Dual and Triple Immunomodulatory Protocols for Recurrent Implantation Failure in Endometriosis and Adenomyosis: Clinical Outcomes and Safety Profile

Neeraj Munjal Pahlajani, S Janardhanan
In: International Journal of Clinical Obstetrics and Gynaecology · 2026 · vol. 10(2) , pp. 1560–1567 · doi:10.33545/gynae.2026.v10.i2t.2222 · W7160148977
article OA: closed CC0
Full text JSON View on OpenAlex View at publisher
Full text 2,428 characters · extracted from oa-doi-fallback · 4 sections · click to expand

Abstract

Background: 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.

Methods

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.

Results

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.

Conclusion

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. Pages: 1560-1567 | 463 Views | 290 Downloads Download Full Article: Click Here How to cite this article: Neeraj 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

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

endometriosisadenomyosis

Citation neighborhood (no data yet)

We don't have any in-corpus citations linked to this paper yet. This is a recent paper (2026) — citers typically take a year or two to land, and the OpenAlex reference graph may still be filling in.

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
unpaywall
last seen: 2026-06-05T02:00:03.366016+00:00
License: CC0 · commercial use OK