Comments on IVF Authority: DQ-alpha Matching in IVF: The Controversy, How It ...

i must first bless you for you are not one of thes...

2011-08-11T15:52:40.401-07:00

i must first bless you for you are not one of these ivf docs which behaves as if there is nothing like reccurent failure but only hard luck. i am a md myself and have put my diagnosis myself after 13 misses (with your help)and have done my Hla dq alpha myself. i have 50 percent share with my husband. my question is; i am planning a last ivf next month (as i cannot make hla dq test to a blastocyst) i found a center to make endometrial coculture. i am planing to have transferred only one blastocyst which have succeced to survive in my endometrial cells. i know 5 days is very short but may this make a sense in your opinion?

Dear Dr. Sher, I am 39 years old went through 1 I...

2011-02-01T18:31:33.748-08:00

Dear Dr. Sher,

I am 39 years old went through 1 IVF cycle and transfered three ovums. 2 implanted but resulted in blighted ovums. Is there any testing that you recommend for my RE to do before moving on to the next IVF Cycle?

I have an autoimmune disease called inner ear auto immune disease that attached my right ear in 2006. I also have had elevated prolactin levels previously.

What can be done to prevent the blighted ovums from reoccuring? Do you recommend the Progesterone in Oil (PIO) versus the Crinone?

Dear Dr.Sher, I have experienced r...

2011-01-31T21:26:03.262-08:00

Dear Dr.Sher,
I have experienced recurrent pregnancy loss from 2009. I have lupus ,cytokines ,NK cells and some blood clotting disorders. I have gone through many IVF cycles. Firt IVF - 1 embryo transferred, it split into 2 embies in 6 weeks, lost both of them in 9 weeks after seeing the heartbeats ( due to allergic reaction caused by high cytokines/NK cells). Second cycle FET( frozen embryo transfer) 1 embryo transferred , failed due to thin lining. Third cycle simulated FET, 2 embryos transferred lost both of them in 6 weeks( hcg tend to rise for first few weeks and then declined). All this time I was not aware of having cytokines and NK cells. Then mid last year I met a reproductive immunologists, she identified all my autoimmune issues, we charted out a plan with IVIG and prednisone,went ahead with
fourth cycle -fresh IVF 2 embryos transferred ,1st HCG borderline positive, then increased during the second test from third HCG test, it started to decline and ended up in a chemical pregnancy. We went ahead with DQAlpha HLA test. My gene combination is 0102 0105 and my husband's 0102 0103. My immunologist was not too concerned with the DQAlpha test since its not 0501 gene type which is mainly responsible for miscarriage, the explanation she provided for chemical pregnancy would have been due to my sudden drop in estrogen levels inspite of being on estrogen patches. Also, I am taking plaquenil for lupus. She said that could have made my follicles shrink and stop producing estrogen. For the next cycle, she asked me to stop the med before embryo transfer until she ask me to start it back. (Note : All embryos transferred until now in each cycle were graded as the best quality embryos. Also, I got allergic reaction from the brand of estraderm patches that I used my cycle. Rashes in the spot where I applied the patches...not sure if that has do anything with estrogen levels dropping). Does the gene match I mentioned above reveal 50% match between me and my husband? what do they mean by DQALPHA 4.1 match? Do we have to transfer only one embryo then? Please let me know.
Thanks.

Hello Dr Sher, I am as well in this unfortunate s...

2010-10-29T06:49:38.461-07:00

Hello Dr Sher,

I am as well in this unfortunate situation of recurrent miscarriages.

We had two natural achieved pregnancies in 2008 and 2009, first one - miscarried at 5 and 1/2 weeks and second one - ectopic pregnancy misdiagnosed at 6 weeks and ruptured at 8 weeks so I have lost my right Fallopian tube.

During the surgery for ectopic pregnancy I have been diagnosed with endometriosis and we moved directly to IVF treatment.

natural IVF #1 - a grade one embryo transferred but chemical pregnancy
natural IVF #2 - another grade one transferred, no pregnancy.

We live in The Netherlands and clinics in Europe are not very willing to check immune issues.

What would you recommand to us?
Thank you,
AdaByron

I agree!. Might I suggest that you call 800-780-74...

