{"paper_id":"4bfa7979-77f8-4e66-90d2-09fd0e9b201f","body_text":"Peer Reviewed Journal | Embase Indexed Journal\nAuthor(s): Neeraj Munjal Pahlajani and S Janardhanan\nAbstract:\nBackground: Recurrent implantation failure (RIF) remains a challenging clinical entity in assisted reproductive technology. Immune dysregulation, particularly in patients with endometriosis, has been implicated in implantation failure. This study evaluates the efficacy of empirical immunomodulating agents including Thymosin alpha-1 (Thymovian), Intralipid (Improvian), and Atosiban (Atosivian) in improving IVF outcomes in patients with laparoscopically or imaging-confirmed endometriosis and RIF.\nMethods: This retrospective observational study included 21 patients with history of three or more failed blastocyst transfers with endometriosis confirmed by laparoscopy or imaging, treated between July and December 2025. Patients received empirical immunomodulatory therapy with protocol-based approach: Dual therapy (Thymovian + Improvian) for RIF patients, and Triple therapy (Thymovian + Improvian + Atosivian) for RIF patients with associated adenomyosis/endometriosis. Primary outcomes included biochemical pregnancy rate and clinical pregnancy rate.\nResults: The overall biochemical pregnancy rate was 52.4% (11/21) and clinical ongoing pregnancy rate was 47.6% (10/21). Dual therapy achieved a 60.0% success rate, while triple therapy showed 44.4% success. Early pregnancy loss occurred in 9.1% of positive cases. Minimal side effects (skin rash and itching) were observed in one patient during Intralipid administration; sensitivity testing was subsequently implemented. All other drugs demonstrated excellent safety profiles.\nConclusion: Empirical immunomodulating agents with protocol-based selection demonstrate promising efficacy in patients with confirmed endometriosis and RIF. Dual therapy is recommended for RIF patients, while triple therapy with Atosiban addition is indicated for RIF with adenomyosis/endometriosis. These preliminary results support the role of immune modulation in improving implantation outcomes.\nPages: 1560-1567 | 463 Views | 290 Downloads\nDownload Full Article: Click Here\nHow to cite this article:\nNeeraj Munjal Pahlajani, S Janardhanan. Dual and triple immunomodulatory protocols for recurrent implantation failure in endometriosis and adenomyosis: Clinical outcomes and safety profile. Int J Clin Obstet Gynaecol 2026;10(2):1560-1567. DOI: 10.33545/gynae.2026.v10.i2t.2222","source_license":"CC0","license_restricted":false}