A 44 year old lady visited our fertility center with her 52 year old husband with 10 year infertility medical record at September 2016. The lady was submitted in laparoscopic surgery for endometriosis at 2007, and at 2010 she performed laparoscopic surgery and removed the right salpinx and a year later the left one was removed respectively.
The couple has started attempts for a baby since 2008 and they had their IVFs from 2011 until May 2016, and they never had a successful pregnancy. So, they heard about our center and wanted to exhaust their last chance so they would not let down their dream to have a baby.
Their next step according to our guidance was to do our specific individualized immune tests. The lady was tested for NK panel (total, endometrial NK cells, and their activity), where the endometrial NK number was too high. Also, Platelet-leucocyte-aggregates (PLA) test was performed and this marker was high too. We explained the couple that NK was the major reason for their failed implantation, and we planned therapeutic strategy in order to regulate the NK cells and go to next IVF trial with much higher chances for successful pregnancy. On the other hand, Husband’s sperm analysis and DNA fragmentation were fine, while the levels of Vitamin D3 of the lady were low and we administered supplement of Vitamin D3 and baby aspirin.
Based on the diagnostic result, 2 dosages of intralipid were administered before the embryo transfer in order to regulate suitably the NK cells for the next IVF trial. Then, the process of embryo transfer of 2 embryos followed and after 10 days a positive pregnancy test was detected for the FIRST TIME after so many years. Then a final dosage of intralipid was administered, so the danger of miscarriage can be limited down at the first trimester of gestation. At the first UV one embryo was detected with positive heart beats and pulses, and the couple was very happy. Later, The Nuchar translucency screening was followed and level 2 ultrasound by Dr. Spyros Papageorgiou and the pregnancy continued normally without any problems. The baby was born at November 2017 with 3100gr weight and the couple was very happy after all these 10 years of trials.
CAUTION: 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).