2010-10-25T12:35:55.887-07:00

I agree!. Might I suggest that you call 800-780-7437 to set up a free medical telephone consultation with me to discuss in detail.

Geoff Sher

Hi Dr. Sher, I'm curious as well if this coul...

2010-10-23T04:14:08.435-07:00

Hi Dr. Sher,

I'm curious as well if this could be our issue. My husband and I are both 33. We have never been pregnant naturally and have been trying for over 4 years. 5 failed IUI's with clomid/hcg.

IVF#1 long lupron; transfered 1-8cell top grade and 1 6-cell good grade, failed.

IVF#2 long lupron; transfered 1-8cell top grade and 1-8cell good grade, blighted ovum.

IVF#3 cancelled (microdose lupron poor response) and converted to IUI; chemical pregnancy.

IVF#4 long lupron; transferred 1-10cell top grade and 2-8cell top grade with assisted hatching; chemical pregnancy detected between 6dp3dt-8dp3dt.

Could this issue of transferring perfect 3day embroys be related to an alloimmune problem? We have never had enough embryos to make it to a 5d transfer as I have not stimmed well even though I have excellent FSH (4-5) and low normal antral follicle counts.

Indeed! This is totally compatable with an allimmu...

2010-09-02T06:17:35.310-07:00

Indeed! This is totally compatable with an allimmune problem. I suggest you call 800-78700-780-7437 and set up a free medical telephone consultation with me to discuss.

Geoff Sher

Dr. Sher, I'm wondering if this situation appl...

2010-08-30T12:29:16.108-07:00

Dr. Sher, I'm wondering if this situation applies to me. I had 2 miscarriages, followed by a successful pregnancy, and then 6 more miscarriages.

Then we switched to DE, and I lost the pregnancy from the fresh cycle. I'm now in a FET cycle, pregnant again, but betas are very low.

Which tests should my RE do?

e would need to talk. Please call 800-780-7437 and...

2010-08-12T16:05:47.113-07:00

e would need to talk. Please call 800-780-7437 and set up a consultation by phone (free).

Geoff Sher

Thank you for your reply. If I did send my blood o...

2010-08-11T21:35:48.617-07:00

Thank you for your reply. If I did send my blood over for testing and it turns out to be a match (1 gene in common I would assume) what would my next step be? Would I have any chance of having another child?

Indeed aloimmune implantation dysfunction can be t...

2010-08-11T11:30:34.406-07:00

Indeed aloimmune implantation dysfunction can be the cause of this. You do not have to live in the U.S A to get the tests done here. You could (as so many do), send your blood here for testing.

Geoff Sher

Hi Dr Sher I am in New Zealand and don't thin...

2010-08-11T02:59:25.286-07:00

Hi Dr Sher

I am in New Zealand and don't think many of these tests are available here. I had a child 5 years ago followed by a blighted ovum, another child born at 33.5 weeks, 3 blighted ovums, a 17 week loss due to a subchorionic hematoma, 4 blighted ovums and have just had a 12 week miscarriage, appearing normal except for a gestational sac measuring a week behind the fetus. Can this happen with alloimmune disorders? As far as I'm aware IVIg is not available here, what are my chances to have another child with heparin and steroid treatment? Thanks.

You should have a full alloimmune and autoimmune a...

2010-08-05T17:48:11.185-07:00

You should have a full alloimmune and autoimmune assessment with hubby. The tests needed can be obtained by calling Linda Danner RN at 800-780-7437. Tell her I asked for her to asist.

Good luck!

Geoff Sher

Dear Dr. Sher- I am a healthy 33 year old woma...

2010-08-05T13:11:47.806-07:00

Dear Dr. Sher-

I am a healthy 33 year old woman who has been trying to conceive for close to a year. In that time, I have had 3 early losses, all before 7 weeks. Two of these losses were on natural cycles, and the last one was on my first round of Clomid. Prior to Clomid I went to an RE and had a recurrent m/c panel, endometrial biopsy, hysteroscopy, and sonohystogram. My husband and I were both karyotyped as well. Everything came back normal and my RE recommended Clomid because my cycles average more than 5 weeks with a shorter luteal phase (10 days). I am meeting with him next week to discuss next steps. Should I request more immunological testing be completed? I do know APA was done but I am not sure what else.
I appreciate your input....Heather

Have you had DQa/HLA matching done with your hubby...

