40mg prednisone
<br/> 文章来自: 播种网社区( www.bozhong.com) 详文参考：http://bbs.bozhong.com/thread-1213160-150-1.html

> 脗  
<br/>> It seems really high dose for preg and metformin. what is your lovenox dose?
<br/>> 脗
<br/>> Dr. Kwak's脗 recommendation is 10mg preg before transfer, then change to 20mg afterward. She might increase the dose to 40mg if脗 NK脗 or Cytokine levels spiked dramatically.
<br/>> 脗
<br/>> In my case, I脗 had crazy # NK at 32 and TNF cytokines at 40s couple months before IVF cycle.脗 Ihad 3 IVIGs prior to ET, that improved my egg quality dramatically as well as brought down my NK and TNFlevels to the normal range.
<br/>> 脗
<br/>> As soon as I got BFP, I got another IVIG right away. However, my NK increased to 29 and TNF cytokines jumped to 39 (almost back to square 1#). Dr. Kwak increased my preg dose to 40mg immediately and asked me to get another IVIG. but she still wants me to take 500mg metformin.
<br/>> 脗
<br/>> I heard Metformin and DHEA will help improve egg quality, not damage. I also found out personally脗 IVIG (intralipid) will help it too, b/c high NK and TNF will damage eggs.
<br/>> 脗
<br/>> hope that helps. good luck to you all.
<br/>>
<br/>> 脗
<br/>

Hi Emma,
<br/>
<br/>btw Who is your RI? Have you tried Dr. Kwak, Beer center or Dr. braveman?
<br/>40mg for Lovenox is very minimum.  500mg met is very normal, but i honestly don't know why your dr. prescribed 1500mg (3times) for you.
<br/>
<br/>All those years, my regular blood work showed I had NO problems and NO signs for RPLs. I had normal blood sugar and NO clotting issues as well. Until I met Dr. Kwak, she discovered I had many commons issues just like as other ladies: high NK, TNF, PAI, MTHRT c677 mutation..
<br/>
<br/>Dr. Kwak prescribed 40mg Lovenox for me on CD6. when she did special dropper u/s before my ET, she found out the bloodflow in my uterus was very slow (bad). She increased my daily Lovenox dose from 40 to 80mg.  I also add accupunture to help stimulate the blood circulation. Some studies showed met will help PCOS. I don't have pcos, but I only got few mediocre eggs retrieved from each of my previous cycles (when I was in my early 30s). None of my embryos can be reached to frozen criteria.After I throw all the immune treatments together for this cycle, my eggs# doubled and I even freezed 2 of my embryos.
<br/>REs only put me on PIO and baby aspirin for my previous cycles. Nothing else!!!
<br/>For this cycle, I did LIT, IVIG, Pred, Met, Lovenox (prior to ET), then add estradiol, PIO, prometrium, V-D, V-E, fish oil, flaxseed oil, Folic Acid, Metnax, BA, Maxi Flavonx, calcuim, prenatal v....Accupuncture,
<br/>
<br/>I know everyone is different. This is just based on my case. hope that helps.
<br/>
<br/>
<br/>

刚怀孕时HCG值参考资料：
<br/>
<br/>
<br/>
<br/>b-hcg, 和HCG是不一样的.附上对照表: /
<br/>
<br/>
<br/>
<br/>妊娠周数 HCG（IU/L）(妊娠周数是受精后开始计算)
<br/>
<br/>0.2-1周 5-50
<br/>
<br/>1-2周 50-500
<br/>
<br/>2-3周 100-5000
<br/>
<br/>3-4周 500-10000
<br/>
<br/> 4-5周 1000-50000
<br/>
<br/>5-6周 10000-100000
<br/>
<br/>6-8周 15000-200000
<br/>
<br/>2-3月 10000-100000
<br/>
<br/>β-HCG 人绒膜促性腺激素β亚单位： mIU/ml
<br/>
<br/>参考值: 正常人:0-3mIU/ml
<br/>
<br/>孕早期(孕周是未次YJ开始计算)
<br/>
<br/>孕3周 5.8-71.2mIU/ml
<br/>
<br/>孕4周 9.5-750 mIU/ml
<br/>
<br/>孕5周 217-7138 mIU/ml
<br/>
<br/>孕6周 158-31795 mIU/m
<br/>
<br/>l 孕7周 3697-163563 mIU/mL
<br/>
<br/>孕8周 32065-149571 mIU/mL
<br/>
<br/>孕9周 63803-151410 mIU/ml
<br/>
<br/> 孕10周 46509-186977 mIU/ml
<br/>
<br/>孕11-12周 27832-210612 mIU/ml
<br/>
<br/>孕13-14周 13950-62530 mIU/ml
<br/>
<br/>孕15周 12039-70971 mIU/ml
<br/>
<br/>孕16周 9040-56451 mIU/ml
<br/>
<br/>孕17周 8175-55868 mIU/ml
<br/>
<br/>孕18周 8099-58176 mIU/ml
<br/>
<br/> 文章来自: 播种网社区( www.bozhong.com) 详文参考：http://bbs.bozhong.com/thread-1003093-1-1.html

