Successful pregnancy after lipid emulsion therapy in a woman with recurrent pregnancy loss and recurrent implantation failure: A case report

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.

Keywords

Recurrent implantation failure / Recurrent pregnancy loss / Lipid emulsion therapy / Assisted reproductive technology / In vitro fertilization

Conflict of interest statement

There are no conflicts of interest.

Funding

The study received no extramural funding.

Authors’ contributions

Varaganti Pravardhan contributed to the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed on all aspects of the work. Nancy Nair,

Varaganti Venkata Sai Suvardhan, Aarya Lele, and Rajasi Sengupta contributed to the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed to all aspects of the work.

Publisher’ s Note

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