A successful pregnancy after recurrent miscarriages

In December 2016, a couple in their early 30’s visited Nova IVF Fertility, Mumbai for IVF treatment. 6 months prior, in June 2016, the lady had recovered from a right-side ectopic pregnancy that was removed laparoscopically.

Ectopic pregnancy is a complicated pregnancy in which the fertilised egg implants outside the uterus. However, a fertilised egg cannot survive outside the uterus. If left to grow, it may damage nearby organs and may cause life-threatening loss of blood with symptoms including severe pelvic pain and vaginal bleeding. It is a huge risk to the mother’s life and hence ectopic pregnancies must be terminated. While in the early stages, medication may be enough. For later stages, a surgical termination of pregnancy and cleaning of the fallopian tube is required.

The patient also had a complex medical history where she had a hydrosalpinx on her left fallopian tube. A hydrosalpinx is a condition where the fallopian tube is blocked and is filled with serous or clear fluid towards the ovary. As tubal function is impeded, infertility is a common symptom for those who are impacted. Patients who are not trying to get pregnant and have no pain, may go undetected. But those trying to conceive, will fail, as it causes infertility. As a part of the treatment, her left tube was also removed.

She also underwent an ovarian cystectomy for endometriosis in 2012. In addition, in the year 1995, she was also affected by rheumatic fever.

So, in a nutshell, though the patient was in her early 30’s only, she had a very complicated medical history.

Unsuccessful treatment procedures at other IVF clinics

Before coming to Nova IVF Fertility, the couple took IVF treatments at other clinics. They had undergone 3 IUI (Intrauterine Insemination) cycles and 1 ICSI (Intracytoplasmic Sperm Injection) with self-oocytes.

But unfortunately, none of the treatments could help them conceive and this had left the couple totally devastated and heartbroken.

Treatment at the Nova IVF Fertility centre

In the year 2016, the couple decided to consult a fertility specialist at Nova IVF Fertility, Mumbai. At first, the counsellors at Nova helped the couple prepare themselves emotionally and physically for the IVF treatments and to also cope with the stress that couples may face during the IVF treatment process.

The fertility consultant at Nova assessed their case and suggested either of the following options

1. Donor egg IVF cycle
2. Self-oocyte ICSI cycle

The couple decided to go for self-oocyte ICSI cycle in which an embryo was transferred in a remote cycle as frozen embryo transfer. However, this treatment did not lead to pregnancy.

In June 2017 and subsequently in November 2017, the doctor attempted twice with donor egg IVF cycles. Eggs from two separate donors were taken followed by IVF cycles. She conceived in both the cycles, but the pregnancies did not last beyond 12 weeks.

Later, the doctor conducted frozen embryo transfer and transferred 2 embryos in January 2018. These were taken from the previous donor cycle which was performed in June 2017. This time around, the lady was also given intralipids that helped in achieving a positive beta-hCG. It also aided in maintaining a healthy pregnancy beyond 12 weeks and to full term. In September 2018, the couple was blessed with a healthy baby.

Thus, within less than two years, our Nova IVF Fertility team of infertility specialists, counsellors, embryologists and the entire team were able to rally around the couple and make them achieve a dream that would have remained just a dream, given the historical medical complications of the patient.

What is intralipid infusion therapy and when is it used?

Intralipid infusion is a therapy used to prevent recurrent miscarriages. It is a mixture of high calorific natural fats containing soybean oil, egg yolk phospholipids, glycerine and water. In IVF, it is used in patients who test positive for elevated natural killer (NK) cells that attack the embryo, thus preventing it from attaching to the uterine lining.

The natural killer (NK) cells are a specialised subset of white blood cells or lymphocytes. These cells are a component of the innate immune system and are helpful in fighting viral infections or foreign bodies like tumour cells. But in case of women with such auto-immune disorders, these cells consider the embryo to be a foreign body. As a result, the embryo stays unimpeded, thus causing a miscarriage.

With intralipid infusion, this activity of the natural killer cells can be blocked and pregnancy is sustained. Usually, women with auto-immune disorders are given 1 intravenous intralipid transfusion before the IVF/IUI treatment and 1 after the embryo transfer. Some may also need a 3^rd infusion after conceiving successfully.

With the use of intralipid infusions, pregnancy and live birth rates in women with a history of recurrent embryo transplantation failure and / or recurrent miscarriages, due to elevated natural killer cells, have improved considerably.

Apart from its use in IVF treatments, intralipids are also used as a dietary supplement in patients with multiple sclerosis and for those who are undergoing chemotherapy.

In the case of this couple who was facing recurrent miscarriages, the intralipid infusions were the game changer and helped them get pregnant and successfully carry it full term to deliver a beautiful and healthy baby.

Other reasons for recurrent miscarriages

Recurrent pregnancy losses are emotionally as well as physically draining for a couple. For proper treatment, finding the exact cause is of miscarriages is essential. In some cases, the cause may be identified, while in others, it remains unexplained. Some of the common reasons for recurrent miscarriages are:

1. Anatomical conditions such as the shape and structure of the uterus, cervical incompetence, etc.
2. Thrombophilia or clotting of blood.
3. Ovarian factors such as luteal phase defects, infection and chronic endometriosis.
4. Immune factors such as antiphospholipid syndrome, anti-thyroid auto antibodies, paternal sharing of HLA genes, etc.

Exposure to smoking, alcohol and drugs.