The financial and emotional costs associated with unexplained infertility
or repeated IVF failure can be devastating. So, for couples who advise one or more tests to see if it would take to be ultimately successful, to try and failed again and again to keep, is both simplistic and unfair. starts over seven to eight days after fertilization, the embryo’s root system, with immune cells (lymphocytes) into the uterine lining (endometrium) interact through the exchange of growth factors known as cytokines. It is the integrity of this communication process (known as the “cytokine network”), which regularly penetrate into the root system of the embryo (which is based ultimately become the placenta).
So a dysfunctional immunological interactions between the design and development of the mother all sorts of reproductive problems, ranging from the implantation (such as “unexplained” infertility or repeated IVF failure) and one miscarriage, intrauterine growth retardation , stillbirths, miscarriages and decreased after birth, neurological and physical development.
It follows that the correct implantation not only a prerequisite for embryonic survival, it is also an important factor in determining intrauterine growth and development of the baby and perhaps the most important may ultimately impact on quality of life much after birth.
There are basically two types of Immune Dysfunction implantation (ID)
Auto-ID :
This is by far the most common type. It is expected to be involved in> 90% of cases of immune dysfunction and the implantation occurs when an immunological response of the individual is established, his or her own body cellular components. The most common antibodies in such situations are:
a) Anti-phospholipid antibodies (APA)
b) antithyroid antibodies (ATA)
c ) Antiovarian antibodies.
But yes, it is only in specialized immune cells in the uterine lining as Natural Killer (NK) cells are activated (NKA) and start with the “toxins” known that the root system of attack of embryo implantation, potential release is compromised. The diagnosis of NK-cell activation (NKA) requires highly specialized blood and / or endometrial tests can be performed only in a handful of reproductive immunology laboratories in the United States.
Since Auto-ID
is often genetically transmitted, it is not surprising that more women with a family (or personal) history of primary autoimmune diseases such as lupus erythematosus exist (LE), Scleroderma, clinical or subclinical hypothyroidism, rheumatoid arthritis etc. reactionaries (secondary) can occur autoimmunity in conjunction with a medical condition with general tissue damage. One of these gynecological condition endometriosis.
Auto-ID is usually fatal to the embryo implantation. That’s because it destroys the embryo’s root system from the get-go. Therefore, most of which are currently classified as “unexplained infertility” or “unexplained (repeated failure) IVF as a miscarriage. Autoimmune ID easily vulnerable to reversal by timely, proper administration of selective immunotherapy (see below).
alloimmune ID:
This is unusual, representing less than 10% of cases of ID. alloimmune ID is derived with a response to cellular constituents (e. g. sperm antigens) from another member of the same species (eg sperm). So the sperm contribution to the embryo (ie, the paternal antigen), which makes the embryo a kidney transplant. It is therefore very remarkable that an embryo in the vast majority of cases immunogically “different” to the mother, is growing in her belly. This paradoxical arrangement was allowed by the evolutionary changes that wonderful place. uterine immune cells (mainly NK cells and T cells) play a crucial role in this accommodation. They do this through a balanced release of growth factors (cytokines).
So it is that in less than 10% of IVF cases with the ID of the embryo (associated with the contribution of sperm) shares many genetic characteristics similar to the host (the mother ). If this happens, repeated exposure to such an embryo in the course of time, recalls released to an imbalance of cytokines in the uterine immune cells. This is indicated by the activation of NK cells in the uterus (NKA). In such cases, the root system of the embryo are affected and the embryo is destroyed immediately, but usually is instead “limp” along only one miscarriage, if the supply of nutrients and oxygen exceeded by demand.
to the destruction of the embryo. On the contrary, after the continuing erosion of the reserve, the concept of a miscarriage.
