第5次促排第7次周期又开始了！~~超长方案+免疫治疗（同步更新） [复制链接]

祝你成功

今天是第8天，按理说可以用试纸验一下了。但是考虑到我这次还是在3日，5日，7日打过HCG，主任说HCG代谢时间应该是7天，还嘱咐我别太早测，所以暂时忍了。
上次移植就是测得太早了，天天测，开始想着是看看什么是中队长，从打完HCG开始测，之后每天就开始担心会不会变淡啦之类的，到了最后3,4天，基本神经崩溃了。每天早上4点钟就能醒过来。结果还是血值不好啊~~~555~~~
哭的好伤心好难过好几天。后来LG给我讲了个故事，说他小的时候，看着奶奶蒸馒头，他总是想揭开锅看看馒头熟了没，奶奶不让他看，说一揭锅盖馒头就会瘪了。最后，他蛮神气的告诉我一个道理：馒头要到点再揭锅，早揭锅熟不了--！我汗~~~原来说我呢！！！
所以这次，我决定不过早测试纸了。既然这次抱着必胜的信心（死撑着也要这样想），那就无所谓测不测了。再说，我们家也没剩下太多试纸给我测着玩……
祝福一下自己，这次能见到真正的中队长哦！

谢谢你！不知道你现在是哪个阶段？祝你一切顺利！

亲爱的鱼，我自己在6月的怀孕了，可惜有莫名其妙的流产了，这次试管完全没有着床，去年我做过宫腹腔镜手术，发现内异，宫腔镜没有问题，这次失败后东想西想，为了避免第二次失败，我也矛盾，做这种检查本来就不好，可是不做，又担心是不是真的有问题。这些年看病真的是看怕了，别人说检查什么，我就想自己是不是也应该检查，快成精神病了。
动脉血流检测就作彩超？我也要做一个。
祝早日好孕

引用第25楼nycresident于2010-10-09 03:55发表的 :
免疫不孕论坛的病人说，移植感冒有可能是自身免疫系统抵制胚胎的一种表现。可以看看别的帖子，好像移植后感冒的胚胎都不易着床。

你不必要向她道歉啊，你的话也不是没有道理的，我住院的时候也是被医生一再警告千万不能感冒，说要是身体感冒了，就会影响着床，虽然你说这个话在这里不合适，人家接受不了，那是她只想在这里等到宣泄，而不是什么探讨，感冒了就会打喷嚏，我也觉得打喷嚏的时候小腹也会用力，因为我们的孩子太值钱了，所以希望总是很大，我第二次移植时就感冒了，最后连床都没有着。我是第四次移植才成功的，很赞赏你的风度~呵呵~祝你好孕！

我不是为了单纯安慰自己，我再重申一遍，你是感冒没有成功，也有些感冒没有成功，可是我亲眼见过两个和我移植的姐姐，一个是从移植之前就咳嗽不停，一个是感冒竟然还发高烧，可是两个人都成功了。
也许我这个人是比较较真吧。
我只是想说，对于进入周期的人来说，如同走在钢丝上一般。我们只能昂头向前，不能再左顾右盼，对吗？
已经发生的事情我们无法改变，可以说，我控制不了感不感冒，但是至少我能控制好之后的心情，让它变得没什么大不了，不是对以后的等待的日子会更好？
还是谢谢你的祝福呵~~~
没错，我就是要在这里大声叫大声笑。以往的我，移植的太压抑太辛苦太信心了，我不觉得这样很丢脸，本来我们这些做试管的人都会有些自卑，一定不能再虐待自己的心情了。
不管7天后结果如何，我都会笑着接受。
成功固然更好，不成功也不意味着这是最后一次。

10月15日：第13天，失败了。
这次没有像上次一样着床。我也没分析原因。但是我认为感冒绝对不是原因。因为论坛上也有姐妹感冒宫缩成功的例子，就在同一个月。
下个星期还要去医院找主任分析原因，头大啊~~~就好像被抓逃课一样。不过这次，我确实在认真考虑，是不是换一家医院，换一个实验室水平比较好的北京的医院。对于卵子胚胎不好的人来说，也只能依靠实验室技术了。
可是北京距离我还是觉得远，别笑话我，虽然我在天津，但是一想到陌生的人群，排队挂号，重头再来检查，我就头皮发麻。
对于绝望的心情，可能需要一个星期甚至一个月恢复。
我就是这样。从来不抱着什么随缘不随缘，只希望自己努力过，不要留下遗憾。
第5次促排第7次移植——该如何开始啊？

想要讨论免疫或者感冒问题的姐妹们，现在可以向我开炮了。我失败了。不过我祝那些经历过坎坷的姐妹们都不会尝试多次移植的痛苦而早日获得成功。

感冒确实不是失败的原因。但是很多有免疫问题的病人，其免疫系统在抵制胚胎时会有感冒一样的症状，所以我说真感冒不可怕，可怕的是假感冒。另外有些人会有关节痛，皮肤起疙瘩(好像荨麻疹）。当然，偶尔有这种反应的不必惊慌，但每次移植后（我强调后）都有这种反应的，需要引起注意。国内的免疫检验项目还不是很全，很多检验只是和流产有关系，和着床有关系的几乎说是没有。病人体内TNF-a过高，胚胎就不能着床。NK细胞活性过高，是胚胎不能着床或生化的元首，TNF-a也是NK细胞为了排斥异体产生的。大家可以去看看我转载的一个台湾病人求子的经历，在这个贴的6楼http://www.ivfbbs.com/read.php?tid=28977

这一段老美论坛的帖子

Dear Dr Sher,

I am a 42 year old woman who has been trying to conceive for one year. (yes I know I am a very late starter) I became pregnant naturally the second month we tried. I went on the have a miscarriage at 8 weeks. During the early stages of the pregnancy I felt as if I had mild flue. Sore throat/cough etc.

