title: High fecundity rates following in-vitro fertilization and embryo transfer in antiphospholipid antibody seropositive women treated with heparin and aspirin.
abstract: This study was undertaken to explore whether intervention with heparin and aspirin (H/A) in selected patients undergoing in-vitro fertilization (IVF) 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.
authors.affiliation: University of Nevada School of Medicine.
authors.forename: G
authors.initials: G
authors.lastname: Sher
authors.forename: M
authors.initials: M
authors.lastname: Feinman
authors.forename: C
authors.initials: C
authors.lastname: Zouves
authors.forename: G
authors.initials: G
authors.lastname: Kuttner
authors.forename: G
authors.initials: G
authors.lastname: Maassarani
authors.forename: R
authors.initials: R
authors.lastname: Salem
authors.forename: W
authors.initials: W
authors.lastname: Matzner
authors.forename: W
authors.initials: W
authors.lastname: Ching
authors.forename: P
authors.initials: P
authors.lastname: Chong
mesh_terms: D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D001241:Aspirin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004624:Embryo Transfer; D005069:Evaluation Studies as Topic; D005260:Female; D005298:Fertility / Q000187:drug effects*; D005307:Fertilization in Vitro; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D012189:Retrospective Studies
chemical_list: D017152:Antibodies, Antiphospholipid; D006493:Heparin; D001241:Aspirin