Human reproductive failure is not a clinical feature associated with beta(2) glycoprotein-I antibodies in anticardiolipin and lupus anticoagulant seronegative patients (the antiphospholipid/cofactor syndrome)

It has been suggested that patients with clinical features suggestive of antiphospholipid syndrome but being lupus anticoagulant (LA) and anticardiolipin (aCL) negative, should be tested for antibodies to beta(2) glycoprotein-I (abeta(2)GP-I), a protein involved in the binding of antiphospholipid antibodies (aPL) to phospholipid surfaces. This was investigated in the present study where a total of 385 women aged 相似文献   

The Use of Combined Heparin/Aspirin and Immunoglobulin G Therapy in the Treatment of In Vitro Fertilization Patients With Antithyroid Antibodies

PROBLEM: To compare the effect of heparin/aspirin therapy alone vs. heparin/aspirin in combination with intravenous immuno-globulin (IVIg) immunotherapy on in vitro fertilization (IVF) outcome of patients who test positive for antithyroid antibodies (ATAs). METHOD OF STUDY: Eighty-two women younger than 40 years of age whose infertility was related exclusively to female causes were evaluated. All tested positive for organ-specific antithyroid antibodies (antimicrosomal and/or antithyroglobulin antibodies), but negative for antiphospholipid antibodies. Thirty-seven of these women (group A) received H/A alone, whereas 45 (group B) received heparin/aspirin in combination with IVIg. RESULTS: Ten (27%) of women in group A and 23 (51%) of women in group B achieved live births after completion of a single IVF/embryo transfer cycle (P = 0.027). CONCLUSION: We conclude that IVIg therapy significantly improves IVF success rates in ATA+ women.     

Anticardiolipin antibody levels in women undergoing first in vitro fertilization/embryo transfer

BACKGROUND: The clinical relevance of antiphospholipid antibodies (aPL) in women undergoing in vitro fertilization/embryo transfer (IVF/ET) and the role of IVF treatment in affecting antiphospholipid levels are controversial. The aim of this study was to evaluate anticardiolipin antibody (aCL) levels and the effect of IVF treatment on aCL in women undergoing their first IVF/ET cycle. METHODS: Immunoglobulin G (IgG)- and IgM-aCL were determined by enzyme-linked immunosorbent assay in 50 women undergoing IVF/ET, 18 due to endometriosis, 16 to tubal factor (TF) and 16 to male factor, before starting treatment (T0), on the day of oocyte retrieval (T1) and 14 days after ET (T2). A group of 31 age-matched fertile women served as controls. RESULTS: aCL levels detected at T0 in patients were not significantly different compared with the control group. IgG- but not IgM-aCL significantly increased at T2 in comparison with T0 (P < 0.001) and T1 (P < 0.05). The difference between T2 and T0 reached statistical significance in patients with endometriosis (P = 0.003) or TF (P = 0.018). No relationship was found between aCL and pregnancy. CONCLUSIONS: Our results indicate that IVF treatment increases IgG-aCL levels in patients with endometriosis and TF, but their presence seems to have no clinical relevance.     

血清和卵泡液中抗精子抗体对体外受精——胚胎移植的影响

目的 评价女性抗精子抗体对体外受精－－胚胎移植（ＩＶＦ－ＥＴ）的影响。方法 采用ＥＬＩＳＡ法测定施行ＩＶＦ－ＥＴ的妇女的血清和卵泡液中抗精子抗体（ＡｓＡｂ）。Ａ组：血清ＡｓＡｂ阳性１３例;Ｂ组：血清及卵泡液ＡｓＡｂ均阳性２９例;Ｃ组：ＡｓＡｂ阴性１５８例。分析３组受精率、卵裂率、胚胎发育情况及临床妊娠率和流产率的关系。结果：Ａ、Ｂ组受精率、卵裂率明显低于Ｃ组（Ｐ〈０．０１）。移植日,Ａ、Ｂ组Ⅰ－Ⅱ级胚胎率较Ｃ组低,Ⅳ级胚胎及２原核受精细胞增加（Ｐ〈０．０５）。各组妊娠率及流产率无显著差异（Ｐ〉０．０５）。结论 ＡｓＡｂ对ＩＶＦ和早期胚胎发育有损害,体外培养不能完全清除ＡｓＡｂ对ＩＶＦ－ＥＴ的影响。     

