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Thread: autoimmune related infertility

  1. #1
    Join Date
    Apr 2014
    Posts
    2

    Default autoimmune related infertility

    Dear Dr. Coulam,
    Warm greetings from Philippines.
    I just wonder if you can suggest something on my case. Your suggestion will be highly appreciated. Thank you.
    1.
    I am 37 yrs old. I have HLA-B27 gene. I suffer recurrent uveitis and I had bouts of spondylitis in the past. Never got pregnant. ( Married for about 2 yrs. I had 4 failed IUI); male factor: OAT and erectile dysfunction. I have PCOS – hormone test OK- under control. AMH- 5. I suspect my autoimmune disease is causing my infertility. My next step is IVF with ICSI.
    2. I have consulted several immunologists. But their suggestions: heparin, aspirin, Ivig (for alloimmunity and NK cell. it is to be administered 2 weeks before IVF) and intralipid (maybe used to further suppress immune system).
    3. **Nobody commented on the B cell (CD19): I don’t know if CD19, CD20 depletion strategy is needed or overlooked. (Rituximab- this means one year no fertility work up?)
    4. **TNF-alpha:IL-10 may again be overlooked. (Humira or sometimes it can be managed by intralipid alone?)
    _____
    Leukocyte Antibody Detection – Panel Reactive Antibody – 0%
    NK Assay Full Panel (from Rosalind Franklin April 2014)
    50:1 12.3 % (range 10-40)
    25:1 7.5 % (range 5-30)
    12.5:1 3.6% (range 3-20)
    Ivig 12.5 mg/ml, 50:1 5.9%
    Ivig 12.5 mg/ml, 25:1 5.2%
    Ivig 6.25 mg/ml, 50:1 4.9%
    Ivig 6.25 mg/ml, 50:1 5.5%
    %CD3 65.5% (range 60-85)
    %CD19 19.2% H (range 2-12)
    %CD56 14.6% H (range 2-12)
    %CD19+cellsCD5+ 8.8 (range 5-10)
    Th1/Th2 Intracellular Cytokine
    Tnf-alpha: IL-10 (CD3+CD4+) 31.3 H (range 13.2- 30.6)
    INF-gamma: IL-10 (CD3+CD4+) 18.7 (range 5.8-20.5) 7. Other tests done in our country (Feb and March 2014)
    WBC differential count % cells/ cu. Mm
    Lymphocyte: 34% 2166
    Monocyte: 7% 446
    Granulocytes: 59% 3758
    Total Leukocytes: 100% 6370
    CD3 58.34 (range: 65-80%)
    CD4 30.71 (range: 30-43%)
    CD8 20.32 (range:25-38%)
    CD16+56 22.43 (range: 7-21%)
    CD20 17.96 (range: 7-13%)
    CD19 17.96 (range: 6-12%)

    Anti- Nuclear Antibody- negative
    Anti native dsDNA- negative
    Anti-mitochondrial antibody – negative
    Anti-microsomal antibody- negative
    Anti-thryoglobulin antibody- negative
    Anti-thyroid Peroxidase – negative
    Complement 3 (c3) 74.1 (range: 79-152 mg/dL)
    Complement 4 (c4) 21.5 (Range: 16-38 mg/dL)
    Lupus anti-coagulants
    KCT - 90 (control 75 sec)
    APTT- 28 (control 25 sec)
    DRVVT- 35 (control 35 sec)

    Anti-cardiolipin Antibodies
    ACA IgG 12.97 (normal: 15.0 GPL units/mL)
    ACA IgM 14.25 (normal: 15.0 MPL units/ml)

  2. #2
    Join Date
    Sep 2008
    Posts
    677

    Default

    It is difficult to comment on specific patient treatment without benefit of evaluation and consultation. In generasl, IVIg is recommended in situations where both autoimmune and elevated NK cells are involved. Dr. Coulam

  3. #3
    Join Date
    Apr 2014
    Posts
    2

    Default

    thank you

  4. #4
    Join Date
    Sep 2008
    Posts
    677

    Default

    You are welcome. Dr. Coulam

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