1ST EZS

    Hello,

    We are planning our first EZP. I am known to have the following: High blood pressure, Hashimoto's. Killer cells are elevated. Plasma cells were once elevated after antibiotics, they were 3. I was given antibiotics for Gardnerella, but that was a long time ago. ANA titer was once slightly elevated and a protein Z deficiency could be measured.

    KIR genes were determined and ok. Blood group A positive - antibodies negative.

    How should we proceed?

    A new biopsy should not be done, as it has already been done many times.

    VG

    Dear SoZi,

    Before starting treatment, you should have a detailed initial consultation with one of our doctors to explain the treatment in detail and to identify and treat any risk factors. In your specific case, it is particularly important that your blood pressure and thyroid disease are well controlled.

    When looking for a donor, the KIR/HLA-C constellation will be taken into account in addition to the external characteristics and blood group.

    For the actual treatment, we would probably add ASA and heparin to the treatment plan and possibly discuss with the immunologist whether additional medication is necessary.

    It is very difficult to give an accurate assessment without knowing you personally and having seen the documentation. I would therefore like to invite you to a free initial consultation at our clinic (also online) to discuss the exact procedure.

    Kind regards,

    Dr. Katharina Spies

    Ihr Vida Fertility Team <3

    Hello,

    Thank you for your feedback.

    The following was suggested to us as a possible regimen:

    Start with Progynova 2 mg orally three times a day , about 14 days later Decapeptyl injection, 2 days later Utrogestan 2x 200 mg , Doxicilin 100 mg 2 times a day for 14 days.

    TRANSFER CYCLE: Progynova 2 mg orally three times a day, Dacortin 10 mg, Clexane 40 mg, Adiro 100 mg, Utrogestan 2X 200mg

    The coagulation doctor in Germany says that heparin should only be started the evening before the transfer. Is it bad if you start earlier?

    Does egg donation not trigger ovulation?

    Do 14 days of Doxy. Does it make sense if you have already had plasma cells? (1st biopsy 16, 2nd biopsy 2, 3rd biopsy 3 plasma cells; last biopsy 2023)

    It doesn't help against Gardnerella and Atopobium (detected in the uterus in 2022, then only checked via smear test: positive in 2023, then always negative). I'm worried that the antibiotic will destroy all the lactobacilli that I've been building up for a long time....

    Best regards

    Edited once, last by SoZi (February 13, 2025 at 5:12 PM).

    Dear SoZi,

    In principle, the treatment regimen is correct.

    Unfortunately, I cannot give you any precise information on the use of Dacortin, as this depends on the preliminary examinations.

    We usually give heparin from the start of the progesterone intake at the latest (do not inject on the transfer day!), it would not be a problem to start it earlier.

    Giving doxycicline is also fine, even over 14 days, although I would take vaginal or oral probiotics at the same time to maintain a good microbiome.

    Yours sincerely,

    Dr. Katharina Spies

    Ihr Vida Fertility Team <3

    Hello

    in my example plan, the heparin is only given from the transfer cycle onwards. However, the progesterone is already given in the pre-cycle. So progesterone from 12.3. and heparin and ASA only from 8.4. should this be changed?

    Do you assume that once someone has had plasma cells (I had 16 plasma cells in 2022) that they will come back? I had 3 more after the antibiotic. That was in 2023, after which it was no longer checked. Would it then be more advisable to take Doxy or leave it out?

    Can Untrogestan be affected by a vaginal probiotic?

    I can get Omegaven in Germany. This is given shortly before the transfer, shortly after the transfer and then weekly. In Spain you get Intralipid. If I have understood correctly, on the day of the transfer and then again later. I have read that Intralipid should be given in advance. What is the correct procedure? Can Intralipid and Omegaven be taken together?


    Best regards

    SoZi

    Dear SoZi,

    I understand all your concerns, they are completely normal. All patients have a lot of doubts, in your case, which is even more complicated, I can't imagine how many questions you must have.

    Nevertheless, such precise questions, with a whole patient file to consider, should not be answered in a forum. To me, that would be unprofessional, even dangerous. And it should also come from an immunologist specializing in fertility, not just a gynecologist. At least that's how I would do it with one of my patients.

    I'm sorry I can't give you more specific answers, but I'm missing important data. My best advice would be to ask all these questions to your doctor who knows your case 100%. If, after your transfer, you would like me to take a closer look at it, please send me everything at contact@vidafertility.com and I will be happy to give you my recommendation.

    However, I hope it doesn't come to that, because that would mean that you are happily pregnant after this first transfer. I wish you the best of luck!

    With best regards.

    Dr. K. Spies

    Ihr Vida Fertility Team <3

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