Implantation Failure

What is Aspirin? 

Aspirin is commonly known as a pain killer when taken in its standard dose (300-600mg) but not widely known for its anti-blood clotting functions. Aspirin prevents excessive blood clotting when taken in small doses (75mg) and so is useful in this dose in situations where we wish to prevent excessive blood clotting and/or encourage adequate blood flow through small blood vessels. We recommend that Aspirin is taken as a daily tablet on a full stomach.

What is Prednisolone? 

Prednisolone is a steroid; this is a substance found widely in many hormones and immune mediators in the body. Steroids are therefore a class of drugs that mediate many body reactions and generally boost the functioning of body systems. They are commonly used to mediate immune functions to prevent excessive body reactions to immune stimulus and so reduce inflammation, pain and disease. We recommend that Prednisolone is taken as a daily tablet on a full stomach.

Why do we sometimes recommend Aspirin and/or Prednisolone for women undergoing IVF? 

We may recommend the use of Aspirin and/or Prednisolone to improve the chances of pregnancy and live birth during IVF treatment in women with the following conditions:

• Repeated unsuccessful IVF cycles despite transfer of quality embryos
• Repeated miscarriages (following natural or assisted conception)
• Known auto-immune conditions
• Positive uterine NK-cells
• Advancing reproductive age (usually women over 42 years and/or severely diminished ovarian reserve)

There is no robust evidence backing up the use of these medications during IVF treatment cycles and they are not recommended by NICE. Many fertility Specialists however consider that there is enough anecdotal evidence to justify their use in these difficult situations for which no other interventions exist and so are happy to provide them in such specific situations. We would always discuss the benefits and risks of taking Aspirin and/or Prednisolone with you and only prescribe them with your consent.

Are Aspirin and Prednisolone safe to use in pregnancy? 

Aspirin and Prednisolone are relatively safe drugs to use in pregnancy and there is robust data on their use in this situation. As always, we would prefer you do not take any medication that is not necessary in a pregnancy situation and so would only prescribe these drugs if we believe their benefits in your situation outweigh the risks of their use.

What side effects could you experience with Aspirin and Prednisolone? 

Aspirin is a very well-tolerated drug with few side effects but has been known to cause gastric disturbance (especially if taken on an empty stomach), nausea and vomiting. It’s rare for Aspirin in the low doses (75mg) we use for IVF to cause bleeding problems but we recommend you advise your healthcare providers that you’re taking Aspirin if you develop any bleeding whilst using it.

Prednisolone is a well-tolerated drug with few side effects but has been known to cause nervousness, mood changes, irritability, headaches, bowel dysfunction and insomnia. More severe side effects of Prednisolone are unusual but always discuss with a member of the Aurora team if you have any concerns.

Any further questions?

We hope you have found this information helpful but please speak to your Aurora Fertility Nurse on 01625 617 316 if you have any further questions.

What is Intralipid therapy?

Intralipid infusion therapy is a sterile fat emulsion containing soy oil, chicken egg yolk, glycerine and water. The infusion is in liquid form and administered intravenously. It is a non-invasive procedure carried out in clinic as part of a treatment cycle.

Why is it used?

Research has found that raised natural killer cell activity (toxic white blood cells) can act against an embryo and prevent its implantation into the endometrium. This is known as implantation failure.

In addition, some auto immune disorders can also have a detrimental impact upon the healthy implantation and early progress of an embryo which can also cause implantation failure and early miscarriage. Intralipid therapy is designed to combat these factors.

Who may benefit from intralipid therapy? 

Intralipid infusions can help women who have had implantation failure or early miscarriage/s. Treatment is available for women as part of a treatment cycle at Aurora or women having treatment elsewhere in the UK or overseas.

When is the best time to have the infusions?

A patient will have up to two or three intralipid infusions before a pregnancy test is due and up to three after a positive pregnancy test. The infusions are given as prescribed by your specialist.

How are the infusions carried out?  

As the intralipid is in liquid form it is administered by inserting a cannula (a fine plastic tube) into a vein in the arm or hand. Each infusion takes around an hour during which the patient will be seated comfortably and in private. The patient may eat and drink normally whilst the infusion is taking place and a clinical team member will monitor the patient throughout the appointment.

Are there any noticeable effects of the infusion? 

There are no serious adverse effects with the infusion although some patients may experience a headache, nausea or flu-like symptoms. The infusion is not given to anyone with a known allergy to soy oil, eggs, peanut, peanut based products or any active ingredients in the infusion. After treatment the patient can resume normal activities such as driving.