Immune Treatments

  
 

Our Consultants aim to advise you on the most appropriate treatments for you, given your circumstances, your medical history and the results of testing.

Here, you’ll find our most commonly used treatments, but does not include the 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.

Intralipid or IVIg infusions

Intralipid and IVIg (Intravenous immunoglobulin) are given by intravenous infusion by our Doctor at Wimpole St. For long distance patients, other arrangements can usually be made. Intralipid is a solution of soyabean oil, egg yolk and glycine in saline, which has been shown to normalise the killing power of Natural Killer cells in the blood. Intralipid infusion will usually take about one hour. Most of our patients experience no side effects from Intralipid infusion 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. IVIg is a solution of human antibodies in saline which has been shown to normalise the killing power of Natural Killer cells in the blood, and to normalise the population of Natural Killer cells in the blood. IVIg infusion will usually take about 2 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. Eating small snacks and keeping hydrated during the infusion is also recommended. As a precaution against allergic reaction to IVIg, antihistamines are sometimes given to patients. Due to the increased risk of allergic reaction, patients with low levels of IgA are closely monitored during the IVIg drip.

We commonly give the first infusion 7-14 days before planned Embryo Transfer/implantation, followed by subsequent infusions on a positive pregnancy test and first ultrasound scan. Decisions on whether to give Intralipid and/or IVIg are based on NK assay results, the severity of immune issues and the patient’s preferences. 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 the patient’s 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. Depending on the circumstances, when they are discontinued for whatever reason, steroids need to be tapered down gradually.

Clexane and/or low dose aspirin

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 anti-coagulant with very predictable results which is given in the form of daily subcutaneous 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 gestone starting after Egg Collection (or ovulation or before Frozen Embryo Transfer), but alternatives (cyclogest or utrogestan pessaries, crinone gel) are available or may be used in combination with gestone. Gestone is normally injected into the upper outer quandrant 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)

In cases where the prospective mother has a low level of anti-paternal blocking antibodies (measured on the LAD test), 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

This is a highly effective drug for reducing elevated TNF-alpha which was developed for auto-immune conditions like Rheumatoid Arthritis. We also find it 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 2 subcutaneous injections, 2 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 (Neupoge)

G-CSF is originally used to increase the production of the blood white cells in the bone marrow. It was found to improve embryo implantation and reduce the risk of miscarriage in a group of patients particularly those missing some of the Killer-Cell Immunoglobulin-like Receptors (KIR).

Antibiotic treatment

Depending on infection testing results and other aspects of the patient’s medical history, we may advise various antibiotics to clear diagnosed infections for both partners 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 and B12

All women who are trying to conceive benefit from at least 400mcg of folic acid started 3 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) and G-CSF (Neupogen)

Patients suffering from poorly developed uterine lining on previous cycles can benefit from the addition of Viagra. Neupogen was found to improve the lining in such cases as well.