to trigger the final maturation of the egg(s) and the production of progesterone by the ovaries. Lupron or Ganirelix/Cetrotide and gonadotropin injections are discontinued on this day and the patient is scheduled for egg retrieval approximately 35 hours after receiving the intramuscular injection of hCG. Subcutaneous heparin injections are discontinued approximately 12 hours prior to the egg retrieval and re-started after the embryo transfer procedure.

All patients receive an oral antibiotics beginning about seven days after the initiation of gonadotropin therapy and continuing for a few days after the embryo transfer procedure.

Egg Retrieval (ER)
ER involves a non-surgical procedure where, under direct ultrasound guidance, a needle is passed along the side of a vaginal ultrasound probe through the top of the vagina into follicles (small fluid filled spaces that each contain an egg), within the ovary(ies). The follicular fluid is aspirated and collected in a test tube, which is promptly delivered to the embryologist(s) for analysis and processing. The procedure itself is relatively painless, however patients commonly experience some residual postoperative abdominal discomfort and /or cramping that rarely persists for more than a few hours. Postoperatively, all patients are given detailed instructions and are discharged within an hour or two with a prescription for analgesics (pain killers) and other medications as indicated.

Sperm Processing
A sperm specimen is usually obtained from the male partner through masturbation. On some occasions however, physical, medical and/or religious constraints demand that sperm be obtained through condom collection following intercourse, or by inserting a needle directly into the testicle(s) under local anesthesia and aspirating sperm. The two variations of this procedure are known as Testicular Sperm Extraction (TESE) and Percutaneus Epididymal Sperm Aspiration (PESA). TESE and PESA are procedures of choice in cases where there is blockage of the sperm ducts (as occurs following vasectomy or following severe injury or infection), where the man is born without sperm ducts (congenital absence of the vas deferens), or in cases where as a result of testicular failure, sperm does not reach the ejaculatory ducts. Sometimes, in cases of retrograde ejaculation, sperm can be collected from the man's bladder. Infrequently, in men with spinal cord injuries, ejaculation is facilitated by electrical stimulation (electro-ejaculation). Donor sperm, obtained from a sperm bank, can be used when indicated.

Sperm must undergo a biochemical and structural changes known as capacitation, before an egg can be fertilized. Capacitation (which under normal circumstances takes place in the woman's reproductive tract) must be accomplished in the embryology laboratory prior to insemination of the eggs. Motile sperm are processed and activated in specialized culture media and sophisticated techniques are used to enhance poorly mobile sperm.

Fertilization in the Laboratory

Conventional IVF: In vitro fertilization literally means "fertilization in glass". Fluid aspirated from ovarian follicles is examined in the embryology laboratory. The eggs are identified and extracted, and are placed in a specialized culture medium. Several hours later, approximately 50,000-100,000 processed sperm are placed around each of the eggs. The eggs and sperm are allowed to incubate together in a carefully controlled environment. Approximately 16-24 hours later, the eggs are inspected microscopically for fertilization as evidenced by the presence of two nuclear bodies. These binuclear unicellular bodies are referred to as "pro-nuclear embryos".

Intracytoplasmic sperm injection (ICSI): The ICSI procedure involves the direct injection of a single sperm into each egg under direct microscopic vision. The successful performance of ICSI requires a high level of technical expertise. ICSI has literally revolutionized IVF. Initially, ICSI was used specifically to achieve fertilization in male infertility. When ICSI is employed in such cases, the IVF birth rate is unaffected by the presence and severity of the male factor. In fact, even when the absence of sperm in the ejaculate requires that ICSI be performed on sperm obtained through Testicular Sperm Extraction (TESE), the birth rate is no different than when IVF is performed for indications other than male infertility. Today, it is commonly used in conventional (non-male factor) cases. At SIRM, we advocate the use of ICSI in virtually all IVF.

Assisted Hatching: In selected cases where it is felt that the zona pellucida (the envelopment of the embryo/blastocyst) is unusually tough or thickened, a process known as assisted hatching (AH) may be employed. The process involves deliberately making a small aperture in the wall of the embryo (usually with a laser) so as to promote hatching (rupturing) and thereby facilitate implantation. It remains controversial as to whether AH actually improves pregnancy rates.

