After analysing your circumstances, medical history and the results of testing, our consultants will advise you on the most appropriate treatments to tackle any issues.

Below, you’ll find a useful overview our most commonly used treatments (not including medications used for IVF, IUI or other methods of ovarian stimulation). This information is provided to help you on your fertility journey with us but is not a substitute for medical advice.

The HFEA’s view on immune treatment is available here.

Intralipid or IVIg Infusions

Intralipid and IVIg (Intravenous immunoglobulin) have both been shown to normalise the killing power of natural killer cells in the blood. They are given by intravenous infusion on site at our clinic on Wimpole Street, London. 

IVIg is a solution of human antibodies in saline, and an infusion will usually take about two hours. Most of our patients experience no side effects from IVIg infusion apart from tiredness, feeling cold and slight headache (which can be relieved by taking paracetamol) but allergic reaction is a possibility. We recommend that, in cold weather, our patients bring warm clothing and eat well before the infusion as this normally eliminates these side effects. As a precaution against allergic reaction to IVIg, antihistamines are sometimes given to patients.

Intralipid is a solution of soya bean oil, egg yolk and glycine in saline. Intralipid infusion usually takes about one hour. Most of our patients experience no side effects but due to the risk of allergic reaction to the ingredients it may not be suitable for patients who are allergic to soya bean oil or eggs.

Decisions on whether to give Intralipid and/or IVIg are based on NK assay (Natural Killer Cell testing) results, the severity of immune issues and the patient’s preferences. We commonly give the first infusion 7-14 days before a planned embryo transfer/implantation, followed by subsequent infusions on a positive pregnancy test and first ultrasound scan. The duration and timing of further infusions during pregnancy are made on the basis of the severity of immune issues, the results of NK retesting and your own preferences.

Corticosteroids

Corticosteroids including prednisolone and dexamethasone tablets are used to suppress natural killer cells and inflammation. The most common side effect experienced by our patients is insomnia which can be reduced by taking the tablets at breakfast time. For many of our patients, steroids are commenced on day 5-7 of your cycle or IVF stimulation and continued until 12 weeks of pregnancy.

Clexane

Thrombophilia (‘sticky blood’ conditions) may compromise blood flow to the uterine lining or to the growing placenta, leading to pregnancy failure. We also find that elevated levels of NK cells can be associated with similar compromised blood flow.

Clexane is an anticoagulant (‘blood-thinner’) with very predictable results which is given in the form of daily subcutaneous (under the skin) injections, usually into the abdomen.

For many patients, clexane injections are started on day 5-7 of the cycle (for IVF patients, clexane is omitted on the day of Egg Collection). The dose is increased the day after egg collection and continued during pregnancy. The optimum duration of clexane treatment in pregnancy depends on the severity of thrombophilia or other immune conditions diagnosed. Most of our patients experience no side effects except bruising at the injection site. 75-81mg of daily aspirin is also prescribed for many of our patients.

Progesterones

Patients with immune related infertility may benefit from higher doses of progesterone than average due to anti-progesterone antibody activity or inflammation. We sometimes prescribe daily intramuscular injections of prontogest starting after egg collection (or ovulation or before frozen embryo transfer). However alternatives (cyclogest or utrogestan pessaries, crinone gel) are available or may be used in combination with prontogest. Prontogest is normally injected into the upper outer quadrant of the buttock muscle. Most of our patients remain on progesterone support until 12 weeks of pregnancy, but some patients may require support for a longer period. The most common side effect of progesterone treatment experienced by our patients is constipation.

Lymphocyte Immune Therapy (LIT)

The Leukocyte Antibody Detection (LAD) test determines the levels of the antibodies that react to proteins of non-self (most often paternal) blood cells. These antibodies are important because they seem to act in ways protective to pregnancy. Women with repeated miscarriage or implantation failure may have particularly low LAD levels. In such cases, LIT has been shown to improve the live birth rate by increasing the level of blocking antibodies.

LIT is performed using live white blood cells from a healthy blood donor (usually the prospective father, or from other donors depending on the circumstances and immune issues diagnosed). The fresh blood sample is prepared immediately before the treatment to obtain a concentrated solution of white blood cells, which is then injected into the prospective mother’s forearms in a series of very shallow injections.

An initial course of two LIT treatments is usually given 3-4 weeks apart, followed by a repeat of the LAD test after 3-4 weeks. Further treatments may be suggested if the initial response is inadequate or, in some cases as a ‘booster’ treatment in early pregnancy. All blood donors are required to have comprehensive infection screening immediately before the donation. Most of our patients experience no side effects from LIT except for itching and redness at the injection site.

Humira

The Humira drug was originally developed for autoimmune conditions like Rheumatoid Arthritis, and is highly effective for reducing elevated TNF-alpha. TNF-alpha is a kind of messenger protein that is created by white blood cells. It works to help control the immune system’s response to foreign objects, promotes inflammation, and can aid in the healing of cells. But elevated TNF-alpha levels have been linked to lower egg quality, miscarriage, and implantation failure.

We also find that Humira is effective for some patients with elevated uterine NK cells (shown by uterine biopsy) and or endometriosis in the absence of elevated TNF-alpha.

Humira is given in courses of two subcutaneous (under the skin) injections, two weeks apart, followed by a cytokine retest after 7-10 days. Further courses may be required depending on the retest results. We require all patients to be screened for TB before starting any treatment with Humira. Most of our patients experience no side effects with Humira except for minor skin rashes at the injection site and occasionally cold or sore throat symptoms.

G-CSF (Neupogen)

G-CSF was originally used to increase the production of the white blood cells in the bone marrow. It was found to improve embryo implantation and reduce the risk of miscarriage in patients, particularly those missing some of the killer cell immunoglobulin-like receptors (KIR).

Antibiotic Treatment

Depending on infection testing results and other aspects of your medical history, we may advise various antibiotics to clear diagnosed infections for both you and your partner before commencing fertility treatment or, occasionally, as a preventative measure at the time of any gynaecological surgery or during fertility treatment.

Folic Acid, Vitamin B6 & B12

Add-on Treatments: Patient Information Leaflet

Please download our Add-on Treatments Patient Information Leaflet below for evidence and associated risks.

You can also find further information on the British Fertility Society website.

All women who are trying to conceive benefit from at least 400mcg of folic acid started three months before conception. For patients diagnosed with the MTHFR mutations, we may recommend higher doses of folic acid, vitamin B6 and B12.

Metformin

Many of our patients with polycystic ovarian syndrome or other insulin resistance benefit from taking daily metformin tablets to reduce insulin resistance.

Sildenafil (Viagra) & G-CSF (Neupogen)

Patients suffering from poorly developed uterine lining on previous cycles can benefit from the addition of viagra. Neupogen has also been found to improve the lining.

Add-on Treatments: Patient Information Leaflet

Please download our Add-on Treatments Patient Information Leaflet below for evidence and associated risks.

You can also find further information on the British Fertility Society website.