I had another brief chemical pregnancy a few months later after IUI with Gonal F.

After 6 months of trying we turned to IVF at CRGH in London. I have a good ovarian reserve AMH 14.77 FHS of 6. I produced thirteen eggs, ten fertilized and we had five good blastocysts. Two expanded blastocysts were transfered. I had pregnancy symptoms starting 14 days after the transfer and a positive pregnancy test. I then had a day of flue symptoms, aching all over, swollen joints and glands, dizziness and a high temperature. This lasted one day, then the flue symptoms disappeared as did the pregnancy symptoms. Sure enough the pregnancy hormone levels quickly dropped off.

I understand at my age miscarriage is common. However my symptoms seam uncommon. I have been tested for rheumatoid arthritis in the past as my joints sometimes become inflamed. The results were fortunately negative.

My clinic are now testing me for natural Killers Cells this week.

My questions are as follows. Would you recommend that I take steroids when I have my next frozen embryo transfer matter what the results of my tests are? My clinic does not offer IVIG. Should I consider changing clinics to have this treatment if they come back as high.

Perhaps I am just jumping the gun - Are flue like symptoms a symptom of a failing pregnancy.

Its seams such a unknown area, I would really value a second option before using my frozen blastocysts.

Thank You

Deborah

Geoffrey Sher, MDJul 12 2010, 10:57 AM
I think you need immunologic testing (APA/ATA/NKa-K562 target cell test//immunophenotype and DQalpha/HLA matching with husband).

I nmprescribe oral steroids for all my transfers.

Please go to my blog at www.IVFauthority.com and read up on this at "A SWtepwise Aproach to IVF".


Good luck!

Geoff Sher


LondonGirlJul 12 2010, 11:02 AM
Thank You so much for your swift response.

Kind Regards

Deborah
Geoffrey Sher, MDJul 12 2010, 12:33 PM
You are most welcome Deborah!

Geoff Sher
LondonGirlJul 28 2010, 01:14 AM
Dr Sher,

Thank you for you answer to my question in regard to flue symptoms and miscarriage. I have had the test for natural killers cells as you recommended. After my symptoms during pregnancy I was not surprised to find they came back as positive. A steroid was tried on my cells in the lab and there was a 53% reduction in activity.

My clinic has recommended I use a steroid starting three days before egg ###### / or transfer (I forget the details). Continuing the treatment for at least ten weeks if pregnant again. My clinic does not offer intralipids or IVIG. It is a good clinic with good results (CRGH in London) but being a university hospital they are conservative about offering in their words 'unproven' treatments'.

My questions are:

I am considering leaving my three frozen blastocysts there for the moment and start a fresh cycle next month with another clinic (ARGC) which offers IVIG alongside steroids. Would you use IVIG/intralipids given my results?

I seam about to produce a reasonable number of eggs 13 and a good percentage blastocysts. I keep getting pregnant. I am I right to be optimistic as to egg quality (for my age)? Do you think I would benefit from CGH at the blastocyst stage?


I really like your approach to treatment and if your clinic was in the UK I would be knocking on your door. Your thoughts and suggestions are most welcome.

Kind Regards

Deborah
















Geoffrey Sher, MDJul 28 2010, 04:45 PM
I am considering leaving my three frozen blastocysts there for the moment and start a fresh cycle next month with another clinic (ARGC) which offers IVIG alongside steroids. Would you use IVIG/intralipids given my results?

A: Yes!

I seam about to produce a reasonable number of eggs 13 and a good percentage blastocysts. I keep getting pregnant. I am I right to be optimistic as to egg quality (for my age)? Do you think I would benefit from CGH at the blastocyst stage?

A: There is a very high likelihood of an alloimmune/autoimmune implantation dysfunction. While CGH is helpful, it only referenced the embryo, not implantation.

Geoff Sher


LondonGirlJul 30 2010, 05:58 AM
Just a note to say Thank You.

You have helped me make my decision to move to a clinic that offers IVIG/intralipids.

My NK-Cell Cytotoxicity Assay came back as NK Cell 50:1 at 38% (I believe this is very high)
Prednisoline 10ug brought it down to 18% So I can see I would need IVIG to mop up the rest and hopefully get it down further.

I really appreciate you taking the time to answer my questions.

Regards

Deborah
Geoffrey Sher, MDJul 30 2010, 09:49 AM
You are more than welcome Deborah. By raising the issues on this forum you helped others with similar problems in better understanding this very important issue.

I again suggest that you visit my blog, www.IVFauthority.com and read up on "immunologic implantation dysfunction".

Geoff Sher

这个病人几次试管都有感冒症状，先是有怀孕症状，然后有感冒症状，全身疼，关节肿胀，头晕，发烧，时间不长，只有一两天。14天测血值显示着床了，可是随着感冒症状的消失，怀孕症状也消失了。最后结果都是生化了。

她按照医生的建议检查NK细胞活性，结果很高，有38%（正常是<10%）。检验结果表示强的松可以把NK活性降低到18%，如果再加免疫球蛋白，估计NK活性可以降到正常值以下了。因为她的诊所不给打免疫球蛋白，所以这个病人不要她那三个冻囊胚了，换一家诊所（可以打免疫球蛋白的）再重促。