Selecting the Best Embryos for Transfer

Once embryo division (cleavage) has begun, the embryo will continue to divide at regular intervals. (Embryos that divide the fastest are considered the healthiest and the most likely to implant.) Embryos may be transferred 3 days after fertilization when they are divided to the 6-9 cell stage or as expanded blastocysts, 5-6 days post-fertilization when they comprise 100 or more cells with a small collection of fluid inside). Since embryos that fail to become blastocysts are almost always abnormal and incapable of propagating a healthy baby, it is my personal preference to preferentially advocate that blastocysts rather than cleaved embryos be transferred.

1. Graduated embryo scoring (GES) system: The GES system scores each individual embryo out of a maximum of 100 points. Those embryos that are not transferred to the uterus are subsequently re-examined 2-3 days later to determine whether they have developed into blastocysts. Embryos that on day 3 post fertilization have 6-9 cells and have a GES of >70, are the ones that are most likely to develop into blastocysts. Blastocysts are graded on the basis of their cellularity, differentiation of their outer cellular layer (the trophectoderm), the inner core of aggregated cells (the inner cell mass) and the development of a demonstrable collection of fluid inside the blastocyst (an expanded blastocyst) Blastocysts that contain more cells, have a more expanded blastocele, a more prominent inner cell mass and have a well differentiated trophectoderm have the highest grade and are the ones that are most likely to be “competent” (i.e. likely to propagate a viable pregnancy).

2. Early embryo transfer vs. blastocyst transfer: It has long been recognized that the more advanced the embryo’s state and rate of development, the more likely it is to implant successfully into the uterine lining. It is also well established that “poor quality embryos” tend to divide (cleave) and develop more slowly, and are much more likely to arrest before reaching the blastocyst stage. It is therefore not surprising that researchers would focus on trying to grow embryos to the blastocyst stage in order identify “good quality embryos” that are more likely to implant successfully, by their ability to survive to the blastocyst stage of development.

3. CGH analysis of eggs and embryos: This very promising method of selection, currently in use at the Sher Institutes for Reproductive Medicine (SIRM), allows identification of all chromosomes, providing a much more complete analysis than its commonly used alternative – Fluorescence in Situ Hybridization (FISH). CGH performed on the egg/embryo overcomes the inadequacies of previous methods of embryo selection. A recent SIRM study published in Fertility & Sterility (May, 2007) and another soon to appear in the same journal demonstrates a birth rate of more than 60% per chromosomally normal embryo transferred. Now, for the first time, there is a highly reliable method for differentiating between “competent” and “incompetent” embryos.

With the advent of CGH embryo selection, the goal of “one embryo/one baby” is closer than ever to becoming a reality. CGH-based embryo selection also eliminates the current incentive to transfer multiple embryos at a time in order to improve the chance of success. Embryo selection by CGH holds the potential to decrease the cost per IVF baby and lead to a reduction in overall reproductive health care costs.

Embryo Transfer

Undoubtedly, embryo transfer (ET) is a rate limiting step in IVF. It takes confidence, dexterity, skill and a soft touch to do a good transfer. Of all the procedures in ART, this is inarguably the most difficult to teach. It is a true art and we have seen many women fail to conceive simply because this procedure was not performed optimally.

Shortly before the embryo transfer, the embryos/blastocysts are put together in a single laboratory dish containing growth medium. The laboratory staff informs the clinic coordinator that the embryos are ready for transfer, and the coordinator prepares the patient and informs the physician that a transfer is imminent.

Embryos/blastocysts are transferred to the uterus via a thin Teflon catheter. This procedure is conducted under ultrasound guidance with the woman on her back (in the lithotomy position) and with a full bladder.

Today all embryo transfers should be performed under direct ultrasound guidance to ensure proper placement in the uterine cavity. This practice, properly conducted, will significantly enhance embryo implantation and pregnancy rates. We prefer to perform all embryo transfers when the woman has a full bladder. This facilitates the visualization of the uterus by abdominal ultrasound and causes reflex nervous suppression of uterine contractility. The patient is allowed to empty her bladder 10-15 minutes following the embryo transfer.

