Abstract
Recurrent implantation failure (RIF) affects 10% of couples undergoing assisted conception, often due to poor endometrial receptivity. We conducted a systematic review and meta-analysis to evaluate the effectiveness of Intra-venous intralipid (IVI) in improving pregnancy rates in women with history of RIF using. We searched MEDLINE, EMBASE, and CENTRAL for any randomized trials evaluating the use of IVI at the time of embryo transfer in women undergoing assisted conception until September 2020. We extracted data in duplicate and assessed risk of bias using the Cochrane Risk of Bias tools. We meta-analyzed data using a random effect model. We included five randomized trials reporting on 843 women with an overall moderate risk of bias. All trials used 20% IVI solution at the time of embryo transfer compared to normal saline infusion or no intervention (routine care). The IVI group had a higher chance of clinical pregnancy (172 vs 119, risk ratio [RR] 1.55, 95% confidence interval [CI] 1.16-2.07, I2 44.2%) and live birth (132 vs 73, RR 1.83, 95% CI 1.42-2.35, I2 0%) post treatment compared to no intervention. Our findings are limited by the small sample size and the variations in treatment protocols and population characteristics. There is limited evidence to support the use of IVI at the time of embryo transfer in women with the history of RIF. More research is needed before adopting it in clinical practice.
Highlights
More and more couples rely on assisted reproductive technology (ART) to become pregnant worldwide, with an annually rising numbers of cycles performed.[1]
Mothers with history of recurrent pregnancy loss and implantation failure seem to have an impaired immunological response driven by an increased activity of uterine natural killer, macrophages, and T1 helper cells elevating cytokine production and cytotoxicity in the endometrium.[11,12,13]
We reported on dichotomous outcomes using risk ratio (RR) and 95% confidence interval (CI)
Summary
More and more couples rely on assisted reproductive technology (ART) to become pregnant worldwide, with an annually rising numbers of cycles performed.[1]. Our increased understanding of the implantation window characteristics governed by subtitle yet highly regulated pro- and antiinflammatory responses[7, 8] highlighted the potential effect of aberrant immune responses on implantation and pregnancy outcomes.[9] The role of immunotherapy to regulate the maternal immune system has received much attention recently, with a presumed effect in improving endometrial receptivity and the chances for successful conception.[10] Mothers with history of recurrent pregnancy loss and implantation failure seem to have an impaired immunological response driven by an increased activity of uterine natural killer (uNK), macrophages, and T1 helper cells elevating cytokine production and cytotoxicity in the endometrium.[11,12,13] effective screening and diagnostic methods are lacking which limits the process of patient and treatment matching. Various immunological therapies have been evaluated as ART add-on treatments, but evidence of their value to the general population remains unclear.[14]
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