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  • Vi som gör utredning hos Dr Gorgy i London

    Fre 30 nov 2018 12:21 Läst 0 gånger Totalt 37 svar
    Fre 30 nov 2018 12:21

    Hej !
    Finns det nån mer därute som har gjort eller planerar utredning hos Dr Gorgys klinik i London? Den kliniken har bland annat specialiserat sig på att utreda och behandla immunologiska orsaker till oförklarlig barnlöshet. Efter 6 missfall, och en tidigare utredning i Aten, så valde vi att resa vidare till London för en ny större immunutredning där.

    Kliniken heter The Fertility & Gynaecology Academy
    www.fertility-academy.co.uk/

    Det finns flera gamla trådar som inte är aktiva längre, där många också reste till Dr Gorgys klinik. Man kan hitta en hel del info i de trådarna också :

    www.familjeliv.se/forum/thread/47451750-utredning-hos-alan-e-beer/1

    www.familjeliv.se/forum/thread/49826574-utredning-hos-alan-e-beer-trad-2/1

    Det finns också en del engelska trådar där de diskuterar Dr Gorgys klinik.
    www.fertilityfriends.co.uk/

    Här kan vi träffas och prata !

    Välkommen !

  • Fre 30 nov 2018 16:20 #1

    Ett bra tips för att hitta mer info om immunproblem är Agathes FAQ:


    Immune FAQ
    www.fertilityfriends.co.uk/forum/index.php
  • Sön 2 dec 2018 12:13 #2

    Om man bara får upprepade missfall eller aldrig blir gravid, och kanske gjort en utredning genom Landstinget där de inte hittade några fel, och inte får nån mer hjälp av svenska vården. Vad gör man då?

    Vården skyller ofta på otur, men det är ingen orsak. Det finns alltid minst en orsak, och det gäller att hitta den.

    Orsaken kan vara immunproblem, om man har det så kan kvinnans immunförsvar försöka döda och stöta bort embryot som den betraktar som en inkräktare.

    Men tyvärr tror svenska läkare generellt inte på detta. Men utomlands finns det mer kunskap. I USA, London och Aten finns läkare som utreder och behandlar immunproblem.

  • Mån 10 dec 2018 12:29 #3

    Om man har problem med upprepade missfall eller att det bara blir minus
    så kan det vara kvinnans immunförsvar som är problemet.

    Ett bra tips kan vara att börja med att läsa denna bok:
    Is your body babyfriendly av Dr Alan E Beer:
    www.bokus.com/bok/9780978507800/is-your-body-baby-friendly/

    Samt göra IvfSerums Mensblodtest som man gör
    hemifrån och skickar med posten till labbet i Aten, det kostar 300euro:
    www.ivfserum.com/infection-screening/

    Samt att göra hysto hos Serum för att kolla
    så det inte finns några problem i livmodern, det kostar 1650euro:
    www.ivfserum.com/hysteroscopy-with-implantation-cuts/

    Sen om man vill gå vidare med en utredning så kan man
    kontakta en läkare för immunutredning. Här är några förslag på kliniker:

    Serum
    www.ivfserum.com/questionaire/

    Dr D
    www.lifeclinic.gr/

    Dr Gorgy
    www.fertility-academy.co.uk/

    Dr Braverman
    www.preventmiscarriage.com/patient-questionnaire.html

    Om du vill ha kontakt med Serum eller Dr Braverman, börja med att fylla i deras questionarie på nätet, vill du ha kontakt med Dr Gorgy så börja med att ringa kliniken 0044 20 7224 1880 för att boka tid så mailar de patientformulär till dig.
    Vill du ha kontakt med Dr D så börja med att maila honom så mailar han dig sitt patientforumulär.

  • Mån 10 dec 2018 12:39 #4

    Jag och min sambo började med att ringa Dr Gorgys klinik
    och boka en tid för besök och provtagning eftersom vi haft många missfall och
    det senaste trots att embryona var normala kromosommässigt efter PGS, så alltås ,måste det finnas fler immunproblem att hitta.

    Vilka tester tas ? och vilka mediciner/behandlingar kan man göra?
    Här kan du läsa mer:


    Immune Testing

    To establish any issues that may be preventing a successful IVF treatment, we carry out a comprehensive series of tests which check different aspects of your immune system. At The Fertility & Gynaecology Academy we feel it is important that you understand the different tests carried out.


    Once we have identified the problem using the series of tests below, we can provide relevant immune therapy ? for example Intralipids or IVIg infusions, Corticosteroids, Clexane, Progesterones and Lymphocyte Immune Therapy (LIT).


    Natural Killer (NK) Cell Cytoxicity Assay And Immunophenotype

    This test first measures the killing power of the NK cells in your blood. Secondly, it looks at the numbers of different types of white cells in your blood. We look at these specific types of cells because elevated concentrations of them have been shown to be associated with various fertility problems. For example:


    TH1:TH2 Cytokine Ratio

    Cytokines are chemical messengers in the blood. High levels of the TH1 pro-inflammatory cytokine ? TNF-alpha, in particular ? have been shown to be associated with reduced egg quality, implantation failure and miscarriage.


