OP, it seems as though you don't have much faith in your current doctor's recommendation. Have you considered seeking a second opinion? If you're in the NYC area, I'd suggest Dr. Braverman.

I have been doing prednisone and Intralipids for chemical pregnancies. I got a bfp about 10 days ago and no one has mentioned backing off on any of the treatments until getting repeat immune labs to check levels. OP I'd ask your doctor to check levels before discontinuing any treatment, especially if doubling betas indicate that it is working! I see dr Abbasi.

Anonymous wrote:Who is your doctor?

Jonathan scher in NYC

Who is your doctor?

But part of me wonders if this is mumbo-jumbo if he really feels I only need one IVIG treatment in the beginning it seems like he's not even sure I need it

He told me I didn't even need the Intralipid but I might as well try them and them and then when they didn't work he was like let's do IVIG... kind of winging it

Anonymous wrote:Also, Op here: other thing I was thinking is I could always do the IVIG, go kitchen sink approach, with my great embryo, and if IVIG fails, then I prob wouldn't try it again bc I would prob at that point assume it wasn't the answer but I worry if I don't do it my next cycle and have a BFN or chemical, I will wonder if I should have done it?

Well, obviously only you can decide, but I would also wonder about not having done it. And if your RI is going to stop treatments once you have a BFP it seems like a pretty minimum commitment. A bit of IVIg in the beginning and then hopefully you are done.

Also, Op here: other thing I was thinking is I could always do the IVIG, go kitchen sink approach, with my great embryo, and if IVIG fails, then I prob wouldn't try it again bc I would prob at that point assume it wasn't the answer but I worry if I don't do it my next cycle and have a BFN or chemical, I will wonder if I should have done it?

Op : thanks my RI isn't prescribing any further treatments once I get pregnant. Bc I had 2 successful pregnancies before, I think he thinks it's something of an implantation thing but once I have a confirmed pregnancy with good betas he told me I can stop prednisone. Bc I've only had two legitimately normal betas, which both turned into live births, and the 4 chemical pregnancies were all beta < 50, I think it's just getting over that initial implantation dysfunction.

He said prednisone would stop as soon as I got a BFP and I would only do IVIG once, a few days before transfer

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
I would go with what your doctor recommends. IVIg is usually considered more of a treatment than intralipids and if your TNFs are high perhaps that's why. My NK and TNF numbers were only slightly elevated; I did prednisone and intralipids with success (but treated several other issues simultaneously). For higher numbers you may need more intervention.

Well my doctor initially said that intralipids were fine, and I didnt need IVIG. my TNF alpha is 37.5, I don't know if that's "high"- and NK totally normal and T-regs "very good." I did prednisone and intralipids with my last FET, which was a BFN, but that embryo had a pretty crappy thaw and wasn't great to start with so I am not sure if the immune treatments didnt work or if embryo related.

NP. Intralipids are much less expensive (and not a blood product). For this reason, many doctors will recommend at least giving them a try before moving on to IVIG. But PP is correct that other treatements like IVIG, Humira and Neupogen, are more indicated for high tnf-alpha.

Is 37.5 high?

And what is the problem with blood product?

It depends on the lab. With my RFU bloodwork anything over 30 was high. Problem with blood product is that it is not possible to get rid of 100% of all blood born illness. Although rare, people do get blood born illness with IVIG. It does happen but not very often, luckily.

so 37.5 may be so high that intralipids don't reduce it? is TNF alpha elevated alone enough to cause repeated chemical pregnancies, with no other issues, and prior past successful pregnancies/live births?

Yes

PP who did intralipids and my TNF usually ranged between 19 and 25. When it got to 29 or so (range topped out at 30) my RE would have me do an intralipid treatment. The NKs were also usually no more than 1 to 2 points out of range. 37.5 is substantially higher than the numbers I was seeing, which may be why your doc recommends IVIg, particularly if you have already tried intralipids. But if you think there's an issue with the embryo, you could certainly ask to try intralipids with a different embryo.

At the end of the day, though, if you're going down this route you may need to try a couple different kinds of treatments and trust your doctor. For example mine had me stay on 10 mg of prednisone the entire pregnancy. Most people wean off in the second trimester. She felt I could not because every time I tried the numbers immediately went haywire (which may mean that the prednisone rather than the intralipids are what really worked for me). She's the doc and after consulting my MFM, I decided to go with her recommendation.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
I would go with what your doctor recommends. IVIg is usually considered more of a treatment than intralipids and if your TNFs are high perhaps that's why. My NK and TNF numbers were only slightly elevated; I did prednisone and intralipids with success (but treated several other issues simultaneously). For higher numbers you may need more intervention.

Well my doctor initially said that intralipids were fine, and I didnt need IVIG. my TNF alpha is 37.5, I don't know if that's "high"- and NK totally normal and T-regs "very good." I did prednisone and intralipids with my last FET, which was a BFN, but that embryo had a pretty crappy thaw and wasn't great to start with so I am not sure if the immune treatments didnt work or if embryo related.

NP. Intralipids are much less expensive (and not a blood product). For this reason, many doctors will recommend at least giving them a try before moving on to IVIG. But PP is correct that other treatements like IVIG, Humira and Neupogen, are more indicated for high tnf-alpha.

Is 37.5 high?

And what is the problem with blood product?

It depends on the lab. With my RFU bloodwork anything over 30 was high. Problem with blood product is that it is not possible to get rid of 100% of all blood born illness. Although rare, people do get blood born illness with IVIG. It does happen but not very often, luckily.

so 37.5 may be so high that intralipids don't reduce it? is TNF alpha elevated alone enough to cause repeated chemical pregnancies, with no other issues, and prior past successful pregnancies/live births?

Yes

What are you basing that on?