2010-08-02T10:47:35.651-07:00

Have you had DQa/HLA matching done with your hubby. AND was the NK assay that was done the K-562 target cell test? Remember that the concentration of NK cells is not important here...uit is the K-562 test that matters.

If you have no DQa/HLA matching and the NKa 9K-5620was <10% in all dilutions, then I personally, would not have recommended IL.

Geoff Sher

Hi there I just changed clinics and went through i...

2010-07-28T22:12:01.512-07:00

Hi there
I just changed clinics and went through immunological testing (NK assay, APA, Th1/Th2 cytokine ratio). All was negative. I had one prior IVF failure, and a canceled cycle prior to that. Despite all being negative, and having no history of anything autoimmune, my RE is recommending that I still have the intralipid treatment. I'm confused. I already paid out of pocket for all these tests as I have no insurance and now I'll have to pay for a treatment that these tests say I don't need. Is there another reason for using intralipids?

Were you and your husband tested for both DQa and ...

2010-07-20T16:18:11.645-07:00

Were you and your husband tested for both DQa and HLA similarities. If so what where were the tests done ande what were the exact results?

Since no one is born with NK activation...it is possible that you developed NKa activity over time.

Geoff Sher

My husband and I got pregnant in March 2006 on the...

2010-07-13T20:54:43.507-07:00

My husband and I got pregnant in March 2006 on the first try and had a perfect pregnancy, resulting in our son who is now 3 1/2. We began trying to conceive again in August 2008. We have been through a series of failed IUIs. After taking a break, we became pregnant naturally in March 2010, only to result in a miscarriage at 5 1/2 weeks. We then got pregnant again naturally in May 2010, ending in a miscarriage at 7 weeks. We have been working with the Sher Institute in Bedminster, NJ. We had the immune blood testing done on both my husband and myself, and out of the 3 tests on me, found out that I have elevated natural killer cells (12.3). After reading your blog, I am very unclear as to why I have these elevated NKcells if all of our other blood tests came out normal. From what it sounds like, the NK cells are activated only if the DQalphas are similar, which is not our case. Is it possible to have elevated natural killer cells with nothing else going on? Could I have had these when I got pregnant with my son and, if so, how did I carry that pregancy to term? Thank you for any input you can give us...

We should talk. Call 702-699-7437 to set it up. G...

2010-04-12T16:34:22.035-07:00

We should talk. Call 702-699-7437 to set it up.

Geoff Sher

Thank you so much for your response, I am getting ...

2010-04-10T18:44:13.049-07:00

Thank you so much for your response, I am getting my doctor to contact the lab and try to arrange tests asap.

Since my previous comment we had a fifth miscarriage after IVF, this time even earlier (failure began before four weeks) so the urgency to sort this out is even greater.

I can tell you that it is not available in Austral...

2010-03-08T22:23:35.437-08:00

I can tell you that it is not available in Australia since I see many patients here iun the U.S from your country.

I suggest you have your blood tested for NKa and that your and your husband's blood be matched for both DQ alpha and HLA similarities. The bloods can be sent to Reproductive Immunology Associates (RIA) in the U.S.A. Call them at 818-648-3551 and they will provide details.

Geoff Sher

I am in the difficult situation of recurrent pregn...

2010-02-06T04:50:58.042-08:00

I am in the difficult situation of recurrent pregnancy loss (four miscarriages in one year, all arresting by six weeks, no previous pregnancies/children). We have had many tests, including karotyping, and so far there are no answers.

We are now undergoing IVF to have CGH (four blasts are currently being tested, by array-CGH, for a possible future frozen transfer). But I am worried that even if they find a chromosomally "normal" embryo, if we have an undiagnosed underlying immunological issue we will be wasting our time transferring that embryo.

I haven't yet had a NK cell biopsy but my specialist has mentioned it. However having read your website, you recommend the K-562 test rather than endometrial biopsy. I am in Australia and I realise that testing and research varies by country. Could you please you point me to any more information about this test so I can see if it is available here?