Intralipid Immunotherapy for Repeated IVF Failure

Abstract

The intravenous fat emulsion, intralipid, has been hypothesised to be an effective and safe treatment for repeated in vitro fertilisation (IVF), implantation failure and pregnancy loss. This exploratory, retrospective cohort study determined pregnancy outcomes and documented adverse events associated with intralipid use. Ninety-three women were identified as having received intralipid for a history of repeated unsuccessful IVF cycles and pre-viable pregnancy loss in two Australian IVF units that independently recruited between October 2014 and July 2016. Pregnancy outcomes and adverse events were recorded in fresh and frozen embryo transfer cycles in which the infusion was administered. The 93 women who received intralipid had a clinical pregnancy rate of 40.0%, compared with 35.0% in 651 age-matched controls undergoing IVF, which was not significantly different. The intralipid group had a livebirth rate of 35.7%. Apart from flushing, which was experienced by one individual, there were no adverse events associated with intralipid use. As a prelude to definitive evidence of benefit, we did not identify a safety concern or reduced pregnancy rates in intralipid users compared to controls. Indeed, these outcomes were better than expected in a poor prognosis group. This data supports an argument for large, randomised controlled trials to determine the benefit of intralipid in the treatment of recurrent implantation failure or miscarriage.

Immunological Risk Factors in Recurrent Pregnancy Loss: Guidelines Versus Current State of the Art

“…Still, comparing previous studies proves to be complex due to different outcomes such as LBR, clinical pregnancy rate, implantation rate, and various investigated groups (RPL, RIF, idiopathic, non-idiopathic, with or without biomarkers). Concerning safety, several studies and reviews observed no concerns [ 57 , 151 , 152 , 154 , 155 ].…”

Intralipid treatment for women with reproductive failures

“…Evidence from both animal 20 and human 3,4,18,21‐23 studies suggests that intralipid administered intravenously may enhance implantation and maintenance of pregnancy. However, not all human studies have shown an improvement in pregnancy outcome after treatment with intralipid 24‐30 . The results of these studies are summarized in Table 1.…”

“…Chemical pregnancy was recorded for 84 (58.3%) of 144 women in the intralipid group and 76 (50%) of 152 in the control group ( P = .129) 24 . Among the studies that selected patients for treatment based on reproductive history alone, 26‐30 all reported no enhancement after intralipid treatment except one 25 . In one study 21 showing the benefit of treatment with intralipid, 27 of 68 women (40%) with a history of recurrent implantation failure became pregnant after in vitro fertilization and embryo transfer.…”

“…While these side‐effects have been reported in patients who were receiving their nutrition through an injection into the vein, no side‐effects of diluted intralipid infusions used to treat young women experiencing reproductive failure have been observed 29,30 …”

Natural Killer cells role in embryonic implantion

“…Other studies emphasize that this methodology should not be routinely made available to patients, since its real effectiveness is doubtful because it does not have an established population profile for use and, for presenting a reasonable rate of success pregnancy and births with use of this emulsion, in addition to contesting its profitability, since its use at the lowest cost does not exceed any small benefit that it may cause, and is therefore inferior to other techniques. [29][30][31] Conclusion NK cells are important for immunity, since it destroys cells not compatible with normal function of organism. Differentiation into uNK is essential for gestational evolution, since they act on decidua vascularization.…”