HCG是一种含有α、β 两个亚基的糖蛋白，其中β-HCG才是HCG的特异性结构，且β-HCG和α-HCG之间存在一定的比例关系，如果β-HCG含量有3.1IU/L，则HCG总量就有12.5 IU/L。不论单位是什么，这个比值都是一样的。也就是说，HCG的值应该是β-HCG的4倍。对照参考值时请注意您定量检测的是HCG，还是β-HCG。
<br/>
<br/>  
<br/>
<br/>怀孕期间，血清β-HCG的正常参考值如下（单位：mIU/mL）：
<br/>
<br/>  
<br/>
<br/>孕3周 —— 孕4周 9——130  
<br/>
<br/>孕4周 —— 孕5周 75——2600  
<br/>
<br/>孕5周 —— 孕6周 850——20800  
<br/>
<br/>孕6周 —— 孕7周 4000——100200
<br/>
<br/>孕7周 —— 孕12周 11500——289000  
<br/>
<br/>孕12周—— 孕16周 18300——137000  
<br/>
<br/>孕16周—— 孕29周 1400——53000  
<br/>
<br/>孕29周—— 孕41周 940——60000
<br/>
<br/>  
<br/>
<br/>  
<br/>
<br/>怀孕早起HCG的参考值如下（单位：mIU/mL）：  
<br/>
<br/>0.2-1周         5-50  
<br/>
<br/>1-2周            50-500
<br/>
<br/>2-3周            100-5000  
<br/>
<br/>3-4周            500-10000  
<br/>
<br/>4-5周            1000-50000  
<br/>
<br/>5-6周            10000-100000  
<br/>
<br/>6-8周            15000-200000  
<br/>
<br/>2-3月            10000-100000
<br/>
<br/> 摘自 http://bbs.bozhong.com/thread-1250569-1-1.html
<br/>

