images
Sponsors

Ferring Pharmaceuticals, Inc. is the Presenting Sponsor of the AFA Website

Ferring Pharmaceuticals


The AFA thanks Google, a premiere sponsor, for their online advertising grant.

Google Logo

Immunilogic Problems and Infertility

July 14, 2004 - Wednesday
2:49 PM to 3:49 PM (EST)
Guest Speakers: Carter, MD

Categories
Infertility • Miscarriage • Sexual Health


gyune joined
Queens_College joined
Claire joined
moakley joined
Claire Type here I'm confused. Isn't tonight's chat supposed to be on immunological problems with the medical director from Nora?
stacy joined
Dr._Carter joined
marsha_irvine joined
Susanna joined
gyune I thought so.
Lori joined
gyune Dr. Carter, will you let us know when we are able to ask questions?
Dr._Carter I am ready to go.
Queens_College Different consultations different protocols. Encountered this distinction being made between the hormones administered to donor vs. hormones given to recipient. In order to prepare the uterine lining for embryo transfer and implantation, why do some specialists use daily hormone injections for the recipient and other specialists use patch, suppository, high oral doses. Please comment on this distinction and difference in approach.
lorraine_lang joined
Dr._Carter Queens College: This is an endocrinologic question rather than an immunologic question and is unfortunately out of my area of expertise.
Claire Can you give us a brief explanation of your protocol. I've had 7 or 8 IVF failures.
gyune Under immunologic, does cover STD infections such as Herpes Simplex 2?
pr joined
Dr._Carter Claire: The process begins with a battery of testing that is designed to detect specific perturbation in the balance of the cytokines in the immune system. The testing panel is completely unique to my practice. Specifically, the testing battery is designed to detect whether or not there is a excessive basal dominance of Th1 cytokines. Our treatmnet then reverses such an imbalance without inducing global immunosuppression.
maxi joined
Susanna Which specific immune tests suggest the need for IvIg (if any?). I have an LAD problem & Embryo Toxicity Factor but my Nk cells are normal. My RE is prescribing 600mg prog (supp)/ day, PIO shot (1cc) and fragmin. Would you add or change anything?
Dr._Carter Gyune: In so far as STD infections result in an immune response by the host, the answer is yes.
stacy I'm 41, had a miscarriage last month, it was my first time trying to get pregnant. What are my chances of having another miscarriage? I did IUI. Would fresh sperm as opposed to frozen give me better chances? My FSH is 12.
Claire From your website it seems that you feel testing at many other centers
gyune Do you think herpes is a major factor in having recurrent miscarriages. If yes, are there any treatments for it?
Claire are incorrectly managed. So if someone has had testing elsewhere, does it mean that they need to start all over again?
Dr._Carter Susanna: We are not advocates of the use of IVIG for recurrent miscarriage or implanation failure at the present time due to mixed and confusing results in the published literature. We also do not believe in the concept of blocking antibodies and HLA DQ alpha matching. I do feel that a positive embryotoxicity factor coudl be relevant to your problem even in the face of a normal NK number or activity. My approach to your situation would be to explore more in depth immunologic testing.
Dr._Carter Stacy: Most miscarriages are sporadic and the idiology is genetic rather than immunologic. There is no way for me to predict the chances of you having another miscarriage without substantial insight into your medical history.
stacy what is your opinion about Thrombropelia? and the possible treatment if diagnosed?
Dr._Carter Claire: No. You do not necessarily need to start over. I find testing for Th1/Th2 cytokine imbalances, NK cell number and activity, and embryotoxicity factor to be very valuable. However, I see no value in HLA DQ alpha testing and LAD testing.
maxi Type here
Lori Type here DR Carter - is heparin the correct protocol for thrombophelia or even a double thrombophelia?
maxi What affect does endometriosis have on implantation & recurrent miscarriage?
Dr._Carter Gyune: There is no evidence that herpes simplex is a major causative factor in recurrent miscarriage. There are effective treatments available for suppressing genital herpes virus replication. However, these treatments are not curative. I would be happy to discuss this further with you. Please find my contact information at my website . . . http://www.multiplemiscarriage.com
Dr._Carter Stacy: I consider the connection between thrombophilia and recurrent miscarriage to be very strong. Current mainline therapy for thrombophilia in the context of recurrent miscarriage is aimed at anticoagulation . . . ie, heparin and aspirin. Other possible treatments also exist and are being actively explored.
gyune Thank you Dr. Carter.
Lori left
Claire Most RE's cite egg quality as the reason most older women do not get pregnant. Do you feel that your battery is something that older women (44) could benefit from? I had an idiopathic low platlet count for a couple of years as a kid that resolved on its own. My mother took DES while she was pregnant with me and I have chronic urticaria that I'm not on meds for but produces hives every day. Any thoughts?
