Intra lipid infusion: A revolution or fad?
Recurrent IVF/ICSI failure(RIF) has a devastating social and psychological effect on the affected couple. Some scientists believe that the immunological system has a hand to play in RIF while others believe the quality of the embryos are more important than immunological factors. The components in question are the NK (Natural Killer) cells and TNF (Tumour Necrosing Factor)- Alpha.The premise of the pro-immunology scientists’ is simple; they believe the foetus’s genetic code is different from the mother’s hence the women’s body may reject the foetus unless her immune system is suppressed.
Types of immunological modifiers currently available and their effects:
Intra lipid infusion:
Intra lipid(IVIL) is a solution of soya bean oil, egg yolk and glycine in normal saline. It is high in calories with essential fatty acids usually administered in patients who require extra nutritional supplementation. It’s believed to have a stabilizing effect on the cell membranes which reduce the action of natural killer(NK) cells on them. RCOG in 2015 stated that there is no rationale for using IV Intra lipids. Some of the side effects recorded are severe sepsis if not administered properly and a hypercoagulable state. Patients who are IgA deficient are recorded to have severe side effects.
Immunoglobulins(IVIg) are highly purified components retrieved from large amounts of human plasma. They are usually administered in patients who are severely immune deficient (Agammaglobulinemia, Rheumatoid Arthritis, ITP, Haemophilia, etc.) Side effects with Immunoglobulins are rare however fever, headache, kidney failure and anaphylactic shock have been reported. Immunoglobulins are also believed to suppress NK cell activity and like intra lipid infusion, immunoglobulin infusion is also heavily debated) ASRM from 5 randomized trials has reported a possible beneficial effect of IVIg for secondary RIF. Due to the wide unavailability of IVIg, IV Intra lipids are more researched on.
Corticosteroids suppress NK cells and along with them the complete immune system as a whole. There is no proven advantage of using it in pregnancy and the risks to the baby outweigh the benefits. Some studies show that it increases blood pressure, diabetes and premature births.
Lymphocyte Immune therapy:
Prepared from the white blood cells of father (or donor) and is usually injected into the mother such that her immune system develops a tolerance to the foetus. This therapy allegedly increases blocking antibodies which protects and stimulates placental cells. Developed and studied on by the late Dr. Alan Beer who send his patients to Mexico to get this treatment done because it was banned in the United States. Although LIT has provided mixed results in terms of pregnancy rates , it cannot be warranted as a mainstream treatment without sufficient controlled trials.
Adalimumab(Humira) is a TNF- Alpha inhibiting, anti inflammatory medication (similar to methotrexate) used to treat rheumatoid arthritis, psoriasis, Crohn’s disease,etc. Since this treatment is an immune suppressant it increases the risk of infection, especially in Indians where the latent tuberculosis is very common.
G-CSF was found to improve on the implantation rates in patients missing the Killer-cell Immunoglobulin like receptors (KIR). Women with RIF have not shown any beneficial effects in several trials, although endometrial perfusion of GCSF may be effective in expanding unresponsive endometrium. G-CSF has the potential to improve endometrial thickness but has minimal effect in patients with recurrent implantation failures. This opens up a complete new field of reproductive medicine called Reproductive Immunology which will help us better understand the complexities of immune system in relation to implantation and pregnancy.
All of these medications are still at the experimental stages so prior to agreeing to these modalities do ask your specialist these questions.
- Why do you think I need this treatment?
- How will these improve my chances of having a successful pregnancy?
- What are the side effects of the treatment?
- What re the costs involved?
What are your views on these newer modalities? Let us know in the comments below.