Liz,
<br/>
<br/>Happy to share my thoughts with you. You say:
<br/>
<br/>I was wondering if you could give me some advise before I enter into
<br/>an FET cycle?
<br/>
<br/>** I am happy to try.
<br/>
<br/>My question is whether I should go back for more LIT for help in nk
<br/>suppression since I don't suppress well w/ IVIg in test tube.
<br/>
<br/>** I will do my best.
<br/>
<br/>You say:
<br/>
<br/>DS said that since I have APA's, I should not use LIT too much
<br/>because it can flare these antibodies. (?) Do you know anything
<br/>about this?
<br/>
<br/>** I have never heard Dr Beer say that LIT induces APAs. In fact,
<br/>reading Dr Beers old posts, it seems he would say quite the opposite
<br/>(that LIT helps to treat APAs). The whole idea that LIT induces APAS
<br/>would be quite against Dr Beer's general ideas. Here are some Dr
<br/>Beer quotes that might shed some light on this issue:
<br/>
<br/>*******************
<br/>Dr Beer's words:
<br/>
<br/>"There are five categories of immune problems that can cause
<br/>pregnancy loss, IVF failures and infertility. Category 1 is the
<br/>least severe, while Category 5 is the most severe. Without
<br/>treatment, a woman with Category 1 problems can experience recurrent
<br/>pregnancy loss, which may activate other categories of immune
<br/>problems from Category 2, 3, 4 or 5..."
<br/>
<br/>** This quote would imply that treating category 1 helps to prevent
<br/>the development of the later categories , which includes APAs
<br/>(category2)
<br/>Also see this Dr Beer post below:
<br/>
<br/>**************************
<br/>
<br/>Also, if I test negative, could the ACA only test positive when I am
<br/>pregnant?
<br/>
<br/>IN MY EXPERIENCE 15% OF WOMEN TURN POSITIVE WITH A PREGNANCY. THIS
<br/>IS MORE COMMON WHEN THE WOMAN IS DQ ALPHA 4.1
<br/>
<br/>**************************
<br/>
<br/>** This would imply that DQ alpha 4.1 match (and subsequent low
<br/>blocking antibodies) would aggravate APAs and that LIT would help
<br/>reduce the 4.1 problem. This again would imply that LIT could help
<br/>prevent APAs.
<br/>
<br/>This general idea is also repeated in this other AEBeer quote:
<br/>
<br/>********************
<br/>
<br/>"Women whose first baby is DQ 0501, DQ 0501 are at high risk to make
<br/>an autoimmunity response that involves the production of an antibody
<br/>(immunity) in their body that attacks the glue (Phospholipids) that
<br/>are important in building the placenta of the baby."
<br/>
<br/>********************
<br/>
<br/>**Also Dr Beer has talked about how LIT can help reduce miscarriages
<br/>(which, in so doing, should help reduce APA production). See these
<br/>quotes:
<br/>
<br/>MISCARRIAGES CAN MAKE THIS PROBLEM WORSE. I SEE A 15% INCREASE IN
<br/>THE INCIDENCE OF APA'S WITH EACH PREGNANCY THAT IS LOST......
<br/>
<br/>"I have found that there are 5 categories of immune problems that
<br/>can lead to miscarriages and infertility. I have also found that
<br/>each pregnancy that is lost can increase the incidence of each of
<br/>these problems by 15% so that by the fifth loss 60% of women have
<br/>immune problems in my practice..."
<br/>
<br/>********************
<br/>
<br/>**Lastly, Dr Beer talked about how LIT could help reduce the
<br/>autoimmune response in general ....which, again, would imply that
<br/>LIT can help to reduce APAs. See quote:
<br/>
<br/>"Lymphocyte immune therapy was introduced by me many years ago as a
<br/>treatment for recurrent miscarriages. Since then, LIT has been
<br/>utilized for prolonging transplant survival of recipients of kidney
<br/>transplants. It has proved beneficial as a treatment for patients
<br/>with diabetes mellitus, rheumatoid arthritis, autoimmune
<br/>encephalomyelitis and autoimmune thyroiditis. Studies in progress
<br/>show that LIT also provide protection against HIV infection of
<br/>lymphocytes of the host being immunized."
<br/>
<br/>************************
<br/>
<br/>** So in conclusion, if LIT causes APAs, I have never heard this
<br/>idea from Dr Beer. (and Dr Beer has been doing LIT for over 25
<br/>years..). Nonetheless, it is possible that Dr Stricker knows of a
<br/>new APA/LIT study that I am not aware of? If so, I would be
<br/>surprised and interested to see it.
<br/>
<br/>You say to me:
<br/>
<br/>So I am in a bind since my LAD is high again (B-cells IgG 99.4, T-
<br/>cells IgG 97.8) after a recent booster of LIT, but I fear that even
<br/>though I plan on doing 2 IVIg's pre-conception, I'll still need more
<br/>suppression/protection with LIT.
<br/>
<br/>** Yes, I understand this dilemma.
<br/>
<br/>You say:
<br/>
<br/>I also plan on taking Dexamethasone and have been on Fish Oil.
<br/>
<br/>** Thanks for sharing this. This treatment may help the NK
<br/>suppression ...though may not be enough by itself.
<br/>
<br/>You say:
<br/>
<br/>Here are some test results through the past year.....
<br/>
<br/>** Thanks for sharing this.
<br/>
<br/>Test Name............Baseline... LIT#1.....LIT#2&Enbrel.....IVIg#1
<br/>50:1 15.7 11.3
<br/>14.8 12.6
<br/>25:1 7.7
<br/>8.2 12.7 8.6
<br/>12.5:1 3.7 n/a
<br/>10.2 5.9
<br/>IgG conc 12.5:50:1 14.0 n/a
<br/>20.8 21.8
<br/>IgG conc 12.5:25:1 13.3 n/a
<br/>12.7 12.4
<br/>IgG conc 6.25:50:1 11.0 n/a
<br/>24.7 17.8
<br/>IgG conc 6.25:25:1 8.6 n/a
<br/>18.9 13.0
<br/>
<br/>TNF-a:IL-10 28.7 17.3
<br/>21.7 13.0
<br/>IFN-g:IL-10 20.4 7.3
<br/>7.3 7.1
<br/>
<br/>** Again, thanks for taking the time to share these numbers. Good
<br/>news, it seems your most important numbers (the NK 50:1, the
<br/>cytokine ratios) all look calm right now. Though, I agree, your
<br/>IVIG suppression is not ideal, suppression in the test tube does not
<br/>always equal NK suppression "in real life". I would ask what your
<br/>history of IVIG suppression is "in real life". Has IVIG helped calm
<br/>your killing power during a pregnancy flare in the past? This
<br/>information would help us with your LIT decision.
<br/>
<br/>You say:
<br/>
<br/>Although my nk's have never been really high, they did go up to 19.8
<br/>after IVF transfer, so I know they have the potential to flare. I
<br/>just want to do as much as I can to prevent this from happening
<br/>again.
<br/>
<br/>** See my question to you above. Were on on IVIG during this time of
<br/>pregnancy flare?
