Controversy exists regarding the benefits of intravenous
intralipid therapy in patients with a poor reproductive history. It is frequently reported that there is no evidence to support the effectiveness, utility or safety for this treatment. While individual studies may be perceived as weak, a systematic review and meta-analysis were performed to determine if there is any advantage to patients. PubMed, Embase and Scopus searches were performed with the target populations being either recurrent pregnancy loss (RPL), or recurrent implantation failure (RIF) undergoing assisted reproductive technology (ART) and receiving
intralipid infusions. These cohorts were compared with either placebo, no intervention or alternative treatments. The most relevant outcome measures were considered to be clinical pregnancy rate (
CPR), live birth rate (LBR), implantation rate (IR) and
miscarriage rate (MR). Twelve studies encompassing 2676 participants met the criteria for selection and were included and reviewed. Treatment of the target population with
intralipid led to an improvement in IR (Odds Ratio (OR): 2.97, 2.05-4.29), pregnancy rate (OR: 1.64, 1.31-2.04), and LBR (OR: 2.36, 1.75-3.17), with a reduction in MR (OR: 0.2, 0.14-0.30). Although intravenous
intralipid is not recommended as a routine treatment for
recurrent miscarriage or implantation failure, there is enough data to suggest consideration in selected patients where routine testing is unremarkable, standard treatments have failed and immunological risk factors are present. The presence of abnormal uterine natural killer (uNK) cells needs more study as a target marker to determine those who could benefit.
LAY SUMMARY: There is controversy regarding the benefits and efficacy of intravenous
intralipid therapy in patients with a poor reproductive history. It is frequently reported that there is no credible evidence to support their use. A situation we frequently face as medical professionals is patients asking us to consider immune
therapy (such as
intralipid) for reproductive failure where good quality embryos have been used.
Intralipid infusions have been reported to improve pregnancy rates with IVF, and reduce the
miscarriage risk in selected patient groups, but study results are not universally accepted. We have performed a detailed review and analysis of the literature to determine if there is any benefit to this immune treatment in specific patient groups. Our paper identified and analyzed 12 studies, finding that treatment with intravenous
intralipid leads to an improvement in implantation, pregnancy and live birth rates, with a decrease in
miscarriage rate. This study shows that there is evidence to suggest consideration of
intralipid in certain patients where standard treatments have failed.