    Leukocyte Antibody Detection (LAD)

    This test requires a sample of blood from both the prospective mother (or gestational carrier) and another person (usually the prospective father). It measures the levels of blocking antibodies in the prospective mother?s blood to samples of white cells from the prospective father. Low levels of blocking antibodies are associated with higher rates of miscarriage and implantation failure.


    HLA-DQ Alpha Testing

    The test determines which DQ Alpha markers your body cells carry. To achieve the best results, this test is usually carried out for both the prospective mother and the prospective father. This is because where the prospective mother and father carry very similar markers, there is an increased chance that their embryos may carry identical markers to the mother. In that case, there may be an increased rate of implantation failure and/or miscarriage. This can be due to an increased immune response which may become more aggressive with each successive attempted implantation of a DQ Alpha matching embryo.


    Testing By Uterine Biopsy

    This test requires a small sample taken from the lining of the uterus, ideally before your period is due. The sample can be taken at our clinic or, in some cases, taken elsewhere and forwarded to us. Samples are analysed for excessive levels of uterine NK cells, for adequate levels of FoxP3 +ve T-regulatory cells and for the health and development of the uterine lining.


    Tests For Inherited Thrombophilia: Factor II & V and MTHFR Gene Mutation

    These are genetic conditions, some of which are very common. All thrombophilia (?sticky blood conditions?) can cause problems for maintaining an adequate blood supply to the uterine lining and to the growing placenta, which results in increased rates of implantation failure and miscarriage.


    Tests For Acquired Thrombophilia/Antiphospholipid Antibodies

    Additional tests for thrombophilia may be available to you via your GP, but if not, can be arranged through The Fertility & Gynaecology Academy.


    Screening For Autoimmune Factors

    Undiagnosed autoimmune disease may be associated with increased risk of pregnancy failure, potentially due to elevated TNF-alpha ratios. A screening panel will commonly include tests for Antinuclear Antibodies (ANA), Anti-Histone and ds-DNA antibodies. These tests may be available to you via your GP, but if not, can be arranged through The Fertility & Gynaecology Academy.


    Killer-Cell Immunoglobulin-like Receptors (KIRs)

    KIRs are a family of protein receptors on the surface of NK cells, mostly inhibitory but some activating. There is an increased risk of implantation failure and/or miscarriage if particular members of the activating KIRs are missing. The risk can be reduced by using G-CSF (Neupogen).


    www.fertility-academy.co.uk/immune-testing/

    Vilka mediciner/behandlingar finns:
    Immune Treatments

    After analysing your circumstances, medical history and the results of testing, our consultants will advise you on the most appropriate treatments to tackle any issues.

    Below, you?ll find a useful overview our most commonly used treatments (not including medications used for IVF, IUI or other methods of ovarian stimulation). This information is provided to help you on your fertility journey with us but is not a substitute for medical advice.


    Intralipid or IVIg Infusions

    Intralipid and IVIg (Intravenous immunoglobulin) have both been shown to normalise the killing power of natural killer cells in the blood. They are given by intravenous infusion on site at our clinic on Wimpole Street, London. For long distance patients, other arrangements can usually be made.


    IVIg is a solution of human antibodies in saline, and an infusion will usually take about two hours. Most of our patients experience no side effects from IVIg infusion apart from tiredness, feeling cold and slight headache (which can be relieved by taking paracetamol) but allergic reaction is a possibility. We recommend that, in cold weather, our patients bring warm clothing and eat well before the infusion as this normally eliminates these side effects. As a precaution against allergic reaction to IVIg, antihistamines are sometimes given to patients.


    Intralipid is a solution of soya bean oil, egg yolk and glycine in saline. Intralipid infusion usually takes about one hour. Most of our patients experience no side effects but due to the risk of allergic reaction to the ingredients it may not be suitable for patients who are allergic to soya bean oil or eggs.


    Decisions on whether to give Intralipid and/or IVIg are based on NK assay (Natural Killer Cell testing) results, the severity of immune issues and the patient?s preferences. We commonly give the first infusion 7-14 days before a planned embryo transfer/implantation, followed by subsequent infusions on a positive pregnancy test and first ultrasound scan. The duration and timing of further infusions during pregnancy are made on the basis of the severity of immune issues, the results of NK retesting and your own preferences.


    Corticosteroids

    Corticosteroids including prednisolone and dexamethasone tablets are used to suppress natural killer cells and inflammation. The most common side effect experienced by our patients is insomnia which can be reduced by taking the tablets at breakfast time. For many of our patients, steroids are commenced on day 5-7 of your cycle or IVF stimulation and continued until 12 weeks of pregnancy.


    Clexane

    Thrombophilia (?sticky blood? conditions) may compromise blood flow to the uterine lining or to the growing placenta, leading to pregnancy failure. We also find that elevated levels of NK cells can be associated with similar compromised blood flow.


    Clexane is an anticoagulant (?blood-thinner?) with very predictable results which is given in the form of daily subcutaneous (under the skin) injections, usually into the abdomen.


