多次试管失败的姐妹们，去查查免疫吧

nycresident

呵呵，中医比西药还更西医化了。

nycresident

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。

nycresident

发些帖子给懂英文的看看了

vesnaMay 16 2011, 01:30 PM
Doctors please help me
! i) L. ?% ~9 ]. JI am currently 5 weeks and 5 days pregnant.I am on lovenox,prednisone 30 mg and IVI-g
*
$ r4 e/ p2 G: II have immune issue elevated nk and elevated cytokine level.
My first results BEFORE IVI-G
NK 50:1= 24.5
- A5 v6 c% d( f( HTNF ALFA =47.7
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9 L) |  w. `! s7 q  Q1.FIRST IVI-G
After IVI-g on 04/18/2011 my results are
! E& E6 d1 C3 q* z$ m. j* eNK 50:1=14.8
TNF ALFA=37.9
5 i# H+ H; A$ N6 V/ N0 sWe were so happy because level dropped
I had transfer on 04/25 and I get pregnant
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+ G) L. E8 Q1 x8 `  ?6 u5 H3 S) ]2.SECOND IVI-G
. h0 Y0 Q4 M/ vOn 05/04/2011 I had one more IVI-g
Results from that infusion came today but elevated
) D& P; t1 `2 HNK 50:1=31
) v9 _, x2 y- @* v% w- QTNF ALFA 49.5

3.THIRD IVI-G after one week
05/11/2011 results for couple of days
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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?
3 g8 `$ a2 b. }( ?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.
. v% W1 |. H! N4 ?I guess levels are little bit lower because I had the third ivi-g after only one
3 W. A8 f  W' ^& u# R8 [week.
Please help me do I have chance for this for baby
vesna
, I! o& ]; p! y9 A1 }' N% tGeoffrey Sher, MDMay 16 2011, 04:39 PM
2 A% Z: W$ _5 ^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.

; ~; M; c4 C. R( j& J. oGeoff 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
6 A/ F4 I& L5 ]5 c9 vHow much IVIG are you getting. I used to prescribe 40G per infusion at least! Now I have completely supplanted the IVIG with Intralipid.
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Good luck!
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0 m- J, A: Z, s- SGeoff Sher
3 l, T8 S9 u3 k) a. L# q0 jvesnaMay 17 2011, 05:08 AM
: t8 F+ Z4 u6 _. g6 _[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.

1 v% L2 g6 G6 Y+ c6 {Good luck!

Geoff Sher
# M& c( j) R6 G[/quote]
* X, B0 I5 _6 G/ rDear 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
* G+ A. u7 ^6 V2 J( P# s  X' k8 K, MvesnaMay 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.
2 c% k& C( j1 x! V; e& D2 ^4 ^9 g9 M4 z5 J
7 s5 K7 j2 B0 M8 C0 J, z/ f: G1 eGeoff Sher
+ q8 h- `( w5 j( h+ Y0 K: J[/quote]

Thank you for you answer dear Dr.Sher
; m8 R% h2 @5 A0 f3 ^9 PMaybe ,I am wrong,I have to check tomorrow
8 |" `! W1 t, z# Hhugs
vesna
Geoffrey Sher, MDMay 17 2011, 03:33 PM
' t* H6 s- O  c3 xI think you should!

Geoff Sher

nycresident

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。

nycresident

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。

nycresident

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。

nycresident

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。
- }' D5 y  s1 c0 I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
# O8 ~0 k5 f% t$ B; o' p强的松是促排的时候就开始吃，一直吃到12周。

, T' b; R  q" S1 R) y5 v) I上面是我从一个试管医生的博客里看来的。

; p0 I% i& b) g# Y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。

nycresident

patient question:
! j0 z$ H3 \1 O- i1 @$ r5 P) z: @- kDoctors- 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.
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4 S: Q0 ~: {' @! Q3 B- e! |& h$ ?
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.
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6 p5 r* g& Z$ I9 `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?
9 Z( ?' g. e$ T1 F  H! M5 ]$ o
Thank you for your help.
9 \& r1 n0 N+ H* \& P+ q
Dr' s answer
" K- ?+ N8 Y4 p8 y/ v. wEven 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.

nycresident

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。
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Immunologic Treatment
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4 p- d, a3 x% K4 pINTRALIPID 20% - FINALLY AN EFFECTIVE, SAFE AND LOW COST ALTERNATIVE TO IVIG THERAPY
- u/ r0 X) w  D/ H% V: @. d+ z6 t1 ISIRM 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.
- v8 T6 ?" C2 e+ E2 h  m
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.
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Against this background, SIRM physicians have collectively decided to virtually abandon further use of IVIG, in favor of Intralipid.

/ f' p! @' G9 h4 h/ A% xBelow are some clinical details about Intralipid:

! }$ \, E/ H6 \% i9 H/ K8 OIntralipid (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.
* E3 i4 z& j/ E1 D8 w) q& VAt 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.

nycresident

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。