<br/>
<br/>You say:
<br/>
<br/>Also, as a side note my TNF-a:IL-10 did not immediately go down
<br/>after beginning Enbrel as you can see. It took an increase to
<br/>75mg/week from 50mg/week to see a change. It continued to stay low
<br/>before and after my IVIg/IVF transfer.
<br/>
<br/>** Thanks for sharing this. This is important information to know.
<br/>
<br/>You say:
<br/>
<br/>Any help would be greatly appreciated.
<br/>
<br/>** I will share my thoughts. I think to the LIT decision depends a
<br/>lot on your history of NK suppression "in real life" . Just remember
<br/>that LIT might offer you positive immune calming effects even when
<br/>blocking antibody levels are good (as they are). In fact, there is
<br/>a recent LIT study by Pandey et al that demonstrates LIT's general
<br/>postive effects quite nicely. Recurrent miscarriage patients with no
<br/>blocking antibodies and no LIT experienced a low 25% pregnancy
<br/>success rate (as would be expected). Those witn sufficient blocking
<br/>antibodies and no LIT recived a 44% pregnancy success rate (better
<br/>but still not great). However those who actually performed the LIT
<br/>procedure received a 85% success rate. So it seems that the act of
<br/>doing LIT have added immune benefits beyond just boosting the
<br/>blocking antibody levels So in conclusion, I see a possible
<br/>argument for you to do another LIT. (Note that the study also
<br/>(oddly) shows the benefits of paternal LIT over donor LIT.. but that
<br/>is another issue!!)
<br/>
<br/>Ofcourse these are just my layperson opinions and thoughts on all of
<br/>all this. Sorry my answer is not very straightforward. Yours is a
<br/>very interesting question. I might also get a second opinion from
<br/>Chris as well.
<br/>
<br/>(And see the Pandey study below.)
<br/>
<br/>Jane
<br/>
<br/>************************************
<br/>Blocking antibody/ LIT study
<br/>*************************
<br/>
<br/>Int Immunopharmacol. 2004 Feb;4(2):289-98
<br/>
<br/>Induction of MLR-Bf and protection of fetal loss: a current double
<br/>blind randomized trial of paternal lymphocyte immunization for women
<br/>with recurrent spontaneous abortion.
<br/>Pandey MK,
<br/>Agrawal S.
<br/>Molecular Medicine Program, Guggenheim -18, Mayo Clinic, 200, First
<br/>Street, SW, Rochester, MN-55905, USA. pandey.manoj@mayo.edu
<br/>
<br/>The present study was conducted to evaluate the efficacy of paternal
<br/>lymphocyte (PL) immunotherapy and its relation with the development
<br/>of mixed lymphocyte reaction blocking antibodies (MLR-Bf) and the
<br/>success of pregnancy outcome in women with recurrent spontaneous
<br/>abortion (RSA). A total of 124 women with unknown causes of
<br/>abortions was registered for immunotherapy under double blind
<br/>randomized trial by using the list of computer-generated numbers.
<br/>Each 5 x 10(6) autologous lymphocyte (AL), third party lymphocyte
<br/>(TPL) and PL was dissolved separately in 1 ml of sterile normal
<br/>saline (NS). Each 1 ml of cell suspension and neat NS was injected
<br/>in women with RSA through intramuscular (250 microl), intradermal
<br/>(250 microl), subcutaneous (250 microl) and intravenous (250 microl)
<br/>routes. All women participants with RSA received six identical
<br/>immunizations at the regular interval of 4 weeks, and were then
<br/>screened for the development of MLR-Bf after the completion of
<br/>immunization course, and also at the first, second and third
<br/>trimesters (12th, 24th and 36th weeks) of pregnancy. However,
<br/>nonimmunized MLR-Bf positive women with RSA did not receive any kind
<br/>of therapy (NT) and were used as one of the control group in the
<br/>present study. We have observed that PL-immunized women with RSA
<br/>showed a significantly increased level of MLR-Bf (>30) and pregnancy
<br/>success (84%) as compared to those women with RSA who received
<br/>either AL (33%), TPL (31%), NS (25%) or those who did not receive
<br/>any kind of treatment (NT, 44%; P<0.001). Our results indicated the
<br/>importance of immunotherapy with PL in women with RSA and also
<br/>showed that MLR-Bf can be considered as one of the important factors
<br/>for pregnancy improvement.
<br/>
<br/>************
<br/>
<br/>--- In immunologysupport@yahoogroups.com, "Liz Lombardi"
<br/><alombardi@...> wrote:
<br/>>
<br/>> Jane,
<br/>> I was wondering if you could give me some advise before I enter
<br/>into an FET cycle?
<br/>>
<br/>> My question is whether I should go back for more LIT for help in
<br/>nk suppression since I don't suppress well w/ IVIg in test tube.
<br/>>
<br/>> DS said that since I have APA's, I should not use LIT too much
<br/>because it can flare these antibodies. (?) Do you know anything
<br/>about this?
<br/>>
<br/>> So I am in a bind since my LAD is high again (B-cells IgG 99.4, T-
<br/>cells IgG 97.8) after a recent booster of LIT, but I fear that even
<br/>though I plan on doing 2 IVIg's pre-conception, I'll still need more
<br/>suppression/protection with LIT.
<br/>>
<br/>> I also plan on taking Dexamethasone and have been on Fish Oil.
<br/>>
<br/>> Here are some test results through the past year.....
<br/>>
<br/>> Test Name............Baseline... LIT#1.....LIT#2&Enbrel.....IVIg#1
<br/>> 50:1 15.7 11.3
<br/>14.8 12.6
<br/>> 25:1 7.7
<br/>8.2 12.7 8.6
<br/>> 12.5:1 3.7
<br/>n/a 10.2 5.9
<br/>> IgG conc 12.5:50:1 14.0 n/a
<br/>20.8 21.8
<br/>> IgG conc 12.5:25:1 13.3 n/a
<br/>12.7 12.4
<br/>> IgG conc 6.25:50:1 11.0 n/a
<br/>24.7 17.8
<br/>> IgG conc 6.25:25:1 8.6 n/a
<br/>18.9 13.0
<br/>>
<br/>> TNF-a:IL-10 28.7 17.3
<br/>21.7 13.0
<br/>> IFN-g:IL-10 20.4 7.3
<br/>7.3 7.1
<br/>>
<br/>>
<br/>> Although my nk's have never been really high, they did go up to
<br/>19.8 after IVF transfer, so I know they have the potential to flare.
<br/>I just want to do as much as I can to prevent this from happening
<br/>again.
<br/>>
<br/>> Also, as a side note my TNF-a:IL-10 did not immediately go down
<br/>after beginning Enbrel as you can see. It took an increase to
<br/>75mg/week from 50mg/week to see a change. It continued to stay low
<br/>before and after my IVIg/IVF transfer.
<br/>>
<br/>> Any help would be greatly appreciated.
<br/>> Getting nervous
<br/>> Warm Regards
<br/>> :)Liz
<br/>>
<br/>
<br/>