Paige joined
Robin joined
Lori joined
Lori Type here
Dr._Carter Maxi: I meant to say that I am interested in learning more about this topic myself. Sorry for the typo.
Lori Dr Carter We are having bad weather and I lost my connection - I do apologize but I lost the whole screen and I don't know if you answered my question about a double thrombophelia - so I will post it again - please - thank you!
Dr._Carter Claire: Your situation is complex, but my testing battery and treatment protocol can be of significant value for older women with a history of reproductive failure. I would be happy to discuss your personal situation in more detail. Please email me at info@norallc.com.
maxi I have had 4 miscarriages in the past year (at age 41) and am wondering what role my endometriosis may be palying & what tests I should have done to identify/eliminate any variables that should be treated.
Susan joined
Lori Would you reccomend the use of heparin for a double thrombophelia? I have had 5 misscarriages - the first with my eggs then 4 with donor fresh and frozen cycles, and now they have discovered the dbl thrombo.
Dr._Carter Lori: I did not answer your question, but I will now. Heparin and aspirin therapy is the mainstay for thrombophilia associated pregnancy loss. This is true even if multiple factors are contributing . . . such as a combination of acquired factors like APS and heriditary factors like Factor V Leiden mutation.
lorraine_lang left
Susanna Dr. Carter, what is your protocol in general for immune system issues?
Lori I don't know what APS is? But if I'm understanding you correctly - you feel with this new info and the use of the heparin and baby asa - I have a chance for a live birth?
Dr._Carter280 joined
Dr._Carter280 Lori: I have been disconnected a couple of times. DId you receive my reply to your question?
Claire I've already put a call into your office today when I saw that you'd be speaking tonight because I think the immunological piece in my situation has never been properly worked up even thought I've done testing at Millenova Labs and an anticoagulation panel. Everything was normal, except on the anti-coag panel I had a double mutation noted on a particular gene (I'm sorry I forget which one but I am supposed to take extra folic acid. My question is, is there more than one way to measure for nk cells and antiphosphilids as they were normal in my case. It seemed from your website that you are saying you do something differently.
Dr._Carter280 Maxi: However, I can state that the connection between recurrent miscarriage and endometriosis appears to be endocrinologic rather than immunologic. Therefore, I consider endometriosis to fall outside of the realm of my expertise.
Lori Yes, thank you, I did to the first question and now I have posted a second question.
stacy left
Dr._Carter280 Susanna: The process begins with a battery of testing that is designed to detect specific perturbation in the balance of cytokines (Th1 and Th2) in the immune system. The testing panel is completely unique to my practice. Specifically the testing battery is designed to detect whether or not there is an excessive basal dominance of Th1 cytokines. Our treatment then reverses such an imbalance without inducing global immunosuppression.
wannababy joined
Susanna What is your protocol in general for immune system issues and what protocols do you NOT use that other RE's use?
Dr._Carter280 Lori: APS is anti-phospholipid syndrome, which is an acquired autoimmune cause of thrombophilia. The success rate for heparin and aspirin in thrombophilia associated pregnancy loss is excellent. It approaches 75% in some studies.
Tiggy joined
Lori Dr Carter - what is APS? And do you feel that with my new info and diagnosis of the dbl thrombo that with the use of heparin and baby asa that I will have a good chance for a live birth?
Dr._Carter280 Susanna: I am an immunologist and not an endocrinologist. The fields are quite different in their approaches to diagnosing and treating recurrent reproductive failures. My testing battery and treatment would be completely different from an RE's.
Tiggy I am undergoing fertility treatment an had a beta blood test yesterday which was 5.64 the Dr. is retesting tomorrow. What is the chances of it being a positive test?
Dr._Carter280 Susanna: I should add that my treatment is unique in reproductive medicine.
Dr._Carter280 Tiggy: It is not possible to say given the information you have provided. I would be speculating.
Susanna Could you tell us specifically what your treatment entails besides heparin and aspirin?
Claire Can you tell us if any controlled studies been done on your testing and if so what and where? I'm asking here really about stats and validity.
Tiggy If i had sex the night prior to the blood test would my levels register that quickly? How many days after conception does it take for a blood test to show a positive?
maxi Dr. Carter, what is your website where we can go to find more information about your practice & area of specialization?
