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Miscarriage & Perinatal Loss Carolyn Coulam, MD is a pioneer in the research on RPL (Recurrent Pregnancy Loss)

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  #1  
Old 04-02-2012, 03:06 PM
trishk trishk is offline
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Default 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..
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Old 04-03-2012, 10:26 AM
Carolyn Coulam MD Carolyn Coulam MD is offline
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IVIg is usually sufficienet to treawt elevated NK cells. You should talk with your doctor about your specific treatment. Dr. Coulam
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Old 06-21-2012, 01:14 PM
trishk trishk is offline
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Default 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?
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Old 06-28-2012, 01:19 PM
Carolyn Coulam MD Carolyn Coulam MD is offline
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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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