singhatjejen skrev 2013-06-17 14:57:25 följande:
Cff: Jag har bara tagit om TNF av chicagotesterna.
Neupogensköljning av slemhinnan är det bara om man har problem med att få slemhinnan tjock nog? eller har det någon effekt på immunförsvaret också? var får du hjälp med detta?
Neupogen testas nu för lite allt möjligt. Man kan skölja livmodern med det för att få tjockare slemhinna (som jag beskrev ovan), man testar att injicera under stimuleringen för att få poor responders att producera fler ägg och man injicerar efter ET för att förhindra recurring miscarriages. Längre ned har jag klippt in några sammanfattningar av studier från Fertility & Sterility. Neupogen är varunamnet, ämnet kallas Filgrastim och består av något som förkortas G-CSF.
Min danska läkare har (efter mina önskemål) skrivit ut neupogen för sköljning av livmodern. De första sköljningarna gjorde jag där, denna gång skall jag få hjälp med första sköljningen i Falun (men det är min danska läkare som skrivit ut neupogenet och har ansvar för min behandling).
Dr Gorgy har skrivit ut neupogen för att injicera efter ET pga mina immunologiska problem (jag har högt tnf alfa och CD 19 och CD 19+5, vet inte vilket av problemet som neupogenet skall hjälpa mot - har för mig att han kopplade ihop det med eventuell KIR-problematik, det testet har jag inte tagit).
Neupogen är ganska dyrt, ca 1000 kronor per injektionsflaska (säljs bara i 5-pack). Det går åt en hel flaska till livmodersköljningen, medan man vid injicering använder ¼-dels flaska vid fyra tillfällen för ”poor responder”-behandlingen och mot missfall ¼-dels flaska varannan dag från ET fram tills hjärtslag vid VUL, dvs ca 4 veckor = 14 injektioner= 4 flaskor.
Från Fertility & Sterility angående neupogen för poor responders:
P-213 Tuesday, October 23, 2012 GRANULOCYTE-COLONY STIMULATION FACTOR (G-CSF): AN OPTION TO IMPROVE IN VITRO FERTILIZATION (IVF) OUTCOMES IN POOR RESPONDERS.
A. S. Cambiaghi R. B. F. Leao. Reproduction, IPGO, Sao Paulo, SP, Brazil.
OBJECTIVE: To assess the effectiveness of granulocyte colony-stimulating factor for improving the ovary response in IVF cycles of poor responders women.
DESIGN: It was a prospective, therapeutic, self-controlled clinical trial.
MATERIALS AND METHODS: Between July and December 2011 we selected 10 women that would be submitted to an IVF cycle. The inclusion criteria were: 2 previous failures in cycles with less than 3 oocytes and early follicular phase serum levels of FSH within normal limits. All of them were submitted to the same protocol for ovarian stimulation used in their last cycle, with the association of 0,25 ml Filgrastim 300 mcg/ml subcutaneous every other day from the day of the beginning of ovary stimulation and repeated for 4 times. The study variables were: number of oocytes, mature oocytes and third day embryos, expressed as mean; and pregnancy rate, expressed as percentage. These variables were compared to the last cycle of the same women. T student test was performed to compare means. Pregnancy rate was compared using Fisher’s exact test.
RESULTS: Before G-CSF, it were found means of 1,1 oocytes, 0,9 mature oocytes, 0,6 embryos, without any pregnancy. After G-CSF treatment, it was observed 2,4 oocytes, 1,7 mature oocytes, 1,1 embryos and pregnancy rate of 20%. We observed an increasing in number of retrieved oocytes, mature oocytes and embryos in the group that used G-CSF in comparison to those seen in the preceding cycles. All the results haven’t had statistical significance probably due to a small number of cases.
CONCLUSION: In poor responders, G-CSF adjuvant therapy seems to improve the number of retrieved oocytes, mature oocytes, embryos and pregnancy rate. Nevertheless, larger studies are needed to confirm the effectiveness of this approach for poor responders.
Från Fertility & Sterility angående neupogen för repeated implantation failures:
P-254 Tuesday, October 23, 2012 GRANULOCYTE-COLONYSTIMULATION FACTOR(G-CSF)MAY IMPROVE PREGNANCY RATE IN PATIENTS WITH REPEATED IMPLANTATION FAILURES.
A. S. Cambiaghi R. B. F. Leao. Reproduction, IPGO, Sao Paulo, SP, Brazil.
OBJECTIVE: To assess the effectiveness of G-CSF for improving the implantation and pregnancy rates in in vitro fertilization (IVF) cycles of women with repeated implantation failures.
DESIGN: It was a prospective randomized controlled clinic trial.
MATERIALS AND METHODS: Between November 2011 and March 2012, 20 women that would be submitted to an IVF cycle in IPGO (Sao Paulo, Brazil) were selected. The inclusion criteria were: 2 previous failures in IVF cycles with embryo transfer, normal early follicular phase serum levels of FSH and age no more than 40 years. A computer-based randomization was used to allocate the patients to two groups. All of them were submitted to the same protocol for ovarian stimulation with GnRH antagonist and hMG. In group 1, in addition to the usual luteal support, women received 0,25 ml of Filgrastim 300 mcg/ml subcutaneous every other day from the day after the embryo transfer until the confirmation of gestational sac with fetal heart beat documented by transvaginal ultrasound 6 weeks after embryo transfer. In group 2, they received only usual luteal support. The study variables were: age, number of oocytes, mature oocytes and embryos, expressed as mean; and pregnancy rate and implantation rate, expressed as percentage.
RESULTS: There was no diference in age, number of oocytes, mature oocytes and embryos comparing the two groups.With the use of G-CSF, we observed an increasing in implantation rate from 10 to 19% and pregnancy rate from 20% to 40%. All the results have had no statistical significance, probably due to a small number of cases.
CONCLUSION: G-CSF adjuvant therapy may improve the pregnancy rate in IVF cycles. Nevertheless, larger researches must be done to confirm the efficacy of G-CSF adjuvant therapy to improve the implantation and pregnancy rates in patients with repeated implantation failures and to define which group of patients could have benefits with this treatment.