We diagnose alloimmune ID known by testing male and female partners for the joint use of genetic markers as DQA and HLA. A sufficient degree of matching to the diagnosis. We also have the embryo recipients for NKA in an attempt to test the relative seriousness of the problem can be measured. This is once brcause NK cells in the uterine lining to be enabled and the cytokine balance is disturbed, the situation is so serious and remain (or sausages), when the cells are medically disabled NKA (down regulated) at least 1 week advance of the embryo (s) reach the uterus.
usually takes the exposure of uterine NK cells into an embryo repeats alloimmune matching of these cells are activated (NKA). Until this occurs, a pregnancy can be determined and even go to a normal birth in defiance of the ID. Then, over time, repeated exposure of embryos to the uterus of the mother Matching, NK cells are activated and the couple found a miscarriage. Ultimately, the NKA will be set up permanently, and the couple will not become pregnant. It is not uncommon for such couples, from a child together in a phase of repeated miscarriages one of the secondary infertility can be found.
Unfortunately immunotherapy for alloimmune ID is probably not as successful as in the treatment of auto-ID. Selective immunotherapy is not always simple curative in the case of the former. Although selective immune therapy improves the chances of success in alloimmune ID, it can not become a successful outcome.
heparin and aspirin therapy
There convincing evidence is that regular subcutaneous administration of heparin twice daily or low molecular weight heparin ( Clexane, Lovenox) once daily (starting with the beginning of the stimulation of the ovaries) is clearly IVF birth rates in women who improved to APA-positive test.
Aspirin on the other hand, has little or no value, and in my opinion. The reason is because it increases the risk of bleeding. This effect can add up to a week and could bleed risk for egg collection and leads intrauterine bleeding at the time of embryo transfer, potentially compromising IVF success.
IVIG therapy and Intralipid
The main objective of selective immunotherapy for immune down-regulate ID (lower toxicity) of NKA. allowed in the past and the only effective way to reach the U. S by intravenous infusion of a blood product such as immunoglobulin G (IVIG) are known. But the administration, a blood product understandable cause for concern regarding the transmission of viral infections such as HIV and hepatitis.
To make it even worse, competitive IVF clinics to all this bad press by the red flag and sometimes even go so far capitalized to infertile couples seeking IVF services for those who ventured IVIG access to care services. This created a “herd instinct” that the serious practice of those who advise us of IVIG therapy influenced.
Despite this, we were not prepared to do by prejudice or malice, which we knew them to be held was the right thing and the reward for taking this stance, it came in the form of thousands of babies (who would otherwise never to have been born) is now the brightness of the life of an equal number of couples who would otherwise have remained childless.
In 2006, began reporting on a product called Intralipid (IL)-surface, a synthetic product that for intravenously before embryo transfer to produce a similar regulatory effect, such as IVIG NKA achieved. In 2007, we began administration of IL patients with NKA. Originally, this treatment for those who need IVIG limited, but rejected for various reasons treatment. Later, we expanded the process to other patients with IVF NKA. Until today we have more than 200 women with IL, with impressive results (forthcoming). Against this background, the SIRM physicians has virtually abandoned IVIG suppressed, it IL.
Compared with IVIG, which is about $ 4,000 – $ 5,000 per infusion is virtually cost and side effects can be unpleasant and potentially dangerous, IL, where, as recommended by the SIRM is used to provoke no risk and / or side effects and costs less than $ 400 per infusion (ie 1:10 of the cost of IVIG).
user
corticosteroid therapy (prednisone, dexamethasone and /> Prednisilone)
steroid therapy is an important The mainstay of most IVF programs. Some programs require daily prednisilone oral methyl prednisone or dexamethasone while others prescribe, beginning with the initiation of ovarian stimulation with gonadotropins, and training until after the ultrasound in pregnancy.
Every seed when it will thrive in the healthy development of plants requires that they be placed in a fertile soil. Thus a successful pregnancy require optimal seed (embryo) and floor (endometrium) relationship be established.
questions, while 30% of cases a non-receptive endometrium is the reason for the failure. It follows that with IVF, completely focused on embryos (seeds), the quality does not reduce the risk of failure in patients with endometrial receptivity (surface) problems. should be able to influence
The evaluation of immunological dysfunction and other factors, the implantation part subjected to the evaluation of patients in preparation for IVF form, and especially in women with recurrent miscarriage (RPL), women with a personal or family history of autoimmune diseases, and women with ‘unexplained’ infertility or IVF failure (s). ——————— ———————— ————————– ———————— ——– Visit the SIRM website at www. haveababy. com Read Dr. Sher’s blog at www. ivfauthority. com