In-vitro fertilization treatment for unexplained recurrent abortion: a pilot study

To determine the effectiveness of in-vitro fertilization (IVF)and embryo transfer for patients with unexplained habitual abortion,we carried out a prospective observational study using a historicalcomparison group. A total of 12 couples with three or more (mean4.91, range 3–10 miscarriages) first trimester spontaneousabortions of unknown aetiology were treated with IVF and embryotransfer (group 1). Patients underwent IVF after combined gonadotrophin-releasinghormone agonist/gonadotrophin treatment for ovarian stimulation,and three to four embryos were replaced into the uterus in allwomen. Eight of the 12 women (66.6%) in group 1 became pregnant(one patient after a frozen-thawed embryo transfer), and allof them had viable pregnancies. A patient with 10 previous abortionsbecame pregnant and carried to term after IVF and embryo transfer,and subsequently miscarried two new spontaneous gestations.A historical comparison group (group 2) included the last eightwomen with unexplained recurrent abortion (mean 4, range 3–8miscarriages) who underwent the same investigations for thecondition and received identical early supportive care in theirnext spontaneous pregnancy as patients in group 1. Three ofthe eight pregnancies in group 2 ended in an abortion. Our resultssuggest that IVF and embryo transfer may be a new therapeuticapproach for unexplained recurrent miscarriage.     

Pregnancy: Antiphospholipid antibodies and human reproductive failure

Routine screening for circulating antiphospholipid antibodies(aPL), namely the lupus anticoagulant (LA) and anticardiolipinantibodies (aCL), was carried out in a total of 1273 women aged<45 years. Of them, 822 were experimental subjects and 451were controls. The former comprised the following three studygroups: 498 infertile patients (group 1), 284 spontaneous recurrentaborters (group 2), and 40 patients with repeated failure ofembryo transfer (group 3). Controls included five groups ofwomen: 125 normal healthy women who had never been pregnant(group 4), 125 normal healthy parous women with no previousabortion (group 5), 52 women in labour after normal pregnanciesat term (group 6), 49 infertile patients achieving a livebirthwith their first in-vitro fertilization (IVF) and embryo transfer(group 7), and 100 female patients with systemic lupus erythematosus(positive controls, group 8). aPL positivity in the eight groupsstudied was as follows: 2.4, 9.2, 10, 0.8, 0, 0, 0 and 42% respectivelyfor groups 1 to 8. There were no differences within groups 1and 3 regarding incidence of aPL when patients were groupedaccording to infertility aetiological factors and indicationsfor IVF respectively. Twenty-six out of 284 recurrent aborters(9.2%) tested positive for aPL, and the LA and/or aCL were identifiedas the aetiological factor in 12% of patients (24/199) withsupposedly unexplained recurrent abortion. Incidence of positivesera for aPL in group 1 was similar to that observed in controlgroups 4, 5 and 6. On the contrary, incidence of aPL positivityin groups 2 and 3 was significantly higher than in control groups4, 5 and 6 and among infertile women (group 1). The differencebetween groups 3 and 7 almost reached statistical significance.Interestingly, there was no difference between groups 2 and3, but groups 2 and 7 resulted probably different regardingincidence of aPL positive sera. As expected, the highest incidenceof patients testing positive for aPL was found in group 8. Seveninfertile patients having circulating aPL and becoming pregnantspontaneously or after specific infertility treatment, successfullycarried to term in spite of the fact that they did not receiveimmunotherapy. Among recurrent aborters, the live-born babyrate was significantly higher after treatment with low-doseaspirin than prior therapy. It is concluded that the presenceof circulating aPL may be associated with recurrent abortionbut not with infertility. In addition, our results favour apossible role of aPL hi failure of implantation after IVF andembryo transfer.     

