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  1. #1
    KNL
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    ANA & IVIG

    I reviewed this link that Lauren posted and came accross this...

    Anti Nuclear Antibodies (ANA Screen)
    This is a component of one's autoimmune response (woman's immune system attacking her own cell nucleus). ANA are antibodies against one or more elements within a biological cell, involved in the machinery of translating gnomic message into proteins. These antibodies can destroy cells, and their effect usually leads to the disease Lupus (SLE). Women with Lupus or ANA are at a higher risk of miscarriage and IVF implantation failure due to inflammatory effects on the placenta and or the fetus. The first test is usually a 'screen' which identifies up to 100 of this type of antibodies as a group. If positive, the ANA panel is ordered to determine if any of the 10 most clinically important antigens in the group is involved. Positive ANA can often be treated with immunosuppressive agents.

    Treatments - If positive Anti-Histone or Anti-Double Stranded DNA (dsDNA); then immunosuppressive therapy is the recommended course. 10mg/day Prednisone or 4mg/day Dexamethasone should be considered. For exact appropriate dosages, consult a Reproductive Immunologist. Treatments should start ten days prior to ovulation.

    I am wondering if anyone has info regarding the tx for this? would IVIG be adequate by itself?
    I have tested postive for ANA.....postive for Sjogrin in 2001 but not since....it is related to antibodies...something I only found out recently.
    I am presently receiving IVIG with Dr Clark & scheduled for another Sept 6.

    Does anyone have any experience with this??
    KNL


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  3. #2
    lfellers
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    ana

    Hi KNL
    I also have a positive ana 1:640. I had two previous miscarriages at 6-7 weeks about a year ago. Now I have not been able to get pregnant for 1 yr. I started baby aspirin about a year ago when I found out after my second miscarriage that I have a positive ana. I am currently doing aspirin and repronex. My MD said he would draw another ana when am in my first trimester and mentioned doing lovenox if my number doubled. Have you heard of these? I have not heard about the IVIG with positive ANA only. Are you doing aspirin?


  4. #3
    Lauren2005
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    Oh, dear!!! Baby aspirin and Repronex are not treatments for ANA's!!!! And then he says he'll add Lovenox??? Also not a treatment for ANA's. This has me very concerned about your doctor.

    This is an excerpt written by the late Dr. Beer, taken from his website http://www.repro-med.net :

    Positive Antinuclear Antibody (ANA)

    This immune problem occurs in 22% of women with recurrent pregnancy losses and nearly 50% of women with infertility and IVF failures. Women with this problem make antibodies to DNA, or DNA breakdown products in the embryo or in the pregnancy. These antibodies form first in the blood as IgM. As the problem gets worse they appear as IgG and live in the lymphatic system and lymph nodes. With more losses they form IgA antibodies which have their home and action in the organs including the uterus. These antibodies can be against pure double stranded DNA (ds DNA), single stranded DNA (ss DNA), or smaller molecules called polynucleotides and histones that make up the single strands (see diagram).

    Consequences

    Antinuclear Antibody (ANA) positive, speckled pattern.

    Autoantibody to DNA leads to inflammation in the placenta.

    Autoimmune disease screening in the woman is negative (No evidence of lupus or rheumatoid arthritis).

    A blood test determines the presence of antibodies to polynucleotides, histones and DNA. This process involves running 27 different tests on a sample of blood.

    The presence of antibodies is also tested for by doing the ANA test. This is a less sensitive test but one that many doctors have already done on their patients before we ever see them.

    The test is reported as a titer and a pattern. Any titer above 1:40 is significant. The titers can get into the thousands such as 1:2,500. This simply means that the test is positive when the blood serum is diluted many times.

    The pattern is reported as homogeneous, nucleolar or speckled:

    Homongeneous: the antibody is to the ss DNA or ds DNA.

    Nucleolar: the antibody is directed to the polynucleotides.

    Speckled: the antibody is directed against the histones.

    Some women demonstrate a mixed pattern of speckled/homogeneous.

    These same antibodies appear positive in women with lupus, rheumatoid arthritis, Crohn's disease and other autoimmune diseases. They are usually in high titers. Pregnancy losses, infertility and IVF failures cause the titers to be much lower and a low positive titer does not mean that you have or are getting an autoimmune disease; however, this is ruled out during the testing.

    In women with autoimmune diseases these antibodies cause inflammation in joints and organs. In women with no autoimmune diseases but a positive antibody, the antibody causes inflammation around the embryo at the time of implantation or in the placenta after implantation. This inflammation is exactly the same as occurs if you get a splinter under your fingernail. The tissue around the splinter gets hot, red and swollen and it happens quickly.

    --

    Here is an excerpt from his treatment protocol, which can be found in the files (you must join the group to access the files) of http://health.groups.yahoo.com/group/immunologysupport/ :

    High number of antibodies to the baby's DNA or DNA breakdown products causing the placenta to become inflamed. See: http://repro-med.net/info/cat1-5.php#cat3

    Testing:

    1. Antinuclear Antibodies: $49
    2. Antibody to DNA histones: $143

    Where tests are performed: Local physician’s network.

