Human Reproduction, Vol. 9, No. 12, pp. 2278-2283, 1994
© 1994 European Society of Human Reproduction and Embryology
research-article |
Immunology: High fecundity rates following in– vitro fertilization and embryo transfer in antiphospholipid antibody seropositive women treated with heparin and aspirin
1University of Nevada School of Medicine; CA, USA 2Harbor/University of California Los Angeles, CA;USA 3Pacific Fertility Medical Centers CA, USA 4Reproductive Immunology Associates Van Nuys, CA, USA 5Sepulveda Veterans Administration Medical Center/University of California Los Angeles, CA, USA 6University of California Los Angeles, CA, USA
Correspondence: 7To whom correspondence should be addressed at: 55 Francisco, Suite 500, San Francisco, CA 94133, USA
This study was undertaken to explore whether intervention with heparin and aspirin (H/A) in selected patients undergoing in-vitro fertilization (TVF) and embryo transfer could improve fecundity rates. Specifically, it explored the possibility that women diagnosed with organic pelvic disease who demonstrated antiphospholipid antibodies (APA) could benefit from H/A administration in a similar manner to that used in patients with recurrent pregnancy loss. We used an enzyme–linked immunosorbent assay for six different phospholipids to identify patients who expressed APA before they underwent IVF/embryo transfer. This study was confined to the first IVF/embryo transfer cycle that followed assessment of APA status and accordingly, the number of IVF/embryo transfer cycles corresponds with the number of patients treated. APA seropositive patients were treated with aspirin, 81 mg orally q.d., and heparin 5000 IU s.c. b.i.d., beginning on day 1 of controlled ovarian stimulation. The endpoint for success was a live birth or an ultrasound confirming fetal cardiac activity (a viable pregnancy). The prevalence of APA in patients diagnosed with organic pelvic disease (53%) was much higher than in those without female pathology (14%). The administration of H/A to APA seropositive patients significantly (P < 0.05) improved the viable pregnancy rate (49%) compared to the untreated APA seropositive group (16%). The viable pregnancy rate for APA seropositive women treated with H/A was also significantly (P < 0.001) higher than for untreated APA seronegative patients (27%). We conclude that all women undergoing IVF/embryo transfer should be tested for APA prior to initiating ovarian stimulation, and those with APA seropositivity should be treated with H/A.
Key words: antiphospholipid antibodies/aspirin/fecundity/heparin/in-vitro fertilization
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