Chemical pregnancies: immunologic and ultrasonographic studies

PROBLEM: Implantation of the embryo determines successful from unsuccessful cycles after in vitro fertilization (IVF) and embryo transfer (ET). The purpose of this study was to compare immunologic risk factors among women experiencing implanation failure characterized by a negative pregnancy test after IVF/ET and those experiencing chemical pregnancies. In addition ultrasonographic measurement of gestational sac size from 24 to 35 days from last menstrual period (LMP) were compared between chemical pregnancies and other pregnancy outcomes. METHODS OF STUDY: Blood samples from 122 women experiencing IVF implantation failure with a negative pregnancy test after ET and 20 women with chemical pregnancies were evaluated for the presence of antiphospholipid antibodies (APA), antinuclear antibodies (ANA), circulating embryotoxins (ETA) and elevated levels of natural killer (NK) cells. Gestational sac size measured from 24 to 35 days form LMP were compared according to pregnancy outcome: term birth (n = 46), ectopic pregnancy (n = 49), spontaneous abortion (n = 56) and chemical pregnancy (n = 20). RESULTS: Women experiencing chemical pregnancies had a higher frequency of APA than women with implantation failure associated with a negative pregnancy test (80% versus 28%, P < 0.0001). The prevalence of ANA, elevated NK cells and ETA was not different between the two groups. The mean gestational sac size from 24 to 35 days from LMP did not differ when chemical pregnancies were compared with pregnancies progressing longer than 35 days. The maximal gestational sac diameter among chemical pregnancies was 3.8 mm. CONCLUSION: Mechanisms involved in implantation failure associated with a negative pregnancy test may be different from those involved in chemical pregnancies. Chemical pregnancies may be the result of defective angiogenesis.     

Antiphospholipid antibodies in women having in-vitro fertilization

Antiphospholipid antibodies have an established associationwith pregnancy complications such as recurrent miscarriage,growth retardation, placental abruption and stillbirth but theirmechanism of action is unclear. We have investigated whetherantiphospholipid antibodies occur more frequently in women havingin-vitro fertilization (IVF) and whether their presence is associatedwith the likelihood of failed implantation. We studied 240 womenundergoing IVF treatment who were <38 years and had attemptedfewer than three previous IVF cycles. Antiphos-pholipid antibodies(anticardiolipin and antiphosphatidyl serine immunoglobulinG and immunoglobulin M) were present in 36 out of 240 (15%)of the study population and were not associated with a failedIVF cycle or miscarriage. There was no association between thecause of infertility and the presence of antiphospholipid antibodies.Antiphos-pholipid antibodies were not detected more frequentlyin women with previous attempts at IVF compared with women havingtheir first cycle, indicating that the high incidence of theseantibodies is not due to the IVF treatment. There was a strongassociation between the presence of antiphospholipid antibodiesand intrauterine growth retardation in singleton pregnancies(P<0.005). We recommend routine screening for the presenceof antiphos-pholipid antibodies in women having IVF in orderto identify those pregnancies at increased risk of intrauterinegrowth retardation.     

Embryo transfer under ultrasound guidance improves pregnancy rates after in-vitro fertilization

Between October 1998 and January 1999, we examined the influence of ultrasound guidance in embryo transfer on pregnancy rate in 362 patients from our in-vitro fertilization (IVF)-embryo transfer programme. These patients were prospectively randomized into two groups: 182 had ultrasound-guided embryo replacement, and 180 had clinical touch embryo transfer. There were no statistically significant differences between the two groups with respect to age, cause of infertility and in the characteristics of the IVF cycle. The pregnancy rate was significantly higher among the ultrasound-guided embryo transfer group (50%) compared with the clinical touch group (33.7%) (P < 0.002). Furthermore, there was also a significant increase in the implantation rate: 25.3% in the ultrasound group compared with 18.1% in the clinical touch group (P < 0.05). In conclusion, ultrasound assistance in embryo transfer significantly improved pregnancy and implantation rates in IVF.     

