Immune Modulation Therapy
Immune modulation therapy refers to the treatment of dysfunctions in the immune system that affects implantation and pregnancy outcomes. The most common immunological treatment options include steroid therapy before implantation and during the early stages of pregnancy, blood thinners and baby aspirin, intravenous immunoglobulin (IVIG) and more recently, Intralipid therapy.
After doing a complete medical analysis, our doctors will advise you on the most appropriate immune treatments to tackle your specific case.
Below, we have provided some information on our most commonly used treatments (not including medications used for IVF, IUI or other methods of ovarian stimulation).
Intralipid or IVIg Infusions
Intralipid and IVIg (Intravenous immunoglobulin) have both been shown to normalise the killing power of Natural Killer cells (NKa) in the blood.
IVIg is a solution of human antibodies in saline and an infusion will usually take about two hours. It modulates immunologic function during the implantation period. We administer IVIg at least 7 days before the embryo transfer and during pregnancy. This method of immunotherapy can result in successful pregnancies in patients who had previously suffered repeated IVF failures.
Intralipid is a solution commonly used for parenteral nutrition. More recently Intralipid has been shown to suppress NKa in culture systems and is proposed to improve pregnancy outcomes. Its use is limited to cases with a history of activated NKa and poor reproductive outcomes.
Our doctors will decide on whether or not to use any or both of these immune treatments in your case based on your NKa results, the severity of immune issues and your preference as the patient.
Corticosteroids
Corticosteroids, which includes prednisolone and dexamethasone tablets, are used for steroid therapy in order to suppress NKa and inflammation. One of the most common side effects when using Corticosteroids is insomnia, however, the chances of experiencing this can be reduced by taking the tablets with breakfast. On average, steroid therapy is started bwteen day 5 and 7 of your cycle or IVF stimulation, and continued until 12 weeks of pregnancy.
Clexane
Thrombophilia is a condition where blood has a tendency to form clots. This may compromise blood flow to the growing placenta, which leads to pregnancy failure. Elevated levels of NKa can be associated with similar compromised blood flow. Clexane is an injection with enoxaparin as an active ingredient, which is a type of medicine called a low molecular weight heparin. It is used as a blood thinner to stop blood clots forming within the blood vessels.
Most of our patients experience no side effects except bruising on the abdomen, which is the injection site. Alternatively, we prescribe baby aspirin for many of our patients.
Progesterones
Patients experiencing immune related infertility can benefit from getting higher than average doses of progesterone to counter anti-progesterone antibody activity or inflammation. Although most patients only need progesterone support until 12 weeks of pregnancy, certain conditions require patients to remain on the support for longer periods of time. Basically, constipation is the most common side effect of this treatment.
Granulocyte - Colony Stimulating Factor (G-CSF)
G-CSF was originally used to increase the production of white blood cells in the bone marrow during cancer therapy. However, it was found to reduce the risk of miscarriage in patients and improve embryo implantation.
Antibiotic Treatment
Before commencing fertility treatment, our doctors may prescribe an antibiotic if you or your partner’s infection testing results indicate the presence of an infection. Antibiotics may also be prescribed as a preventative measure at the time of any gynaecological surgery or during fertility treatment.
Folic Acid, Vitamin B6 & B12
All women who are trying to conceive benefit from at least 400mcg of folic acid started three months before conception. We may recommend higher doses of folic acid, vitamin B6 and B12 for patients diagnosed with methylene tetrahydrofolate reductase (MTHFR) mutations, which is a condition associated with poor methylation and enzyme production necessary for a healthy pregnancy and preventing miscarriage.
Metformin
Patients with polycystic ovarian syndrome (PCOS) may benefit from taking daily metformin or Glucophage tablet to stimulate ovulation. This medication may also reduce insulin resistance in insulin resistant patients.
G-CSF (Neupogen)
Patients who have suffered from poorly developed uterine lining on previous cycles can benefit from the use of G-CSF to thicken the lining in order to secure implantation.