It is important that the woman be as relaxed as possible during the embryo transfer because many of the hormones that are released during times of stress, such as adrenaline, can cause the uterus to contract. Accordingly we offer our patients 5mg of oral diazepam (Valium) about a half hour prior to the embryo transfer, to relax them and reduce apprehension.

Some IVF programs believe that imagery helps the woman relax and feel positive about the experience, thereby reducing the stress level. In such a program a counselor and/or clinical coordinator may help the woman focus on visual imagery for a few minutes immediately prior to embryo transfer so as to enhance her relaxation.

The embryo transfer procedure: When the woman is sufficiently relaxed, she is helped into the appropriate position and made as comfortable as possible. (In programs that rely on relaxation therapy, a counselor or nurse is usually present at the patient's bedside, coaching her in relaxation exercises during the procedure.) When the woman is in the proper position, and her bladder is adequately filled, the physician first inserts a speculum into the vagina to expose the cervix and then may clean the cervix with a solution to remove any mucus or other secretions. An abdominal ultrasound transducer is placed suprapubically on the lower abdomen and the uterus is clearly visualized. The physician then informs the embryology laboratory that embryo transfer is imminent and awaits the arrival of the transfer catheter that will be loaded with the embryos.

The physician gently guides the catheter through the woman's cervix into the uterine cavity. When the catheter is in place, the embryologist carefully injects the embryos into the uterus, and the physician slowly withdraws the catheter. The catheter is immediately returned to the laboratory, where it is examined under the microscope to make sure that all the embryos have been deposited. Any residual embryos would be re-incubated, and the transfer process would usually be repeated to transfer the remaining embryos.

The ET procedure is usually painless and takes less than thirty minutes to complete. Sometimes a prior trial embryo transfer (performed on the 8th day of gonadotropin stimulation) points towards potential difficulty in transferring the embryo(s)/blastocyst(s) to the uterus. In such cases, the procedure may be performed with patient under anesthesia.

Transmyometrial Embryo Transfer (TMET): In rare cases where the shape or partial obstruction of the canal leading in to the uterus (i.e. the cervical canal) severely complicates conventional embryo transfer, this method can be used. The patient is first anesthetized, then, using sterile technique, a needle is passed along the side of a transvaginal ultrasound probe through the wall of the uterus, into the uterine cavity. A very thin catheter is then passed through the needle with its tip protruding into the uterine cavity. The needle is partially withdrawn and the blastocyst(s)/embryo(s) are injected. After the embryo transfer, the woman remains immobile for approximately one hour and is thereupon discharged with specific instructions.

Post Embryo Transfer Management

Immediately prior to being discharged following the embryo transfer procedure, an exit interview is conducted, whereby the patient/couple is/are given directions.
Hormonal supplementation usually involves the administration of intramuscular injections of progesterone and/or vaginal suppositories (comprising estradiol valerate and micronized progesterone) until a blood pregnancy test is performed approximately eight days later (the chemical diagnosis of pregnancy). In selected cases, such progesterone treatment can be replaced with Crinone or Endometrin vaginal applications, once or twice daily. If the pregnancy test is negative or the plasma hCG levels fail to rise appropriately in the ensuing days, all hormonal support is abruptly discontinued.

A positive pregnancy test, followed by an appropriate rise in the plasma HCG concentration, is usually an indication to discontinue daily progesterone injections in favor of three times weekly intramuscular injections of hCG 5000 IU, along with daily vaginal estradiol and progesterone suppositories until the 8th week of pregnancy. In patients who experience an exaggerated response to ovarian stimulation with gonadotropins, hCG administration is withheld (for fear of increasing the risk of severe ovarian hyperstimulation), and intramuscular progesterone injections are continued along with vaginal estradiol and progesterone suppositories until the 8th week of pregnancy. Following an appropriate rise in HCG concentrations, the oral corticosteroids are continued until the 10th week of pregnancy. Thereupon, it is tapered down and stopped within a week or two. Heparin injections are continued until the 10th week of pregnancy and thereupon abruptly discontinued.

