IVIg alternative- Intralipids

For those women who need IVIg therapy but cannot afford the heafty price tag that comes with it will be happy to know that SIRM doctors ar pioneering the field and have had great success with Intralipid treatment.

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.

Adviating 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.

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.
SIRM physicians 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.

So there is now hope for women who need IVIg treatment, but cannot afford it. To get more informaiton about Intralipids and the nearest SIRM center visit, www.haveababy.com.

What is IVIg Therapy?

Having to go through one miscarriage can be terribly upsetting; experiencing multiple miscarriages can be devastating. However, depending on the reason for your recurrent pregnancy loss, treatment may be available to help you maintain a pregnancy. Intravenous immunoglobulin G (IVIg) is an intravenous drug given to women prior to conception through to the sixth month of pregnancy. Although it won’t help all women, those who have experienced recurrent pregnancy loss due to autoimmune factors may find that IVIg is just what they need to maintain their pregnancy.


Using donor blood that has been washed and processed, IVIg is made up of human-derived antibodies. These antibodies help to keep your immune system from recognizing an embryo or fetus as foreign and attacking it. More specifically, IVIg aids in minimizing the actions of natural killer (NK) cells. Amplified levels of NK cells can prevent an embryo from implanting as well as interfere with the proper development of the placenta, which in turn prevents the embryo from developing normally. All of these factors can result in a miscarriage.

Precisely how IVIg works is not entirely clear. It is thought that the drug may block those antibodies that cause your body to reject a pregnancy. However, it is also speculated that IVIg may work by soaking up and defusing the harmful antibodies that can interfere with a pregnancy.

In general, women who have elevated levels of natural killer cells resulting in recurrent miscarriages are thought to benefit the most from IVIg treatment. Yet, recent research has also shown a connection between increased natural killer cell activity and antiphospholipid antibodies (APA): it appears that those with APA are more likely to have elevated NK cells.

Typically, women whose miscarriage problems were linked with APA were treated exclusively with heparin and aspirin. Because of the relationship between APA and NK cells, however, more fertility specialists are testing women affected by APA for NK cells as well. If there are elevated levels of NK cells, then these women will likely be treated with IVIg instead of the common treatments for APA.

In general, IVIg therapy should be started from the first month of pregnancy and continue until the 28th week of pregnancy. However, there is some evidence to suggest that administering IVIg infusions even before pregnancy occurs may be beneficial in preventing miscarriage. IVIg therapy is often done monthly and doses can be given anywhere from one to three consecutive days.

Because IVIg is administered intravenously, to receive this treatment, an IV catheter will be inserted into a vein in your hand or lower arm. This will allow the IVIg solution to slowly drip into the vein and enter your system. Although IVIg can be administered in your home under the supervision of a nurse, the very first time you receive treatment you will need to visit your fertility specialist. The first infusion is always done in a clinical setting under proper supervision in case you experience a severe reaction to the drug.

In order to guard against unpleasant side effects, IVIg infusion must be done slowly. This means that one session can take several hours to complete. However, if you seem to be dealing with the treatment well with minimal side effects, it may be possible to complete treatment sessions sooner. Just how much IVIg a person should receive can vary as dosage is calculated according to your weight.

IVIg can greatly improve your chances of having a successful pregnancy after recurrent miscarriage. Some studies have shown a success rate as high at 80% with the use of IVIg therapy. However just like fertility treatments this therapy comes with a hefty price tag.
Depending on how much IVIg is required for your treatment, each dose could cost as much as $1500. This means that receiving IVIg therapy during your pregnancy could cost in excess of $10,000. Unfortunately, many insurance companies do not cover IVIg therapy (although it doesn’t hurt to contact your insurance provider to double check). As a result, not every couple will be able to afford this treatment.


There are some alternatives to this therapy that are more affordable for women, I will discuss these alternatives in our next blog entry so stay tuned for some valuable information.