IVF Patient With Positive Beta On Immunoglobulins (IVIG) & Has Questions

Question:

Good day Dr Ramirez,

I wrote to you a while ago. We just completed our 3rd IVF (in vitro fertilization cycle) and 2 , 5-day frozen blastocysts were transferred.

I had a blood test on day 10 post transfer and the result was positive. I suffer from rheumatoid arthritis. My doctor gave me 5ml immunoglobulin (integram) on day 2 of my cycle and 5ml again 10 days post transfer. I am also on 600mg cyclogest as well as folic acid , baby asprin, omega 3 & 6 and staminogro.

I am still concerned about the arthritis and worry about the anti bodies - is the immunoglobulin sufficient - what is the protocol, what do you suggest?

My second question is. From the day of the FET I felt this twitch on my left side of my uterus . From 7 days post transfer I have lower back and stomach pains.

Should I worry? I have heard that it is normal for FET patients to get pains and cramps and it is good pains. I have no spotting though. My first beta on day 10 was 198 and my second beta on day 12 was 416 .Can you please advise. Thank you. V.

Answer:

Hello V.,

I believe the immunoglobulin is sufficient from a fertility point of view, but I don't know in regards to the arthritis. You would need to consult a rheumatologist to get the answer to that question.

The pains you are having are probably normal. Many women experience some uterine cramping or pains in the early pregnancy. We call these "growing" pains. Your bHCG levels are good so things look good. At this point, you just have to hope for the best. Congratulations and stay positive!

Follow-Up Question:

Thank you so much for your reply. Do I understand correctly that the dosage of the immunoglobulin that I got is sufficient for the duration of the whole pregnancy and I don't need to get additional imunoglobulin again? The reason why I ask is that I had a miscarriage 7 years ago ( a natural cycle without any meds)- due to the antibodies of the athritis and I am concerned that it might happen again.

Follow-Answer:

Hello Again,

Because the use of Immunoglobulin in IVF is controversial, there are no set protocols or dosages. Therefore, I cannot comment on the dosage or times of delivery. In my experience, however, it is given at the beginning of the cycle, after the transfer and if pregnant again at that time. I would recommend that you look up the Reproductive Immunology Associates website (www.rialab.com/ivf_immunotherapy.php). They are immunologists that have geared their practice specifically to reproductive issues. They will have more specific information regarding the use of immunoglobulins. They will also answer email questions.

Good Luck,

Edward J. Ramirez, M.D., FACOG

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Programwww.montereybayivf.com

Monterey, California, U.S.A.

Twitter with me at @montereybayivf and follow me on Facebook at http://bit.ly/9Iw9oV

Post IVF Transfer Pain: Implantation Pain or Ectopic?

Question:

My wife says that she was experiencing sharp pain yesterday (10 days after FET) on the area near right side of her stomach. She experienced the pain only yesterday and that was during a 3 mile walk. Today she says she feels some pressure near the right ovaries.

I'm concerned. Could you please let me know your suggestions? Thank you.

Answer:

Thank you for your question. This could be normal, but the main concern would be an implantation that occurs in the tubes called an ectopic pregnancy. I wouldn't jump to this conclusion but it is a possibility. This could also be what we typically call "implantation" pain. Please see my overview of what happens after the IVF transfer including pain and bleeding here: "After Your IVF Procedure".

Let me go into more detail regarding both possibilities.

All patients with infertility are at increased risk for an ectopic, even with IVF. The incidence is low but it occurs. At 10 days post transfer I usually have done my pregnancy test. This can give a better idea of how the pregnancy is doing and whether or not an ultrasound will show anything. Generally, the BHCG level has to be over 3000 to see a pregnancy in the uterus and if it is not there with that level, then an ectopic pregnancy as to be assumed. At only 10 days post transfer, it is unlikely to be an ectopic, however. These usually do not become symptomatic until 6-8 weeks of the pregnancy. At this point, it is probably not anything serious.

Pregnancy can also induce other kinds of pains and discomforts. We call them implantation pain or growing pain. Sometimes women tell us that they "feel" a sharp pain within a week or two post transfer. I cannot discount that sometimes the women who complain of this pain (and I have IUI patients who tell me the same) do have a positive pregnancy test. Another possibility on the right side, of course, would be appendicitis. You can still get other illnesses despite trying for pregnancy. However, appendicitis, is progressive and does not come and go. Once the pain started it would progressively get worst. That doesn't fit your wife's scenario. Without further evaluation it is hard to know what is going on. You should probably bring this up with your doctor.

As a side note, if your wife is actively trying to get pregnant using IVF or FET, then I would not recommend a 3 mile walk right now. She should limit her activity to more sedate activities. A short normal walk would be fine, but power walks are not recommended as are heavy exercises like aerobics, karate, gymnastics, running, etc.

Good luck with your cycle and I hope that this will be a success!

Sincerely,

Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF program
http://www.montereybayivf.com/
Monterey, California, U.S.A.