An ultrasound examination is performed approximately 2-3 weeks after the chemical diagnosis of pregnancy, at which time, designated patients with viable pregnancies, receive a final administration of intralipid (in some cases additional monthly doses of intralipid must be be administered ).

Embryo Cryopreservation (Freezing)

There have been dramatic advances in the technology of freezing and storing human embryos for future use. We cryopreserve (freeze) embryos as blastocysts. The recent introduction of “ultra-rapid freezing” (vitrification) which so rapidly freezes the embryo that it avoids ice formation in the blastomeres has revolutionized embryo freezing. Now, very few chromosomally normal embryos are lost in the freeze/thaw process and pregnancy rates with thawed pre-vitrified blastocysts are hardly different from that reported following the transfer of fresh blastocysts.

作者: nycresident 时间: 2011-7-12 02:11
翻译一下

脂肪乳是移植前7-10天滴注，验血怀孕后再滴注一次。
肝素（每天两针）或低分子肝素（每天一针）是促排第一天开始打，一直打到怀孕8-10周，停针时不需要逐渐减量。如果验血失败当天停针。
强的松或地塞米松是促排第一天开始每天吃，，如果怀孕就继续吃到怀孕8-10周，停药时要慢慢减量，而不是突然停止。如果没怀上就停药。

作者: vivian2407 时间: 2011-7-13 22:58
N姐,你好,看了你的帖子,想让你抽出点时间帮我分析一下,我的情况
我今年36岁,之前是自己错,有了孩子,做了药流,从前年开始尝试和老公自然怀孕,但没成功,后来,检查出来是老公精子问题,我各方面指标都很正常,而且,一直我的身体都很健康,一年也难得感冒一次,今年5月,我取了14个卵子,配成4个囊胚,移植了2个,但没成功,问医生失败的原因,他说也没办法解释,我记得,当时刚做好移植时,医生还特地来看我,说这次成功率很高...
现在下个月,我要开始第二次冷冻移植了,你觉得我的情况需要先检查免疫五项,因为在新加坡,我想多做准备来迎接第二次移植,
请给予回复,谢谢你

作者: nycresident 时间: 2011-7-14 22:25
就算是移植了囊胚，也不能保证胚胎没有问题。你只是一次移植失败，说明不了什么问题，没有必要查免疫。但是你如果不放心，医生又愿意给你查，那就去查吧。

作者: vivian2407 时间: 2011-7-14 23:19
标题: 回 67楼(nycresident) 的帖子
谢谢你的回复,我会和我的医生沟通的,谢谢了

作者: 勿忘我 时间: 2011-7-16 16:58
请教N，我是72年的，从未怀孕过。前年7月做过一次试管短方案，失败了。本来想放弃了，可是LG不甘心。LG的染色体 46，XY,INV(9)(P11，Q13)，听说只有25%的概率，昨天刚在网上查到可以做三代提前筛除不好的胚胎，我也动心了。这次想去北医三院。我们打算最后试一次，成不成看天意吧。这样我也打算先查查免疫五项，请问就是封闭抗体检查么？检查需要在特定的时间么（比如月经的第几天）？还是非月经期间？检查前有什么注意事项呢？
十分感谢！！！

作者: 求子之旅 时间: 2011-7-17 14:12
楼主你好，看了你的帖子，心里似乎有点希望，我5年做了7次试管，都没成功，我都没有信心再做了，就像所说的，每次内膜、胚胎都很好，但就没成功，医生也能郁闷。我们这里好像没有做免疫的，那我能按你所说的配方来使用吗？

作者: nycresident 时间: 2011-7-17 17:00
标题: 回 71楼(求子之旅) 的帖子
免疫很复杂，你还是找专门的生殖免疫医生查查。我不是医生，也没有做过免疫治疗，不想耽误你们的治疗。如果当地没有免疫检查，还是去深圳那家医院查查吧。

作者: nycresident 时间: 2011-7-17 17:03
标题: 回 70楼(勿忘我) 的帖子
不知国内的免疫5项是查什么，封闭抗体没怀孕的时候一般都是阴的，说明不了问题，要全面检查还是去深圳那家医院。