Dr._Carter280 Claire: NK cells are an integral part of the Th1 driven immune cascade, and my appraoch is to look more comprehensively at various elements of a Th1 response and not merely NK cells. I agree with your suspicion that simply testing NK cells is inadquate to assess your immune status. The homozygous mutation in a thrombophilia associated gene needs to be pursued in more depth as well. Please contact me at info@norallc.com.
Robin Typically, how do embryos survive the freezing/thaw process? I am 26, and went through an IVF cycle in May; I hyperstimulated and they froze my embryos. I have 4 frozen embryos, 3 fully expanded blasts and one blast. We're having the transfer this month (tomorrow!).
Dr._Carter280 Susanna: We are attempting to recruit patients for a trial of our treatment and we prefer to discuss the details of that treatment in a more personal setting. I can tell you that the treatment makes use of a widely used recombinant protein that FDA approved for other clinical indications and has been shown to specifically reverse the cytokine balance from Th1 dominance to Th2 dominance. Please contact me directly at info@norallc.com to learn more.
Dr._Carter280 Claire: The treatment has been widely used in other clinical indications. I am the first to propose using it in this context. We are in the process of raising grant money to trial the treatment protocol so that we can present data of the sort that you would like to see.
Dr._Carter280 Maxi: Our website URL is http://www.multiplemiscarriage.com
Robin left
Dr._Carter280 Tiggy: The answer to your question depends on several factors includng how much beta HCG is being produced, the type of pregnancy test used and the sensitivity of that test. Positive test results can be obtained by sensitive tests in as few as 7-10 days after fertilization.
Tiggy It was a blood beta test and it was 5.64
Claire I must assume that you've tried the treatment on women in your practice with some success before applying for the grant. Can you say anything about your preliminary findings, specifically, how many women you have had the treatment and outcome. It's hard being in the position of feeling desparate to conceive and not knowing what is sound versus what is has no basis.
Dr._Carter280 Robin: Typically the viability rate post freezing and thaw is excellent. I should note, however, that I am not an IVF practitioner.
Susanna It's also tough to realize that there is no consensus anywhere for treatment of these immune issues - every doctor has a different answer.... & we are on the bleeding edge of this research, most of us having several losses in the past and watching the clock....
Tiggy what do you think doc? How sensitive is a blood test?
Dr._Carter280 Susanna: This is one the most difficult aspects of this field. We hope that our program will form the nucleus for some scientific unity in the future. One benefit that I have is that I do not share the legacy that most of the high profile reproductive immunologists do in the OB/GYN community. The OB community has by and large dismissed immunologic testing and treatment because of mistakes made years ago in the clinical arena. The basic immunology of recurrent pregnancy loss is compelling in unified today, however. The mission is to translate this basic research into clinical realities. I am taking that mission on myself, but you are correct that there is little consensus right now. I appreciate the pos
gyune How lengthy can the government-sponsored trial be for the Carter procedure?
Dr._Carter280 Tiggy: I do not feel qualified to comment in any more depth about beta HCG testing. I recommend that you discuss this further with your OB.
gyune Can you elaborate the cost of Nora's cell mediateed immunity panel?
Tiggy I will tomorrow I was just curious tonight...thanks anyhow
Dr._Carter280 Gyune: It is difficult to predict. It will depend on many factors including how quickly we can recruit patients and how strongly the data trend for success of the program or lack thereof. FDA trials are generally evaluated while they are in progress to see if statistical signficance has been achieved. Efficacy trials can take several years.
Claire Can you respond to my question about your preliminary results? Have these tests been seen to increase the chances of live birth rates in humans or is it all still in the theoretical stage at this point?
maxi I will check out the website. Thanks for the info. Goodnight all.
maxi left
Lori Can we ask for all final questions now. We want to Thank you Dr Carter for all of the valuable information we received tonight! The AFA Staff
Claire I'd appreciate if Dr. Carter could answer my question as I've posted it twice and it seems really an important point of clarification.
Tiggy left
gyune left
Dr._Carter Claire: I attempted to answer your questions. Please email me at info@norallc.com if you did not see my responses.
Lori Claire we have to end - so your's will be the final question of the night please!
Dr._Carter Thank you to everyone.
Lori Thank you Dr Carter - Good Night All - The AFA Staff
Dr._Carter Good night.
Queens_College left
pr left
Dr._Carter left
marsha_irvine left
moakley left
Claire left
Susanna left
Lori left
Paige left
Susan left
wannababy left