A couple came to our Fertility Center after 3 failed IVF trials. They were trying to conceive since 2010. This couple had a miscarriage during the 5th week of gestation and they had an failed insemination before they got into the IVF trials. They tried the first embryo transfer 2014, the second trial the same year with a miscarriage as a result, while the third trial was also ineffective.
The woman (37 years old) was tested by ultrasound for any anatomical problems in her reproductive system. Also, quantity and quality of ovaries were tested by AMH and inhibin B, which were normal.
On the other hand, husband’s (37 years of age) sperm analysis was normal, but DNA fragmentation was also measured for preventive reasons, which was in excellent condition (DFI=6.5%), and very important for high chances of fertilitization.
The next step was the immunological testing for the woman. It was observed increase in the endometrial NK cells, and PLA (platelet-leucocyte aggregates) was also high. It was explained to the couple that that was the major reason for the implantation failure and the major therapy was to regulate the level of the endometrial NK cells. Based on the diagnostic result, the appropriate dosage of intralipid was intravenously infused, and the husband was advised to try for the act of fertilization naturally.
After 2 months of consecutive trials, they notified our center for positive pregnancy test. Immediately, a dosage of intralipid was administered for regulation of NK cells until the first trimester. During the whole pregnancy period, everything went normally and last May the couple has a healthy baby boy at their home after seven years of infertility.
CAUTION TO COUPLES: The infusion of intralipid based on an old protocol with 2 or 3 infusions of 250 ml (one before the embryotransfer or before the (PT) pregnancy test) and 3 infusions after a positive PT, which is administered by anesthesiologist or cardiologist is totally wrong and is not suitable for the successive inhibition of NK cells in reproductive immunology. Also, this dosage is way too much for a woman that wants to be pregnant, and doesn’t contribute to inhibition of NK cells, BUT leads to magnificent increase of NK cells (total and endometrial) and the results will be failed IVF or miscarriage of the embryo.
Conclusively, the administration of intralipid MUST be performed ONLY by specialists, which have the knowhow and experience in clinical and laboratorial issue of NK markers (total, endometrial NK, and activity of NK cells). Couples have to be careful because some labs show a series of CDs, where the claim that is the analysis of NK cells, and they confuse the public. It must be noted that these labs just test of reproductive immunophenotype, which is the subpopulation of lymphocytes.
Serious Side Effects
The administration of high dosage of intralipid (1 of 250ml) can cause a series of serious adverse effects has been reported: acute kidney injury, cardiac arrest, acute lung injury, venous thromboembolism, fat embolism, fat overload syndrome, pancreatitis, allergic reactions and increased susceptibility to infection (Hayes et al., 2016).