作者: 勿忘我 时间: 2011-7-18 14:15
多谢N的及时回复！

作者: 雪绒儿 时间: 2011-7-19 13:37
nycresident，你好，看到你的帖子后，回想了一下我的试管之路，赶紧翻出前两次试管的检查单，发现前年曾在省级医院做试管时查过ANA阳性，1：100，后又到风湿免疫科查了一个ENA，结果显示我是干燥综合症，但当时没当回事，也没治疗，不知这是否是两次失败的主因，心一下凉了一大截，现在正服药降调第三天，是否需要去深圳彻底查一下？这时候去深圳查的话所服的药会影响结果吗？

作者: lucky2010 时间: 2011-7-19 13:49
抗核阳性和干燥综合症反映了你的免疫系统是出问题的，你可以看“等你宝宝”的帖子，她也是一样的问题。服药后深圳的医生可能不会让你检查，但你也是要打电话问问。

作者: 圆梦33 时间: 2011-7-19 21:22
楼主，你好！看到你的成功，我又重新找回了一点信心，我经历了5次移植都失败了，也想过要放弃，但又不甘心，也许我也是免疫的问题，我打算去你说的那家医院查一下，希望能找到原因，我会关注你的帖子，也祝福你一切顺利

作者: 锦江云儿 时间: 2011-7-29 10:16
我做的是DR抗体治疗，锦江好多姐妹作哦

作者: 双宝进行中 时间: 2011-8-5 12:23
楼主，我想问一下，我是第一次试管失败后查了简单的几项免疫，抗甲状腺抗体两项抗体很高，我现在不知道是应该去甲状腺科进行这方面的治疗，还是去深圳针对不孕注射免疫球蛋白治疗。盼回复

作者: lucky2010 时间: 2011-8-5 13:23
你的情况，在治疗免疫的时候会同时给你的甲状腺问题用药，甲状腺问题是反映你的免疫问题的一面镜子，最终还是必须治疗免疫。深圳的检查要求两次促排移植多次失败才符合他们的检查指征，你才做一次试管失败，她们多半是不会给你查的。

作者: nycresident 时间: 2011-8-6 03:39
标题: 回 79楼(双宝进行中) 的帖子
我的甲状腺抗体也偏高，这个是没有办法降的。如果甲状腺素高可以吃药降下来，甲状腺抗体高是免疫出了故障，攻击甲状腺而留下的战绩。如果想知道你是不是生殖免疫有问题，只有查NK毒性高不高了。

作者: 双宝进行中 时间: 2011-8-6 11:49
谢谢luky 和楼主的答复，我们这生殖科给我开的强的松和阿司匹林吃，我在想是不是要自己打免疫球蛋白，帖子里不是说甲状腺抗体的治疗方法就是打免疫球蛋白吗。真不明白为什么免疫不孕的问题在大部分医院没有开展，去深圳确实是不方便，下一次冻胎移植真不知道怎么办了。

作者: 点球 时间: 2011-8-6 19:06
标题: 回 54楼(nycresident) 的帖子
很感谢你的信息,你是在美国吧?

多亏了你这个贴的指引,我去看了"等你宝宝"的贴,两周前查了几个抗体,抗心磷脂阴性,类风湿因子性.抗核抗体阳性,ANA 滴度320,斑点型.我看了一下资料,相当于1:320吧.NK指标待查......

我三次移植从没着过床,血值没大于过2.胚胎全部是A级,子宫好,内膜好.最近的一次移植前做过宫腔镜和诊刮,J11看见两抹很浅咖啡色分泌物,很开心.不久后开始轮流四肢酸痛,是环绕着关节,肌肉也酸.不仅如此,连左小腹都很酸.J13开始有强烈的刺痛感,断断续续的.上一次移植后J4就开始有刺痛感了,一直持续到J14.

你引述的"脂肪乳"的这个方案是针对有抗凝问题的患者,还是没有抗凝问题也可以用?因为方案里有用低分子肝素.我英文很差,怕理解不好,所以想请你指点.谢谢!

作者: 点球 时间: 2011-8-6 19:49
标题: 回 82楼(双宝进行中) 的帖子
自己打免疫球蛋白,怎么打呢?