    How long to receive test results: 5-7 working days

    Other testing available: Placental immunopathology (testing of miscarriage tissue for all 5 categories if immune problem. See: http://repro-med.net/tests/patho.php Starting at $400

    Where tissue is sent: Dr Beer’s Los Gatos clinic or Preferred Speciality laboratory

    How long to receive results: 4 weeks.

    Treatments & costs:

    Prednisone or Dexamethasone: $10/month
    Baby aspirin: $3/month
    Progesterone: $30/month
    Calcium: $3/month

    All costs are estimates and should not be used to establish the exact price.

    Cycle of conception treatment:

    1. Prednisone: 5 mg twice daily, starting on day 6 of the cycle of conception increasing to 10mg twice daily at the time of a
    positive pregnancy test

    2. Baby aspirin: One baby aspirin 81 mg, daily, the cycle of planned conception and continued through pregnancy.

    3. Progesterone: Vaginal suppositories 100 mg twice daily morning and at bedtime 48 hours after ovulation or within 48 hours of embryo transfer through 16 weeks of pregnancy. In some women whose progesterone levels are less than 20, progesterone in oil injections of 50 mg daily intramuscularly are given daily until the levels are above 20.

    4. Calcium: Begin supplementary calcium 500mg two times daily while on prednisone therapy.

    5. Pregnancy testing is done starting on cycle day 23, 25, 27 and 29. The pregnancy test is observed for one hour. A positive test result is reported to beerdoc@aol.com or Dr. Beer’s office at (408) 356-9500.

    If pregnant:

    1. Prednisone dose is increased to 10 mg twice daily and continued until instructed to stop.

    2. Progesterone supplementation continued through 16 weeks of pregnancy.

    3. Baby aspirin continued throughout pregnancy.

    4. Calcium is continued throughout pregnancy.

    5. Quantitative blood HCG is drawn two times per week until heartbeat is established. Progesterone is tested weekly through 10 weeks of pregnancy. See progesterone document: http://repro-med.net/papers/progest.php.

    6. Fasting blood sugar should be monitored monthly.

    7. Repeat NK Assay, Cytokine Assay, ANA, APA, and anti-DNA Histone testing at the time of a positive pregnancy test.

    If not pregnant:

    1. Ask whether you should continue prednisone at 5mg twice daily.

    2. Discontinue progesterone.

    3. Continue baby aspirin.

    4. Continue calcium

    Weaning from prednisone treatment:

    1. Wean off prednisone slowly according to the following protocol:

    i. Prednisone 10 mg in the morning, 5 mg in the evening for 7 days.
    ii. Prednisone 5 mg in the morning, 5 mg in the evening for 7 days.
    iii. Prednisone 5 mg daily for 3 days.
    iv. Prednisone every other day for 3 times.
    v. Stop prednisone completely.

    Please share this with your doctor (and/or find a new doctor!!!) I hope this is helpful and that you are soon treated appropriately.


    Lauren


  5. #4
    dukercook
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    I have read that IVIg may be used in treatment of certain types of APA. But only certain types.

    ANA is prednisone and baby aspirin.

    There is a link from Lauren regarding recent articles. They are great to tell you about treatment possibilites.


  6. #5
    lfellers
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    Thanks for all the info. I have been to two different RE's and they both said that predisone won't be nessarey unless ana at least doubled. I did the repronex because I have a lining of 6mm, not because of ana. Good luck to all of you and thanks for the info.


  7. #6
    KNL
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    Ivig

    Thanks for the info....
    I recently saw my RE....& she was curious about the IVIG.... & was reluctant about steroids because of possible side affects....
    I have been taking Baby aspirin for the past 3 yrs while TTC...have done IUI's with injectibles one attempt at IVf. Have made significant health changes from wheatgrass, salmon oil....little to no sugar etc...
    I am wondering now if IVIG is enough ?


  8. #7
    Lauren2005
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    Hard to say... which issues are you dealing with? ANA, for example, tends to need the steroids but some people end up succeeding without it. Remember that there's no such thing as 100% success rates with one protocol vs. 0% success rates with another. Do you have elevated NKa as well? How about low LAD or APA's, etc.? IVIg is enough for some issues, but not others, and for some people, but not others. Regarding your doctor's concerns, you might want to work with a licensed naturopath, who can suggest more natural alternatives to steroids... I hope that's helpful and wish you the very best.

    Lauren


  9. #8
    KNL
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    Ivig

    Thanks for all the info
    With the testing that I have had done the only thing that has been postive is ANA speckled pattern. 1:160.....down from 1:320
    Dr. Clark has not recommended anything other then IVIG...
    will it be enough?


  10. #9
    dukercook
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    To me the IVIg seems excessive. I have not seen it used for ANA. But that doesn't mean it isn't. Your doctor may not want to put you on a steroid, and may feel the results from IVIg is better.

    Have you discussed this with your doctor? Is IVIg covered by insurance?


  11. #10
    KNL
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    Ivig

    my re is very reluctant with steroids & Dr. C felt IVIG is sufficient....I am part of a research study so no ins necessary...only travel costs....


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