    For many patients, clexane injections are started on day 5-7 of the cycle (for IVF patients, clexane is omitted on the day of Egg Collection). The dose is increased the day after egg collection and continued during pregnancy. The optimum duration of clexane treatment in pregnancy depends on the severity of thrombophilia or other immune conditions diagnosed. Most of our patients experience no side effects except bruising at the injection site. 75-81mg of daily aspirin is also prescribed for many of our patients.


    Progesterones

    Patients with immune related infertility may benefit from higher doses of progesterone than average due to anti-progesterone antibody activity or inflammation. We sometimes prescribe daily intramuscular injections of prontogest starting after egg collection (or ovulation or before frozen embryo transfer). However alternatives (cyclogest or utrogestan pessaries, crinone gel) are available or may be used in combination with prontogest. Prontogest is normally injected into the upper outer quadrant of the buttock muscle. Most of our patients remain on progesterone support until 12 weeks of pregnancy, but some patients may require support for a longer period. The most common side effect of progesterone treatment experienced by our patients is constipation.


    Lymphocyte Immune Therapy (LIT)

    The Leukocyte Antibody Detection (LAD) test determines the levels of the antibodies that react to proteins of non-self (most often paternal) blood cells. These antibodies are important because they seem to act in ways protective to pregnancy. Women with repeated miscarriage or implantation failure may have particularly low LAD levels. In such cases, LIT has been shown to improve the live birth rate by increasing the level of blocking antibodies.


    LIT is performed using live white blood cells from a healthy blood donor (usually the prospective father, or from other donors depending on the circumstances and immune issues diagnosed). The fresh blood sample is prepared immediately before the treatment to obtain a concentrated solution of white blood cells, which is then injected into the prospective mother?s forearms in a series of very shallow injections.

    An initial course of two LIT treatments is usually given 3-4 weeks apart, followed by a repeat of the LAD test after 3-4 weeks. Further treatments may be suggested if the initial response is inadequate or, in some cases as a ?booster? treatment in early pregnancy. All blood donors are required to have comprehensive infection screening immediately before the donation. Most of our patients experience no side effects from LIT except for itching and redness at the injection site.


    Humira

    The Humira drug was originally developed for autoimmune conditions like Rheumatoid Arthritis, and is highly effective for reducing elevated TNF-alpha. TNF-alpha is a kind of messenger protein that is created by white blood cells. It works to help control the immune system?s response to foreign objects, promotes inflammation, and can aid in the healing of cells. But elevated TNF-alpha levels have been linked to lower egg quality, miscarriage, and implantation failure.


    We also find that Humira is effective for some patients with elevated uterine NK cells (shown by uterine biopsy) and or endometriosis in the absence of elevated TNF-alpha.


    Humira is given in courses of two subcutaneous (under the skin) injections, two weeks apart, followed by a cytokine retest after 7-10 days. Further courses may be required depending on the retest results. We require all patients to be screened for TB before starting any treatment with Humira. Most of our patients experience no side effects with Humira except for minor skin rashes at the injection site and occasionally cold or sore throat symptoms.


    G-CSF (Neupogen)

    G-CSF was originally used to increase the production of the white blood cells in the bone marrow. It was found to improve embryo implantation and reduce the risk of miscarriage in patients, particularly those missing some of the killer cell immunoglobulin-like receptors (KIR).


    Antibiotic Treatment

    Depending on infection testing results and other aspects of your medical history, we may advise various antibiotics to clear diagnosed infections for both you and your partner before commencing fertility treatment or, occasionally, as a preventative measure at the time of any gynaecological surgery or during fertility treatment.


    Folic Acid, Vitamin B6 & B12

    All women who are trying to conceive benefit from at least 400mcg of folic acid started three months before conception. For patients diagnosed with the MTHFR mutations, we may recommend higher doses of folic acid, vitamin B6 and B12.


    Metformin

    Many of our patients with polycystic ovarian syndrome or other insulin resistance benefit from taking daily metformin tablets to reduce insulin resistance.


    Sildenafil (Viagra) & G-CSF (Neupogen)

    Patients suffering from poorly developed uterine lining on previous cycles can benefit from the addition of viagra. Neupogen has also been found to improve the lining.


    www.fertility-academy.co.uk/immune-treatments/
  • Mån 10 dec 2018 12:59 #5

    Dessa tester kan också tas:


    Led by renowned fertility specialist Dr A Gorgy, our clinic offers a full range of tests which aim to isolate the problems causing implantation failure. These tests can be broadly grouped into four categories:


    Immune testing
    Infection screening (Mensblodtest)

    Assessment of uterine cavity (Aqua scan eller hysto)

    Karyotyping (på både mannen och kvinnan)

    Sperm assessment (sperm dna fragmentationstest)

    www.fertility-academy.co.uk/has-your-ivf-been-unsuccessful-so-far/

    Eftersom vi redan hade fixat de 4 nedersta punkterna på listan, så var det bara immuntester som återstod. Vissa immuntester hade vi tagit hos Dr D i Aten, men Dr Gorgy tar fler tester.
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