托人弄免疫球蛋白,估计还行,但上哪里去打呢?没有注射单,哪个医院肯给打呢?我一直感到很疑惑....
我曾经碰到过中心医院不给打促排的药,说是"生物制品".

很想知道有没有姐妹在上海或南京打过免疫球蛋白,是不是也像广州那里,可以在医院开药,在那里注射?

作者: nycresident 时间: 2011-8-6 21:00
标题: Re:回 54楼(nycresident) 的帖子

引用第83楼点球于2011-08-06 19:06发表的回 54楼(nycresident) 的帖子 :
1 L# X1 o# p h f( ?% P很感谢你的信息,你是在美国吧?7 s1 g& v( k* S
2 c, }6 Y/ R- E1 o
多亏了你这个贴的指引,我去看了"等你宝宝"的贴,两周前查了几个抗体,抗心磷脂阴性,类风湿因子性.抗核抗体阳性,ANA 滴度320,斑点型.我看了一下资料,相当于1:320吧.NK指标待查......
* f# ^7 N) A& g# [2 t- \. u4 m; O$ P% j2 T7 d
我三次移植从没着过床,血值没大于过2.胚胎全部是A级,子宫好,内膜好.最近的一次移植前做过宫腔镜和诊刮,J11看见两抹很浅咖啡色分泌物,很开心.不久后开始轮流四肢酸痛,是环绕着关节,肌肉也酸.不仅如此,连左小腹都很酸.J13开始有强烈的刺痛感,断断续续的.上一次移植后J4就开始有刺痛感了,一直持续到J14.
( t: C* I0 b& }! d( M1 S2 n.......

脂肪乳是针对nk毒性高的人，不过听你的描述，你可能还有TNF高的问题，TNF高靠脂肪乳是压不下来的。建议你还是去深圳看看吧，只有那家医院治疗方案齐全。

作者: 点球 时间: 2011-8-7 04:50
标题: 回 85楼(nycresident) 的帖子
谢谢你的回复.你说的,正是我最担心的事,因为类风湿因子查下来我没问题,就是在移植后的最后几天出现了关节酸.等J14后就没事了.

估计是在着床的时候,ANA围绕胚胎引发了炎症,从而启动了NK细胞开始"进攻".我是从你推荐的Beer实验里的解释里看来的.

我去一次深圳很不方便,我在法国.

在我们这里看医生很不方便,要有医生的推荐信.已经约了特诊了,但还要等一个月.

我就跟他说,要验TH1:TH2对吧? 还有NK的数量和毒性.

作者: nycresident 时间: 2011-8-7 07:06
标题: 回 86楼(点球) 的帖子
你可以打电话到Beer中心问问，他们接受远程病人，你可以把血样放在冷冻箱里速递过去。
http://repro-med.net/repro-med-s ... ;id=1&Itemid=14

reproductive immulogy 方面的检验，很多诊所是做不了的。美国也就是有4家实验室可以做，英国有一家，欧洲别的国家还没有听说可以做。

英国你方便去吗，这个医生好像不错
Dr. Paul Armstrong
Dr Paul Armstrong
The Portland Hospital
205-209 Great Portland street
London W1W 5AH England
0207-580-4400 (Speak to Paulette his secretary)
0207-390-8156 (Speak to Milly his secretary)
Email: drpaul.armstrong@btconnect.com
- OR -
Royal London Hospital
Whitechapel London E1 1BB England
ph 0207-377-7000 ex 2579
Ph (Speak to Anne, his secretary) 171-377-7000 ext. 2579
URL: www.drpaularmstrong.co.uk
Patient comments: “Does both LIT and IVIG. LIT is done subcutaneously and intravenously. He states it is more effective and works faster this way when I asked him. He also wanted me to do the LIT just the once 3 weeks before ET, so no
retesting.” “Does not do donor LIT. He only meets patients on Fridays and does LIT treatments on Tuesdays. Dr Armstrong does advocate IV LIT along with subQ.”
Also: “As of January 2009, apparently he will prescribe Intralipids”

另外，你可以到yahoo去注册一个id，然后申请加入这个discussion group http://health.groups.yahoo.com/group/immunologysupport/，里面有很多信息，你到file那里去可以下载一些有用的文件。

作者: 点球 时间: 2011-8-8 05:36
标题: 回 87楼(nycresident) 的帖子
非常感谢你那么多的信息,就像我先前说的,如果没有你,我就不会那么快发现我有ANA的问题.或许还在"坚持不懈"地继续傻做试管.所以,我要把内心深处最真挚的祝福送给你.