One versus two embryo transfer after IVF and ICSI: a randomized study

BACKGROUND: The main reason for adverse treatment outcome in assisted reproduction is the high rate of multiple pregnancies. The only strategy to avoid dizygotic twins is to transfer one embryo at a time. METHODS: A total of 144 women, who had had at least four good quality embryos available after IVF/intracytoplasmic sperm injection (ICSI) and who had no more than one previous failed treatment cycle, were randomized to have either one or two embryos transferred. The treatment outcomes including those after frozen embryo transfer were compared between these groups. RESULTS: The clinical pregnancy rate per transfer was 32.4% in the one embryo transfer group and 47.1% in the two embryo transfer group, the difference being not significant. Eleven twin deliveries (n = 39) occurred in the two embryo transfer group and there was one pair of monozygotic twins in the one embryo transfer group. The cumulative pregnancy rate per patient after transfer of fresh and frozen embryos was 47.3% in the one embryo transfer group and 58.6% in the two embryo transfer group. CONCLUSIONS: Our results indicate that among women who have good quality embryos in their first IVF/ICSI, good treatment results can be achieved. They support the idea of changing embryo transfer policy towards one embryo transfer without any remarkable decrease in the success rate, while dizygotic twins can be avoided.     

Antiphospholipid Antibody Prevalence in Patients With IVF Failure

Antiphospholipid antibodies (APAs) have been associated with reproductive wastage. The purpose of this study was to establish the prevalence of APAs in women who have had at least 12 embryos transferred during several in vitro fertilization (IVF) cycles without ensuing pregnancy. Sera from 42 women with IVF failure and 42 women who successfully conceived after IVF were tested for the presence of APAs by ELISA. Successful post-IVF pregnancy was determined by obtaining two consecutive rising beta-hCG levels followed by an ultrasound to confirm a viable conceptus. The sera were tested for three isotypes of antibody: IgA, IgG, and IgM against seven phospholipids: cardiolipin (CL), phosphatidyle-thanolamine (PE), phosphatidylinositol (PI), phosphatidic Acid (PA), phosphatidyl-glycerol (PG), phosphatidylcholine (PC), and phosphatidyl-serine (PS). From the IVF failure group, 11/42 (26.2%) were positive for APAs. From the control group, 2/42 (4.8%) were found positive only for IgA against PE. The difference between IVF failure and successful IVF groups was significant (P=0.01). These results suggest that antiphospholipid antibodies should be considered an important marker for increased risk of IVF failure. Patients who are involved with an IVF program should be tested for the presence of APAs prior to initiation of an IVF cycle.     

Acquired and inherited thrombophilia: implication in recurrent IVF and embryo transfer failure

BACKGROUND: The objective of this study was to determine the incidence of undiagnosed thrombophilic factors and its relation to IVF and embryo transfer failure in women who have had three or more previous IVF-embryo transfer cycles. METHODS: The study group comprised of 90 consecutive women with three or more previously failed IVF-embryo transfer cycles (group A). Two control groups were enrolled: group B (n=90) included women who have had successful pregnancy after their first IVF-embryo transfer cycle, and group C (n=100) included women who conceived spontaneously with at least one uneventful pregnancy and no previous history of miscarriage. All women were tested for the presence of inherited [factor V Leiden (FVL) mutation, prothrombin mutation, methylenetetrahydrofolate reductase (MTHFR) mutation and deficiencies in proteins S and C and antithrombin III] or acquired (lupus anticoagulant and anticardiolipin) thrombophilic factors. RESULTS: An increase in the incidences of FVL, MTHFR and antiphospholipid antibodies was found in the study group compared with the two control groups. At least one inherited or acquired thrombophilic factor was detected in 68.9% of women with repeated IVF failure compared with 25.6 and 25% in the groups B and C, respectively (P<0.01). Combined thrombophilia (two or more thrombophilic factors) was significantly higher in women who have had repeated IVF failure as compared with the two control groups (35.6 versus 4.4 and 3%) (P<0.0001). CONCLUSION: Thrombophilia has a significant role in IVF-embryo transfer implantation failure. Women with repeated IVF-embryo transfer failure should be screened for thrombophilia.     

