When autoimmune infertility is present, the Center for Human Reproduction’s physicians focuses on calming down the hyperactive immune system in women attempting IVF, explains Dr. Norbert Gleicher.
In principle when we suspect autoimmune problems in a patient we treat two things we believe the most important thing to treat is the hyperactive immune system and therefore the most important treatment we can give our medications that calm down that hyperactive immune system and for that purpose we use in principle corticosteroids suppo glucocorticoids those are oral
Medications which are widely used in medicine which are widely used in in obstetrical care for certain medical problems they are quite safe they have some side effects which increase with dosage and length of treatment so we try to keep the dosages to a minimum and the treatment is short as possible but generally they are very safe and have been used for decades and
That is the principal drug we use for immunosuppression in recent years however it has also become apparent that a big issue in autoimmunity is inflammation and that means this is kind of a nonspecific process where various areas in the body are affected by an inflammatory process when when we say inflammation we usually first associated bacterial viral as cause
But optim unity can also lead to inflammation and because it has been in recent years recognized that inflammation is such an important component of our immunity we have also started using anti inflammatory age to suppress in general inflammatory processes now we don’t use the anti-inflammatories the the standard over-the-counter anti-inflammatories we use drugs
That also are rheumatology colleagues use for that purpose probably the best-known one is a drug called plaque renault so some patients not all will get also plaque vanilla or other anti-inflammatory drugs selectively and the the most severe cases where we either have failed with just glucose steroids and or plaque vanel or where we see a lot of abnormalities in
Those patients we will also resort in addition through intravenous therapy usually with a medication called intravenous gamma globulin intravenous gamma globulin is once again a drug very widely used in medicine in our team unity in transplantation medicine it is a blood product it is made out of blood contributions really plasma contribution the immunoglobulins
The antibodies that we all have combined from many patients so it is a pool of antibodies against anything and it is generally used in medicine when a hyperactive immune system has to be calm down because it has antibodies against anything coming down at it and that we have found to be a very effective drug in selected cases we don’t use it in the majority of cases
But in selected cases we have found that it makes difference it’s a controversial issue because it is very hard to do prospectively randomized studies on on this but in our experience we have found it to be effective in a good number of the most severe cases where everything else has failed now the problem or one of the problems with intravenous gamma globulin is
That it is quite expensive and that many insurance companies don’t cover it so it creates significant additional cost for that reason some of our colleagues use another product called inter lipid intra lipid is something completely different from ivig they only think it has in common with ivig is that it is also given by intravenous infusion as the name said it
Is a lipid solution which is widely used in medicine as a nutritional supplement to people who cannot eat in standard ways it was more or less accidentally discovered to have the same kind of immunosuppressive effects as ivig though i have to say that our experience with intra lipid has not been as successful as with intravenous gamma globulin so our preferred
Drug is clearly ivig but if a patient cannot afford the cost then we will resort to intro lipid so all of these drugs have the principal purpose of suppressing hyperactive immune systems now because there are some data to suggest that one of the problems from immune system activation may also be a hypercoagulable state meaning a state where there is formation of
Little blood clots taking place within the woman’s body we are also in conjunction with immunosuppression trying to prevent clot formation i personally am not really convinced that this makes much of a difference i’m convinced that the important treatment is the immune suppression but because there are some data to suggest that this may also be a contributing
Component we usually give patients a baby aspirin a day and not infrequently we’ll also give them an anticoagulant by injection but only at the prophylactic dosage this can be either heparin or something that is called lovenox which has the advantage that you have to give it only once a day rather than twice a day as with heparin so two components immunosuppression
And anticoagulation both are usually given together you
Transcribed from video
Two Treatment Options for Autoimmune Infertility By Center for Human Reproduction