I had over 20 NKu's at my biopsy. I used Enbrel 75mg/week
<br/>> for 2
<br/>>    months. I was able to get them below 4. I am sure the Humira
<br/>> can help
<br/>>    you as well. Make sure you continue to check your NKassay
<br/>> panel as
<br/>>    Humira has a tendency to cause Nk flares. Don't worry, you
<br/>> will have
<br/>>    an improvement. It just takes some time. Don't give up!!

  > Got my biopsy result back and it is bad--"Many CD57
<br/>> cells/hpf are
<br/>>    > identified...", Chris said the number is about 20 and I need
<br/>> to be
<br/>>    on Humira
<br/>>    > for 2 months. Does anyone have the similar report like mine and
<br/>>    have a good
<br/>>    > biopsy report (NKU reduction effectively) after 4 Humira
<br/>>    injections? Thanks.
<br/>

My NKUs were assessed at 9
<br/>>    > > > per field and I
<br/>>    > > > wound up doing two months of humira.
<br/>

Thank you San
<br/>> > > What I did was biopsy first and to DB's surprise (because
<br/>my
<br/>> > cytokines were low), found the NKu's. PSL lab sent me the
<br/>> results
<br/>> > and the picture stained to reveal all the NKU's. We saw 22 at
<br/>> least.
<br/>> > I started 50mg Enbrel and did another biopsy after 4 weeks.
<br/>The
<br/>> > NKu's went down to about 10 or 12 and DB increased my dosage
<br/>to
<br/>> > 75mg/ week. I did another biopsy after 4 more weeks and the
<br/>> stain
<br/>> > revealed just 1. Anything under 4 is good. I have continued
<br/>the
<br/>> > Enbrel throughout my IVF cycle. DB said no need to biopsy
<br/>again.
<br/>