The question
Hello! I'm so grateful to come across this generous offering to answer questions :)
I am 36 years old and currently 5W, 2D (gestational sac measures 5W, 5D). Natural pregnancy, B-HCG numbers strongly doubling. I have an RE in Chicago and see a Reproductive Immunologist as well. I am currently on 20mg prednisone, 40 Lovenox twice/day, baby aspirin, PIO, Metformin, and other supplements.
My history is two losses (natural pregnancies) at 6W 3D and 6W 4D; heartbeat both times, but nothing by 7 weeks. We did not test the first loss, but tested the second with chromosomally normal results. After the second loss, my OBGYN did a full RPL workup and I tested positive for Lupus Anticoagulant (blood was drawn when still carrying the missed miscarriage). Further testing showed I had retained tissue (not sure if from first or second loss, and if it was from first, could that have effected second pregnancy). With RI, I tested positive for PAI-1 gene and elevated PAI-1 level; NK 50:1 blood test result was 24.4.
My bloodwork with positive pregnancy shows NK controlled at 20.4; CD56 at 4.6; homocysteine at 5.4; cytokines normal, all bloodwork is looking good. However, the concern is in approaching the 6 week mark as my losses were at the same time. My understanding is just because my immune response is okay now, it could surge at any time.
IVIG has been recommended by my RI, but not my RE. My RI does not endorse Intralipids. My question is, could the current protocol of 20mg prednisone and Lovenox shots be enough for a successful pregnancy? Or is 20.4 NK too high?
My sincere and humble thanks!
Answer from Dr. Geoffrey Sher
Ideally treatment for NKa+ should commence >10days prior to embryo transfer and be combined with a steroid (prednisone or dexamethasone). Starting this late might not work!
I was the first to recommend IVIG for NKa+ and it works well but it is a blood product, it is very expensive and side effects are common. Intralipid/steroids work just as well at a fraction of the cost and with a low risk of side effects.
If you have proven NKa+, then treatment not inclusive of IVIG or IL will likely be ineffective.
Good luck!
Geoff sher
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Herewith are online links to 2 E-books recently co-authored with my partner at SFS-NY (Drew Tortoriello MD)....... for your reading pleasure:
- From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; http://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf
- Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view
I invite you to visit my very recently launched “Podcast”, “HAVE A BABY” on RUMBLE; https://rumble.com/c/c-3304480
If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or email her at concierge@sherivf.com\
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General information only, not medical advice for your own situation. For that, book a consultation.