Conversion of cycles involving ovarian hyperstimulation with intra-uterine insemination to in-vitro fertilization

Conversion to in-vitro fertilization (IVF) and embryo transferas an alternative to cancellation was offered in 27 consecutivecycles of controlled ovarian hyperstimulation and intra-uterineinsemination (IUI) cycles with excessive follicular developmentin patients with idiopathic infertility. IVF and embryo transferwas performed in 25 cycles, resulting in 13 pregnancies (52%),with 22% of couples having at least two embryos cryopreserved.The pregnancies have resulted in one singleton and two twinbirths, one spontaneous abortion, and nine ongoing pregnancies(including one triplet gestation). Four patients developed severeovarian hyperstimulation syndrome (OHSS) after IVF and embryotransfer, including two cases requiring paracentesis. Threeof four OHSS patients were pregnant, resulting in live birthsof healthy twins, one spontaneous abortion and one ongoing singletongestation. In two cycles a spontaneous luteinizing hormone (LH)surge occured, preventing oocyte retrieval. For these two women,drainage of all follicles except the five most likely to fertilize(18–22 mm diameter) was performed, followed by IUI, withno pregnancies or OHSS observed. Conversion of patients fromIUI cycles to IVF/embryo transfer cycles avoids cancellationof the very cycles with the best chance of achieving pregnancy.OHSS remains a problem, necessitating extensive pre-IVF counsellingand post-transfer vigilance.     

Impact of Anticardiolipin Antibody on the Outcome of In Vitro Fertilization and Embryo Transfer

Citation Zhong Y‐P, Ying Y, Wu H‐T, Zhou C‐Q, Xu Y‐W, Wang Q, Li J, Sheng X‐T, Li J. Impact of anticardiolipin antibody on the outcome of in vitro fertilization and embryo transfer. Am J Reprod Immunol 2011; 66: 504–509 Problem To investigate the impact of anticardiolipin antibody (ACA) on the outcome of in vitro fertilization and embryo transfer (IVF‐ET). Methods A total of 76 infertile women positive for anticardiolipin antibody (ACA+ group) and 819 controls negative for anticardiolipin antibody (ACA? group) undergoing IVF‐ET in the First Affiliated Hospital, to Sun Yat‐Sen University, were retrospectively analyzed. Women were diagnosed as having pure tubal factor infertility. Results The proportion of patients with a history of spontaneous abortion in the ACA+ group was significantly higher than that in ACA? group (19.7% versus 8.9%). The IVF rate, pregnancy rate and implantation rate in the ACA+ group were markedly lower than those in the ACA? group (75.5% versus 78.9%, 31.3% versus 48.6% and 16.1% versus 28.1%, respectively). Furthermore, the incidence of pregnancy loss in the ACA+ group was higher than that in the ACA? group (32.0% versus 15.1%). Conclusion ACA‐positive patients had significantly decreased IVF rate, pregnancy rate and implantation rate and high risk of abortion. Therefore, ACA positivity predicts poor outcome of IVF‐ET, and pre‐treatment to lower ACA level may be clinically beneficial for patients receiving IVF‐ET.     

