4g/4g, hetero MTHFR, & CD57+
Dear Dr. Coulam:
Thanks so much for the information you have provided about the 4g/4g mutation and other issues on this board. I was recently diagnosed with 4g/4g after many years of unexplained infertility, including 4x failed iui, 1x failed ivf, and 1 successful fet with a 6 week miscarriage. Stim response & lining always look good, and nearly 100% fertilization on fresh cycle.
You've written about 4g/4g causing implantation failure...what is the treatment for this? My PAI-1 serum was normal when tested, but I'm afraid that there may be a clotting factor anyway.
Also, I've taken 2 doses of Humira, but my CD57+ was still out of range on my most recent biopsy. I've read your stance that Humira can cause issues with implantation; would you recommend I not take another round? Will IVIG be enough to overcome 4-5 CD57+ with low FoxP3?
Thanks for any advice you are willing to offer! This is such an overwhelming diagnosis, and I fear I am running out of time..
IVIg is usually sufficienet to treawt elevated NK cells. You should talk with your doctor about your specific treatment. Dr. Coulam
4g/4g Implantation Failure
Would Lovenox taken prior to transfer in an IVF cycle help with implantation in a 4g/4g situation? If not, what would you recommend? Are there studies on this?
While 4g/4g is definitely a risk factor for implantation failure, it is usually not an all or nothing risk factor. It has been treated with heparin or metformin. is plasma PAI-1 is elevated. You could wait a month after your last humira injetion and recheck you NK cells ( it somemtimes takes that long to see an effect). Dr. Coulam
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