A: A physician or laboratory, hospital or clinic on behalf of the physician must order the laboratory tests.
Q: Who will interpret the laboratory results?
A: 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?
A: 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?
A: 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?
A: 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?
A: 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?
A: 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?
A: 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.
When requested by patient we will supply a health insurance claim form so the
patient can submit the form directly to their own insurance for reimbursement.
Q: Does health insurance pay for the laboratory tests and treatment?
A: 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?
A: Fortunately, blood is easily shipped via express type mail, for example,
FEDEX, DHL, 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".
