UNEXPLAINED IVF FAILURE AND RECURRENT PREGNANCY LOSS (RPL).
MANAGEMENT OF IMMUNOLOGIC IMPLANTATION DYSFUNCTION (IID)
Medications in the Treatment of IID
Intralipid (IL) Therapy:
Intralipid (IL) is a solution of small lipid droplets suspended in water. When administered intravenously it provides essential fatty acids, linoleic acid (LA), an omega-6 fatty acid, alpha-linolenic acid (ALA), an omega-3 fatty acid. IL is made up of 20% soybean oil/fatty acids (comprising linoleic acid, oleic acid, palmitic acid, linolenic acid and stearic acid), 1.2% egg yolk phospholipids (1.2%), glycerin (2.25%) and water (76.5%).
There is evidence to show that the subcutaneous administration of heparin twice daily or low molecular heparin (Clexane, Lovenox) once daily, (starting with the onset of ovarian stimulation) can improve IVF birthrate in women who test positive for certain antiphospholipid antibodies (APA) and with certain thrombophilias (e.g. homozygous MTHFR mutation)
What About Baby Aspirin?
In my opinion, aspirin therapy has little (if any) benefit when it comes to IID and in fact might even reduce the chance of success because it thins the blood and increases the potential to bleed, thereby complicating an egg retrieval procedure or causing intrauterine bleeding at the time of embryo transfer. I do not prescribe it during IVF cycles.
TH-1 Cytokine Blockers (Enbrel, Humira)
I do not advocate the use of TH-1 cytokine blockers such as Enbrel and Humira. I believe this to be relatively ineffective in the IVF setting.
Leukocyte Immunization Therapy (LIT)
There is evidence to show that LIT enhances the ability for the mother’s decidua (uterus) to recognize the DQ alpha matching embryo as “self” or “friend” and thereby avert its rejection. However, the same benefit can be achieved through the use of IL plus corticosteroids.