A number of clinics are now prescribing intravenous intralipids for patients who have failed an IVF cycle. The hypothesis is that intravenous intralipids will help to increase the chances of successful embryo implantation . Intralipids are said to suppress the activity of NK cells in the uterus, thus preventing rejection of the embryo.

Empirical treatment

This is yet another example of the large number of empirical treatment options which are being offered to patients who have failed IVF treatment cycles . Many of these fashions and come and go - and after practicing for over 20 years, I am quite skeptical about the value of most of these.

No clinical proof

It's not that I am prejudiced- it's just that a lot of these interventions which are tom-tommed and hyped when they are new will soon be proven to be ineffective and worthless. A handful of small isolated studies that cannot be duplicated on a large scale by other doctors/researchers means it doesn't work. That's where intralipids is right now. As a conservative doctor, I'd rather other clinics tried them out on their patients, rather than use my patients as guinea pigs.

Read more-Empiric Therapy in IVF - Science vs Emotions

This lack of agreement as regards the utility of some of these "treatments" just highlights the fact that we understand very little about why certain embryos implant, while others don't. While I think it's perfectly okay for patients to explore these therapeutic options, I'm very reluctant to prescribe these treatments unless they are low cost and low risk.

Unpredictability

The fact remains that every IVF cycle is a lottery; and that we really have no way of predicting which cycle will work and which will fail. This is hardly surprising, given the fact that we still understand so little about human reproduction in vivo, and cannot even predict when a fertile couple will get pregnant in their own bedroom.

Just like we don't know which couple will get pregnant in the bedroom, we don't know who will get pregnant in the IVF clinic either. Of course, when the patient does get pregnant after an IVF cycle, we very happy to take the credit, but there is no way of prospectively predicting which individual patient's IVF cycle will fail - and which one's will succeed.

What can be done?

Doctors don't like displaying their ignorance to patients, which is why this is one of those dirty little secrets which IVF doctors will not talk about. Fortunately very few patients ask us, "Doctor, why did my IVF cycle succeed ?", so we don't really need to worry too much about this particular question. However, the more closely we study our successes, the more likely we are going to be able to pinpoint exactly what we need to do to increasing the chances of success for all our patients.

A personal decision

So should you take intravenous intralipid if your earlier IVF cycles have failed and your doctor is advising this? I think this is a decision each patient has to make for themselves; and depends to a large extent on what your worldview about medical therapy is.

If you are an interventionist by nature, who wants to use whatever technology is available, whether or not it's experimental and unproven, then you might want to try it. However, if you believe that there is little we can do to alter the outcome of a biological processes, you might want to hold off until we have more clinical evidence.

Unfortunately, the doctor's advice depends on what his worldview is - not yours ! This is why if both doctor and patient have the same philosophical approach towards medical intervention, they are likely to be quite happy with each other. This is why you need to find a doctor who thinks the way you do !