Asian Pacific Journal of Reproduction
Successful pregnancy after lipid emulsion therapy in a woman with recurrent pregnancy loss and recurrent implantation failure: A case report
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Abstract:
Rationale: Recurrent pregnancy loss and recurrent implantation failure are frequently linked to immune dysregulation, particularly heightened natural killer (NK) cell activity, cytokine imbalance, and autoantibody presence. Lipid emulsion therapy, originally designed for parenteral nutrition, is increasingly recognized for its immunomodulatory potential in reproductive medicine. Patient concerns: A 34-year-old woman with five years of infertility, four first-trimester miscarriages, and three failed in vitro fertilization (IVF) cycles despite transfer of morphologically optimal embryos presented for evaluation. Diagnosis: Routine genetic, endocrine, metabolic, thrombophilia, and anatomical investigations were unremarkable. Immunological testing revealed elevated antiphospholipid and anti-thyroid peroxidase (anti- TPO) antibodies, increased NK cell activity, an imbalanced Th1/ Th2 cytokine ratio, and raised tumor necrosis factor-alpha (TNF-α), suggesting immune-mediated reproductive dysfunction. Interventions: The patient underwent IVF with transfer of a single euploid blastocyst following intravenous lipid emulsion therapy (20%, 100 mL), administered before transfer, on transfer day, and biweekly until 12 weeks. Associated therapies included aspirin, enoxaparin, progesterone, levothyroxine, and supplementation. Outcomes: Serum beta-human chorionic gonadotropin (β-hCG) and ultrasound confirmed pregnancy with subsequent NK cell normalization. The pregnancy was uncomplicated, resulting in spontaneous vaginal delivery of a healthy male infant. Lessons: Lipid emulsion therapy may improve implantation and pregnancy outcomes in immune-mediated recurrent pregnancy loss and recurrent implantation failure, but larger trials are required to validate efficacy and optimize protocols.
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