我们这里NK的数量可以验,他们会送Paris等相关的实验室,我们就等帐单和结果就可.但那个毒性和TNF的东东,当时因为我讲不清楚,labo的小姐也没法帮助我查.现在只要我能够表达得清楚要查什么,只要全国有一个实验室可以做,我就可以不用操心.否则的话,就只能另想办法了.去伦敦我们很方便,但我的护照不允许我自由出入境,因为我暂时不想加入他们籍,所以比较麻烦.

其实,我到现在还搞不清这个毒性是指什么,那个50:1的东东是指活性,那么,TNF-a就是毒性喽?
....一头雾水,我还得再看一遍BB妈妈的日子.我已经看了很多遍了,还是没消化.

作者: nycresident 时间: 2011-8-8 07:10
NK毒性是指K562 target cell test或NK assey。普通实验室查NK细胞数量，合格标准和免疫不孕实验室的标准不一样的，所以人家如果给你的结果是好的，还是不能说明你没有问题。TNF-a是Tumor necrosis factor-alpha，肿瘤坏死因子，查TH1:TH2 Intracellular Cytokine Ratio就行。
。

作者: 点球 时间: 2011-8-8 17:17
标题: 回 89楼(nycresident) 的帖子
谢谢.
但是,我真的比较笨,还是很难缠.......我找出一段台湾蔡博士的话----
"殺手細胞又分成殺手細胞的毒性跟數目,細胞的數目是用CD56 來評估,若超過百分之12 就算太多,會造成攻擊細胞.
T細胞的毒性通常是用 TH1 TH2的比值,或TNF-α 比上IL-10如果超過百分之30,或干擾素比上 IL-10超過百分之10就代表細胞的毒性太強, 無論如何NK的毒性,需要用毒性的阻斷劑像 Humira Enbrel.
而殺手細胞就需要用免疫球蛋白,如果有必要用先生的 LIT,但是有一些人打了IVIG沒有反應這就必須先要作LIT.
最討驗的是血液中的NK測起來是正常的或原本不正常, 但是被你用IVIG壓抑下來,但是子宮的肌肉層還存有 NK細胞, , 舉個例來說台灣本島一清專案,台灣本島沒有流氓了, 可是這些流氓都跑到大陸,跑到海南島去躲起來,所以如果有這樣的情況必須要用 Humira這個要來殺死子宮內的Nk."

再看BB的记录,
NK Assay Panel
                                 結果標準範圍

      50:1                16.4    <15

      25:1                11.9

      12.5:1             6.2

      CD3             55.7    60-85

      CD19             18.0    2-12

      CD56             26.7    2-12

      CD19+CD5+    4.4    5-10

TH1:TH2 intracellular cytokine ratios
                                 結果標準範圍

         TNF-α:IL10    52.6    13.2-30.5

         IFN-g:IL10    3.6    5.8-20.5

我现在处于初级阶段的理解是:
-NK的数量是看CD56,或CD16+/CD56+
-NK的活性是看50:1和25:1,查NK cell avtivation
-Beer labo 的NK Assay Panel.  同时可查NK 数量和活性.
-NK的毒性看T细胞的毒性,也就是看TNF-a, 查TH1:TH2 intracellular cytokine ratios
-CD 57是子宫内的NK,要内膜活检.

IGIV:  控制NK数量和活性.
Hurima or Enbrel:控制TNF-a和CD57
Intralipid:可以替代IGIV

我饶不明白的是,你所指的NK毒性是不是我所认为的NK的活性,也就是,活性就是毒性?

