The Effect of Fat Emulsion Intralipid 20% in Reproductive Outcome for Patients With Multiple Implantation Failure

Multiple implantation failure (MIF) is described as implantation failure in spite of transferring good quality embryos following several in vitro fertilization (IVF) treatment cycles (1). Implantation is a complicated process that requires healthy embryos with receptive endometrium. Many factors can lead to implantation failure due to either maternal or embryonic factors. Uterine anatomy, thrombophilia, immunological factors, and a non-receptive endometrium are amongst the maternal factors and genetic or lab related are amongst the embryonic factors (1). The patient with repeated implantation failure is a challenge for the infertility specialists. Age remains the most important variable influencing outcome in assisted reproduction (2-4). Advanced maternal age manifests its effects on the clinical in vitro fertilization embryo transfer (IVF-ET) procedure that is due to the variable effects on the pattern of ovarian response and on the reduction of implantation efficiency and due to an increased spontaneous abortion rate (2-4). Impaired uterine receptivity leads to implantation failure in assisted reproduction (2-4). Thrombophilia and abnormal immunological response could result in a non-receptive endometrium (2-4) and eventually in implantation failure. Investigation about recurrent implantation failure includes tests for inherited and acquired thrombophilias and with immunological causes. Management should be individualized according to the different etiologies and empirical treatments with low molecular weight heparin (LMWH). Aspirin or corticosteroids are not effective for women with RIF whose test results are negative in thrombophilic tests (2-4). If leukocyte antigen dissimilarity is proven immunologically, treatment with intravenous immunoglobulin (IVIG) might be helpful; however, treatment with intralipid infusion in the presence of increased natural killer cytotoxic activity could be helpful too but is still controversial. Data supporting this practice is conflicting. The suggested therapy in recurrent implantation failure is intralipid, which is a fat emulsion containing soybean oil, glycerin, egg phospholipids, glycerol, and water. It provides essential fatty acids, linoleic acid, omega-3 and 6 fatty acids, and alpha-linolenic acid (5). Intralipid suppresses natural killer cell activity (NKa) is similar to the effect of IVIG (5). Intralipid is a milky solution, originally used to provide energy to the patients who could not eat (6) and it is made of purified soybean oil and egg phospholipids. Intralipid has been initially used for parenteral nutrition in patients who are unable to take food orally (6). The mechanism of Abstract Objectives: The aim of this study is to evaluate the effect of fat emulsion intralipid 20% on reproductive outcome of patients with multiple implantation failure (MIF). Materials and Methods: A retrospective study of 30 women with MIF who received intralipid 20% with in vitro fertilization, intracytoplasmic sperm injection (IVF-ICSI). The treatment cycle was conducted in reproductive endocrine and infertility medicine department (REIMD) at Women Specialized Hospital, King Fahad Medical City (KFMC), from January 2015 to December 2016. Results: Thirteen of 30 women (43.3%) had a positive pregnancy test and 17 (56.7%) did not. Pregnancy rate showed no statistically significant difference with the use of long protocol in comparison to short antagonist protocol. Use of intralipid 20% did not affect the embryo grading or yield the higher number of frozen embryos. Conclusions: MIF is a challenging situation in reproductive medicine. Intralipid 20% might be an effective treatment for patients with MIF.