Effect of dehydroepiandrosterone on oocyte and embryo yields, embryo grade and cell number in IVF

BACKGROUND: The aim of this study was to investigate the effect of treatment with dehydroepiandrosterone (DHEA) on fertility outcomes among women with diminished ovarian reserve. MATERIALS AND METHODS: This is a case-control study in an academically affiliated private infertility centre. Twenty-five women with significantly diminished ovarian reserve had one IVF cycle before and after DHEA treatment, with otherwise identical hormonal stimulation. Women received 75 mg of DHEA daily (25 mg three times daily) for an average of 17.6 +/- 2.13 weeks. We performed a comparison of IVF outcome parameters, before and after DHEA treatment, including peak estradiol (E(2)) levels, oocyte and embryo numbers, oocyte and embryo quality and embryo transfer statistics. RESULTS: Paired analysis of IVF cycle outcomes in 25 patients, who underwent cycles both before and after DHEA supplementation, demonstrated significant increases in fertilized oocytes (P < 0.001), normal day 3 embryos (P = 0.001), embryos transferred (P = 0.005) and average embryo scores per oocyte (P < 0.001) after DHEA treatment. CONCLUSION: This study confirms the previously reported beneficial effects of DHEA supplementation on ovarian function in women with diminished ovarian reserve.     

Increased prevalence of thyroid antibodies in euthyroid women with a history of recurrent in-vitro fertilization failure

This study was undertaken to evaluate whether the presence of thyroid antibodies in euthyroid women is associated with an adverse outcome in an in-vitro fertilization (IVF)-embryo transfer programme. In 24 women (study group: mean age +/- SD: 31.5 +/- 4.4 years) who failed to conceive after having three or more cycles of IVF and embryo transfer, serum concentrations of thyroglobulin (TG), thyroid peroxidase antibodies (TPO) and anticardiolipin antibodies (IgG and IgM) were measured using commercially available kits. The control group comprised 24 consecutive patients without endocrine dysfunction (mean age +/- SD: 30.3 +/- 4.1 years) seeking infertility treatment in our department of assisted reproduction. All patients in both the study and the control groups were determined to be euthyroid by demonstrating normal concentrations of thyroid-stimulating hormone (TSH). In the study and control groups respectively, 13 and two patients demonstrated positive titres of TG, TPO or both thyroid antibodies (Fisher's exact test: P = 0.002). Mean serum concentrations of TG were significantly increased in the study group compared to the control subjects (156 +/- 167 IU/ml versus 33.5 +/- 32.0 IU/ml; U-test: P = 0.009). Serum concentrations of TPO and anticardiolipin antibodies were similar in both groups. Our investigations revealed that thyroid antibodies might be independent markers for reproductive failure in an IVF-embryo transfer programme.     

Cervical dilatation has a positive impact on the outcome of IVF in randomly assigned cases having two previous difficult embryo transfers

BACKGROUND: The difficulty of embryo transfer has been reported to affect success rates in some centres, but not in others. Cervical dilatation has been proposed as a means to overcome difficult embryo transfer, but consistent criteria for patient selection are lacking. In a prospective randomized study, we examined the influence of cervical dilatation 1-3 months before embryo transfer on the outcome of IVF in cases having difficult embryo transfer in two previously failed IVF cycles. METHODS: Two alternative methods of embryo transfer preparation were evaluated in 283 randomly assigned women having difficult embryo transfers in two previously failed IVF attempts. Randomization was made using a computer-generated random number table. Cervical dilatation before starting any IVF treatment was used in 145 cases, and no dilatation was performed in 138 cases. RESULTS: The cervical dilatation group yielded a significantly higher pregnancy rate than the non-dilated group (40% versus 24%; P < 0.01). Likewise, the implantation rate (24.1% versus 14.9%; P < 0.01) and the live birth rate (34.48% versus 19.56%; P < 0.01) were significantly higher in the dilatation group than in the non-dilated group. CONCLUSIONS: In patients with prior difficult embryo transfer, cervical dilatation 1-3 months before embryo transfer lead to an improved pregnancy rate.     

