SIRM physicians have long advocated aggressive treatment of immunologic implantation dysfunction in women undergoing IVF. In cases where there has been Natural Killer Cell activation (Nka) (as evidenced by an abnormal K562 target cell test) we have championed the use of IVIG to down-regulate (deactivate) the Nka. In this manner, many women who otherwise might not have achieved success with IVF have gone from infertility to family.
For us at SIRM, advocating the use of IVIG over the last decade, has come at a considerable price. Clearly, women requiring IVIG have been concerned about the cost (more than $4000 per dosage), reported side effects and, given the HIV/hepatitis scare, have been reluctant to receive a blood product. To make matters worse, under-informed critics have for unexplained reasons played on such unfounded fear often raising it to the level of alarm. The fact is that over the years we have administered IVIG to thousands of women, without a single report of viral transmission and few significant (but always transient) side effects.
About a year ago reports began to surface regarding a low cost (about ten times less than IVIG) synthetic product called Intralipid, which upon being infused more than a week prior to embryo transfer would lower Nka and further more, was virtually free of side effects.
About a year ago, we began evaluating the effect of Intralipid in patients who had activated Natural Killer cells, and for whom IVIG therapy would otherwise be indicated. Thus far we have treated more than 30 women with Nka using Intralipid 20%. More than 60% of the patients achieved viable ongoing pregnancies, showing Intralipid therapy to be at least as effective (and perhaps even more so) than IVIG. There were no significant side effects and patient tolerance of this treatment was high. We anticipate that patients receiving Intralipid will soon start reporting on their experience using Intralipid, on various discussion boards.
Against this background, SIRM physicians have collectively decided to virtually abandon further use of IVIG, in favor of Intralipid.
Below are some clinical details about Intralipid:
Intralipid (IL), is a synthetic product composed of 10% soybean oil, 1,2% egg yolk phospholipids, 2.25% glycerin and water. Based on research performed at SIRM and elsewhere, infusion of IL lowers Natural Killer cell activation (Nka) as effectively as does, intravenous gammaglobulin (IVIG.) When indicated IL (as with IVIG) is infused 7-10 days prior to ET and one more time again after a positive pregnancy in women whose Nka is due to an autoimmune causes (antiphospholipid antibodies and/or antithyroid antibodies). In cases of alloimmune implantation dysfunction (DQa and/ HLA matching between the embryo recipient and the male partner) the same applies but in this situation the infusion is repeated at 2-4 week intervals until the 24th week of pregnancy.
We have supplanted IVIG with IL therapy in a significant number of women undergoing IVF , and who had immunologic embryo implantation dysfunction. The results thus far have been excellent, way beyond our initial expectations.
At last we now have a safe and inexpensive alternative to IVIG therapy…Intralipid! What is more, IL costs about 10 times less than IVIG, is not a blood product and is without significant side effects.