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Help for Miscarriages
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Frequently Asked Questions
The workup should include the following tests:
Also very useful:
The workup should include the following tests:
Also very useful:
Please see our page When to Test. Q: Who can order an immune evaluation?A physician or laboratory, hospital or clinic on behalf of the physician must order the laboratory tests. Q: Who will interpret the laboratory results?The ordering physician must interpret laboratory tests. Liability issues discourage a RIA physician from interpreting tests and/or making specific treatment recommendations for a patient that is not directly under our care. A RIA physician is always available to other physicians to discuss laboratory results and make recommendations. Laboratories are prohibited from providing test results (verbal, mail or facsimile) to patients to avoid self-diagnosis and treatment. Q: If an immune problem is identified, when should medication be started and how long would it be continued?All medication must be started prior to conception for maximal benefit. For patients having natural conception or IUI, heparin, aspirin and prednisone are started 5-7 days prior to ovulation, and IVIg is administered 7-10 days prior to ovulation. For patients undergoing IVF, prednisone is usually started 4 weeks before IVF transfer, heparin and aspirin started 2 weeks before IVF transfer, and IVIg is administered 7-10 days prior to transfer. Q: How does ivig work?IVIg works in several ways. For patients who lack blocking antibodies, IVIg provides temporary, non-specific blocking antibodies that will circulate in the mother's body for about one month to protect the fetus. IVIg also down regulates NK cell activity so that they do not damage the fetus. The mechanism by which this happens is very complex; antibodies in the IVIg can attach onto NK cells, signaling them to decrease their killing activity. The effect on the NK cells lasts about one month at which time retesting is recommended. Q: Why does RIA prefer prednisone to other forms of corticosteroid like dexamethasone?Prednisone is the preferred corticosteroid for several reasons. First, it is highly bound to the blood protein albumin. This complex is large and has difficulty crossing the placenta. In addition, an enzyme in the placenta, beta-2-dehydrogenase, inactivates any free prednisone that does get across the placenta. The fetal liver is unable to reactivate the prednisone until about week 30 of gestation. At that time, the active steroid may help increase surfactant production, which helps to mature the fetal lungs. A patient would have to take more than 60 mg of prednisone per day to affect the developing baby. Q: If a woman has had at least one successful pregnancy without immune treatment, does this mean that immune issues can be excluded?Patients who fall into this category are called secondary recurrent spontaneous aborters. Immune problems can develop after a woman has had a normal pregnancy. When this occurs, it becomes very difficult for her to carry a fetus to term without treatment. Q: What is the cost of an immune evaluation for a patient with recurrent miscarriage?The cost of a comprehensive immune workup for recurrent miscarriage is approximately $1300. Some of the tests need to be repeated periodically to adjust medication doses or to identify evolving immune abnormalities. Genetic studies are an additional charge. Fortunately, these do not have to be repeated because they never change. Q: What is the cost of an imune evaluation for a patient contemplating ivf or who has suffered failed ivf?The cost of a comprehensive immune workup for failed IVF is approximately $1100. Some of the tests need to be repeated periodically to adjust medication doses and to identify evolving immune abnormalities. Genetic studies are an additional charge. Fortunately, these do not have to be repeated because they never change. Q: Does reproductive immunology associates participate with any insurance company?Reproductive Immunology Associates does not participate with any insurance company. Payment must accompany a laboratory specimen, unless, your physician has an account with our laboratory. We accept most major credit cards, and personal, bank or cashier's checks, or money orders. If you include a copy of your insurance card (front and back), we will submit a health claim form to your insurance company, on your behalf. You will be required to download the registration form (LINK), complete all of the information on the first page, and return it to us along with the copy of your insurance card. A letter will accompany the health claim form instructing the insurance company to reimburse the patient directly. Q: Does health insurance pay for the laboratory tests and treatment?Health insurance companies vary significantly in their willingness to pay for matters related to reproduction. Since 1990, the number of insurance companies that are paying has steadily increased. Some insurance companies pay for all procedures and treatments less the deductible and co-pay. Much of the success at getting re-imbursement depends upon diagnostic coding. For patients that are directly under the care of a RIA physician, we will provide letters of medical necessity and journal references to support our position. These measures do not guarantee success at re-imbursement; however, they have worked for a number of patients. Q: Is it necessary to go to Los Angeles to become a patient and/or receive treatment?Telephone consultations are available to patients outside of the Southern California area. A patient that chooses to be treated by a RIA physician will have to have the initial treatment on site. She will also need a physician in her geographic location for routine and semi-urgent evaluation and treatment. If the patient has a local physician who is willing to accept recommendations and work with a RIA physician, a trip to Los Angeles may not be necessary. Q: How can I send my blood to RIA to be tested?Fortunately, blood is easily shipped via express type mail, for example, FEDEX, DHL, AIRBORNE, UPS priority. For international patients, the specimen would have to go through customs. As part of the declaration, you would have to say that "the blood is non-infectious and for diagnostic testing". |