The use of laparoscopic ovarian electrocautery in preventing cancellation of in-vitro fertilization treatment cycles due to risk of ovarian hyperstimulation syndrome in women with polycystic ovaries

Fifty women with polycystic ovaries took part in a prospective randomized study. All women required treatment by in-vitro fertilization (IVF) for reasons other than anovulation. They had all previously undergone ovarian stimulation with gonadotrophin therapy which had failed to result in pregnancy or had been abandoned due to high risk of developing ovarian hyperstimulation syndrome (OHSS). Twenty-five women were treated by long-term pituitary desensitization followed by gonadotrophin therapy, oocyte retrieval and embryo transfer (group 1). Twenty-five women underwent laparoscopic ovarian electrocautery after pituitary desensitization followed by gonadotrophin therapy, oocyte retrieval and embryo transfer (group 2). A significantly higher number of women in group 1 had to have the treatment cycle abandoned due to impending or actual OHSS, determined by endocrine and clinical findings. In addition, the development of moderate or severe OHSS in completed cycles was higher in group 1. The pregnancy rate and miscarriage rates in the two treatment groups were similar. The authors propose that laparoscopic ovarian electrocautery is a potentially useful treatment for women who have previously had an IVF treatment cycle cancelled due to risk of OHSS or who have suffered OHSS in a previous treatment cycle.      

Diagnostic hysteroscopy: its value in an in-vitro fertilization/embryo transfer unit.

A total of 324 patients participating in our in-vitro fertilization/embryo transfer (IVF) programme underwent a diagnostic hysteroscopy. Of these, 152 women were referred before their first IVF attempt, because of some hysterosalpingographic suspicion of an intra-uterine abnormality; the other 172 patients had failed to conceive after IVF and transfer of good quality embryos. An intra-uterine pathology (mainly intra-uterine adhesions) was diagnosed in 50% of the patients in each group. Hysterosalpingography, although very sensitive, had low specificity (23%), a false positive rate of 44% and false negative rate of 10%. The main risk factor for intra-uterine pathology was a previous abortion. Conception rates were 22% after surgical treatment and 38% after the diagnostic procedure. We think that hysteroscopy should be performed in every patient failing to conceive after replacement of good quality embryos. It is also recommended whenever a suspicious finding is revealed by hysterosalpingography, before IVF. Routine hysteroscopy before entering an IVF programme should be seriously considered.     

Effect of antiphospholipid antibodies in women undergoing in-vitro fertilization: role of heparin and aspirin

To describe the prevalence of antiphospholipid antibodies in women undergoing in-vitro fertilization (IVF) and to determine if heparin and aspirin affect implantation rates, 191 women with a history of infertility undergoing IVF were prospectively tested for antiphospholipid antibodies. This was a two-centre, non-randomized comparison of women with positive antiphospholipid antibodies receiving heparin and aspirin versus standard treatment. An enzyme-linked immunosorbent assay, with referenced standards and known positive and negative sera on each plate, was utilized to measure antibodies to cardiolipin, phosphatidylinositol, phosphatidylglycerol, phosphatidylserine and phosphatidylethanolamine. Statistical analyses of results included analysis of variance and Fisher's two-tailed exact test. Antiphospholipid antibodies were detected in 18.8% of patients undergoing IVF compared with only 5.5% in the 200 normal controls, 26% in 200 women with recurrent pregnancy loss, and 32% in 200 women with systemic lupus erythematosus. In conclusion, antiphospholipid antibodies were found more frequently in women undergoing IVF than in the normal control population. Although implantation rates appeared higher in the group of women treated with heparin and aspirin, no statistically significant differences were detected in implantation, pregnancy and ongoing pregnancy rates between those who received standard therapy and those treated with heparin and aspirin.