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
I would go with what your doctor recommends. IVIg is usually considered more of a treatment than intralipids and if your TNFs are high perhaps that's why. My NK and TNF numbers were only slightly elevated; I did prednisone and intralipids with success (but treated several other issues simultaneously). For higher numbers you may need more intervention.

Well my doctor initially said that intralipids were fine, and I didnt need IVIG. my TNF alpha is 37.5, I don't know if that's "high"- and NK totally normal and T-regs "very good." I did prednisone and intralipids with my last FET, which was a BFN, but that embryo had a pretty crappy thaw and wasn't great to start with so I am not sure if the immune treatments didnt work or if embryo related.

NP. Intralipids are much less expensive (and not a blood product). For this reason, many doctors will recommend at least giving them a try before moving on to IVIG. But PP is correct that other treatements like IVIG, Humira and Neupogen, are more indicated for high tnf-alpha.

Is 37.5 high?

And what is the problem with blood product?

It depends on the lab. With my RFU bloodwork anything over 30 was high. Problem with blood product is that it is not possible to get rid of 100% of all blood born illness. Although rare, people do get blood born illness with IVIG. It does happen but not very often, luckily.

so 37.5 may be so high that intralipids don't reduce it? is TNF alpha elevated alone enough to cause repeated chemical pregnancies, with no other issues, and prior past successful pregnancies/live births?

Yes

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
I would go with what your doctor recommends. IVIg is usually considered more of a treatment than intralipids and if your TNFs are high perhaps that's why. My NK and TNF numbers were only slightly elevated; I did prednisone and intralipids with success (but treated several other issues simultaneously). For higher numbers you may need more intervention.

Well my doctor initially said that intralipids were fine, and I didnt need IVIG. my TNF alpha is 37.5, I don't know if that's "high"- and NK totally normal and T-regs "very good." I did prednisone and intralipids with my last FET, which was a BFN, but that embryo had a pretty crappy thaw and wasn't great to start with so I am not sure if the immune treatments didnt work or if embryo related.

NP. Intralipids are much less expensive (and not a blood product). For this reason, many doctors will recommend at least giving them a try before moving on to IVIG. But PP is correct that other treatements like IVIG, Humira and Neupogen, are more indicated for high tnf-alpha.

Is 37.5 high?

And what is the problem with blood product?

It depends on the lab. With my RFU bloodwork anything over 30 was high. Problem with blood product is that it is not possible to get rid of 100% of all blood born illness. Although rare, people do get blood born illness with IVIG. It does happen but not very often, luckily.

so 37.5 may be so high that intralipids don't reduce it? is TNF alpha elevated alone enough to cause repeated chemical pregnancies, with no other issues, and prior past successful pregnancies/live births?

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
I would go with what your doctor recommends. IVIg is usually considered more of a treatment than intralipids and if your TNFs are high perhaps that's why. My NK and TNF numbers were only slightly elevated; I did prednisone and intralipids with success (but treated several other issues simultaneously). For higher numbers you may need more intervention.

Well my doctor initially said that intralipids were fine, and I didnt need IVIG. my TNF alpha is 37.5, I don't know if that's "high"- and NK totally normal and T-regs "very good." I did prednisone and intralipids with my last FET, which was a BFN, but that embryo had a pretty crappy thaw and wasn't great to start with so I am not sure if the immune treatments didnt work or if embryo related.

NP. Intralipids are much less expensive (and not a blood product). For this reason, many doctors will recommend at least giving them a try before moving on to IVIG. But PP is correct that other treatements like IVIG, Humira and Neupogen, are more indicated for high tnf-alpha.

Is 37.5 high?

And what is the problem with blood product?

It depends on the lab. With my RFU bloodwork anything over 30 was high. Problem with blood product is that it is not possible to get rid of 100% of all blood born illness. Although rare, people do get blood born illness with IVIG. It does happen but not very often, luckily.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
I would go with what your doctor recommends. IVIg is usually considered more of a treatment than intralipids and if your TNFs are high perhaps that's why. My NK and TNF numbers were only slightly elevated; I did prednisone and intralipids with success (but treated several other issues simultaneously). For higher numbers you may need more intervention.

Well my doctor initially said that intralipids were fine, and I didnt need IVIG. my TNF alpha is 37.5, I don't know if that's "high"- and NK totally normal and T-regs "very good." I did prednisone and intralipids with my last FET, which was a BFN, but that embryo had a pretty crappy thaw and wasn't great to start with so I am not sure if the immune treatments didnt work or if embryo related.

NP. Intralipids are much less expensive (and not a blood product). For this reason, many doctors will recommend at least giving them a try before moving on to IVIG. But PP is correct that other treatements like IVIG, Humira and Neupogen, are more indicated for high tnf-alpha.

Is 37.5 high?

And what is the problem with blood product?

Anonymous wrote:

Anonymous wrote:
I would go with what your doctor recommends. IVIg is usually considered more of a treatment than intralipids and if your TNFs are high perhaps that's why. My NK and TNF numbers were only slightly elevated; I did prednisone and intralipids with success (but treated several other issues simultaneously). For higher numbers you may need more intervention.

Well my doctor initially said that intralipids were fine, and I didnt need IVIG. my TNF alpha is 37.5, I don't know if that's "high"- and NK totally normal and T-regs "very good." I did prednisone and intralipids with my last FET, which was a BFN, but that embryo had a pretty crappy thaw and wasn't great to start with so I am not sure if the immune treatments didnt work or if embryo related.

NP. Intralipids are much less expensive (and not a blood product). For this reason, many doctors will recommend at least giving them a try before moving on to IVIG. But PP is correct that other treatements like IVIG, Humira and Neupogen, are more indicated for high tnf-alpha.