Reproductive System and Pregnancy Open access Peer reviewed

Immunomodulatory treatment protocols with Intralipid and corticosteroids for patients with reproductive failure: Clinical protocols

Tsvetelina Velikova, Maria Kokudeva, Antoaneta Mihova, Adriana Angelova and 1 more

Pharmacia | Aug 19, 2026

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Clinical experience with immunomodulatory protocols combining Intralipid infusions and low-dose corticosteroids suggest that this combined approach is well tolerated, cost-effective, and potentially beneficial for improving reproductive outcomes in appropriately selected patients with infertility.

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Immune-mediated reproductive failure is increasingly recognized in patients with infertility, particularly those with elevated natural killer (NK) cell activity or other immunological abnormalities. This research note presents clinical experience with immunomodulatory protocols combining Intralipid infusions and low-dose corticosteroids. Intralipid, a soybean oil-based lipid emulsion, is used off-label to downregulate NK cell activity, improve implantation, and enhance pregnancy outcomes, whereas corticosteroids modulate excessive immune responses. The protocols are applied during the preconception period and early pregnancy in selected patients following immunophenotyping of peripheral blood cells. Clinical observations suggest that this combined approach is well tolerated, cost-effective, and potentially beneficial for improving reproductive outcomes in appropriately selected patients with infertility. However, the effectiveness of Intralipid therapy and other therapeutic interventions in reproductive medicine remains controversial, highlighting the need for larger, well-designed randomized controlled trials to clarify their clinical benefits.

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Authors

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Tsvetelina Velikova

first | Sofia University "St. Kliment Ohridski"

Maria Kokudeva

middle | Medical University of Sofia | ORCID 0009-0001-2698-8593

Antoaneta Mihova

middle | Medical University of Sofia | ORCID 0000-0002-7911-5147

Adriana Angelova

middle | Medical University of Sofia

Blagovesta Pencheva

last | Medical University of Sofia

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Citation

BibTeX

@article{Velikova2026Immunomodulatory,
  title = {Immunomodulatory treatment protocols with Intralipid and corticosteroids for patients with reproductive failure: Clinical protocols},
  author = {Tsvetelina Velikova and Maria Kokudeva and Antoaneta Mihova and Adriana Angelova and Blagovesta Pencheva},
  journal = {Pharmacia},
  year = {2026},
  doi = {10.3897/pharmacia.73.e168168},
  url = {https://doi.org/10.3897/pharmacia.73.e168168}
}

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