Abbasi or Braverman for immunes?

[Anonymous]

I'm 08:53 pp. Just wanted to ask also is it worth it to even think about switching clinics if we are moving out of the country in may? Dh wants to just go through a cycle without all the immune testing and see what happens and then explore the immune route at our next clinic if we get bfn.

[Anonymous]

Anonymous wrote:I'm newly diagnosed with stage 2 endo and am currently at Dominion. I'm uninspired by their 0/10 SART record with endometriosis patients last year and am thinking of switching to someone more... up to date.

How long does all the testing/retesting take with Abbasi? Would I have enough time to complete it all if I wanted to do a cycle around Feb or March? Does she automatically order the immune testing as part of like a "endo patient" protocol or would I have to push for it?

If you start the process now, testing should definitely be complete by February or March.

I can't say for certain, but I'd imagine she would allow you to have the tests just based on your endometriosis diagnosis if you told her you want to be proactive and avoid spending a lot of $$ without ruling the immune stuff out first. I think this makes a lot of sense. IVF is very expensive and you are in a high-risk group.

As to your question about being worth it to switch clinics if you're moving in May, only you can decide that. But do keep in mind that doctors who support immune treatment tend to be few and far between. It would be a mistake to assume that immune testing and treatment will be easily accessible in your new location, unless you have specific info to the contrary.

[Anonymous]

Question for the PP, for the Hy restricting allele, what is the treatment? Neupogen?

[Anonymous]

He's not going to treat for that specifically, but that will factor into whether or not it is recommended. Treatment is based on your labs. So if you present with elevated TNF, NKs and other cell subsets and you also happen to have an Hy restricting allele he may recommend it. FWIW, the people I know of with Hy restricting alleles were all on Neupogen.

It's all about context though, so if the Hy restricting allele is seen in conjunction with Hy antibodies he may also recommend other therapies.

[Anonymous]

Thanks!

[Anonymous]

Hello this is an old thread but I was wondering the pp who mentioned about hla alleles would know what was the treatment dr b prescribed to his patients who were successful? He has recommended ivig to me - same problem of male baby uneventful pg - but I really can't afford it and he suggests this is the only way.

[Anonymous]

I'm that PP from above and he prescribed Neupogen to those patients. This suggests there is something additional about your HLA that is indicating IVIG or contraindicating Neupogen. Do you have lupus? That would be one consideration. Is this in conjunction with RPL?

I have 2 Braverman babies after 8 losses so I would trust his judgement, but I understand having questions.

[Anonymous]

Is the general consensus that it's worth getting dx'd by Braverman BEFORE starting with Abbasi locally?

Had a consult with her recently and am looking at a copy of the lab slip for the immune testing ordered, and noticed that full HLA testing is not included.
How important is that in someone who's AMA and hadn't managed a single BFP over the last 12 months, 4 of which were stim natural cycles with progesterone support post-O?
We've had 1 accidental pregnancy (almost 2 years ago) that ended in an early MC and that's it.

I have Autoimmune Thyroiditis, so I suppose that puts me at risk for other AI issues.

Is mini IVF a better choice for someone with immune issues?

[Anonymous]

Braverman doesn't have time for his patients. His treatment options are vastly different based on whether you are doing an IVF cycle with him or some other RE. I am his patient and planning to switch to someone else. He used to be good and attentive until a couple years ago but not anymore. I got pregnant the first time I used his protocol. He did not follow up on my results and I miscarried. He got my results from blood work on time but did not review them for 2.5 weeks. I asked him for protocol for my next cycle. He gave me the exact same protocol as before without spending time to review my case. I don't recommend him only because he does not have time. Knowledge-wise, he is the best.

[Anonymous]

I'm one of the PPs on this thread and am now pregnant with my third Braverman baby. He is definitely the best, knowledge wise, but he is getting so popular that I really think it's hard for him to keep up with everything as PP mentioned. Since I've been down this road and we knew what worked that's what we have stuck with and have had success, but it's not always easy to get the right recipe.

I've told him he needs an apprentice or someone to learn from him and I think he's open to that, but I'm sure that's also going to take time. He'd prefer his daughter be that person but I'm not sure the interest is there since she has focused cancer research in the past.

I started out with Abbasi and AEB and when IVIG didn't work I went to Dr. Braverman with Dr. Abbasi's blessing. I think it's fine to start with Abbasi with the understanding that you might also need additional testing if you still are not able to carry to term. HLA is absolutely a factor though. Dr. Braverman is now looking at more cost effective solutions for IVIG, one is called Hizentra, which does not need to be infused. Might be worth asking about if it's part of your protocol.