作者: nycresident 时间: 2011-8-8 18:25
是的，NK毒性就是活性。

作者: 无奈的雨 时间: 2011-8-10 16:40
免疫检查项目：封闭抗体，我08、09年胎停育两次都是抗体阴性而流产，治疗了4月才转阳，现正做试管前期的检查。

作者: 点球 时间: 2011-8-13 07:11
标题: 回 91楼(nycresident) 的帖子
你好,想跟你探讨一个问题.
我查了跟我们当地实验室有联系的在Paris的Labo,不但可以验CD19,CD56,还可验CD16,上面写的也是NK细胞....但我看大多数姐妹是验CD 19和56,那,这个CD16有没有必要验呢?

另外,还可以验IL-10和TNF-alpha. 我在想,等结果出来后,我用TNF-alpha除IL-10不就行了吗?想听听你的看法.

我在网上看到几个姐妹在深圳的报告,我试了一下,TNF-a/IL-10真的就是这么算出来的,你看看:
数据:  TH1:TH2
IL-10 (10%): 1.5
IFN-Y:             24.6
TNF-a :          41.4
IFN/IL-10:       16.4
TNF-a/IL-10: 27.6

另一组:
IL-10 (10%): 0.9
IFN-Y:             27.0
TNF-a :          50.4
IFN/IL-10:       30.0
TNF-a/IL-10: 56.0

那个50:1的毒性东东暂时还没查到,不过,我想如果CD56高的话,毒性也不会低.你说呢?

今天差点闯祸,吓S.  用微波炉做馅饼,先烤了下皮,几分钟的时间,烟雾警报器响了,下楼一看,微波炉里面全是火,烟雾更是不用说了....哎,用我心爱的微波炉换来了教训,以后使用电器也好,煤气也好,都不能离人.我亲戚家还曾烧了面包机呢,还好及时赶到....这次烟雾报警器立了大功劳了,在这里给大家提个醒,没安装的话,有必要装.

作者: nycresident 时间: 2011-8-13 08:46
标题: 回 93楼(点球) 的帖子
我免疫没有查过，觉得应该早对路的实验室整个panel的查，对于a la carte，我就不知道如果给建议了。你问问luck2010看看。

作者: 宝宝来-bb 时间: 2011-8-22 17:10
上次注册过了，密码尽给忘了，，怎么也进不来，只好重新注册一个。。。晕了

作者: 宝宝来-bb 时间: 2011-8-22 17:41
5次试管都没着床，，去上海查了免疫。昨天去拿了结果，写下来，希望JMM给点建议。
FEXL 封闭效率                结果 3.5%    　参考值  ≥5.0%(MLC封闭法)
FBKTK封闭抗体抗独特法       结果 -9.2%       参考值  ≥5.0%(MLC抑制法)
KCD3-抗CD3-BE                            结果 -0.91%       参考值  ≥1.0%(FCM)
KCD4-抗CD4-BE                            结果 0.85%       考考值  ≥1.0%(FCM)
KCD25抗CD25-BE                         结果 1.45%       考考值  ≥1.0%(FCM)

今天打电话给做试管的医生，跟他说数值。试管的医生说这个免疫抗体他们也不懂了，叫我去找免疫科的医生，跟我说免疫科医生说怎么样就怎么样。我本来想问问试管的医生，可不可以两个医生结合治疗，免疫这边在看，试管那边配合用药。

可医生那样一说，说他们也不懂，我心都凉了一截，这样一来求子的路还要走多长？又没有找到合适的医生，免疫+试管还很长呢。。。。

作者: nycresident 时间: 2011-8-22 21:38
你要查和生殖有关的免疫，一般医院的免疫给出的参考值很大的，说你正常了，其实不一定正常。你要去看李大金或者林启德。

作者: 宝宝来-bb 时间: 2011-8-23 17:53
好看那个那医生好像是李大金的学生吧。。。应该去找李大金看看吗？

作者: nycresident 时间: 2011-8-23 18:22
林启德70多岁了，比李大金年长很多，不是他的学生。先到网上搜搜他们的资料再决定。

作者: wen1984 时间: 2011-8-25 19:09
我还没怀孕,也没做过试管,检查项目都差不多查好了,意想不到的事竟然发生了,原来我的抗精子抗体IGM 弱阳性,真是太郁闷了,不知道怎么办好呢

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