[Recurrent miscarriage or failed in-vitro fertilization: antibodies against annexin V, cardiolipin, beta-2-glycoprotein-1 and APC-resistance].
Antibodies against annexin-V, a potent anticoagulant abundant in placental tissues, were recently controversially reported to be associated with recurrent miscarriages or failures of in-vitro-fertilization (IVF) attempts.


METHODS
We screened 56 women (34.7 +/- 4.3 years of age: mean +/- 1 SD) with recurrent IVF failures and/or early pregnancy losses for resistance against activated protein C, lupus anticoagulant and antibodies against annexin V, cardiolipin or beta(2)-glycoprotein-1. Among them the prevalence of APC-R (8/56, 14%) and elevated levels of IgG- or IgM-anti-cardiolipin antibodies (7/56, 12%) were more common than elevated levels of (IgG or IgM) antibodies against beta(2)-glycoprotein-1 (3/56, 5%) or annexin-V (1/56, 2%). 42 (75%) of the women had another IVF-attempt after this haemostaseological evaluation and received low molecular weight heparin and/ or acetylsalicylic acid in the case of positivity for APC-resistance, lupus anticoagulant or antibodies against annexin V, cardiolipin or beta(2)-glycoprotein-1.


RESULTS
The outcome of these IVF-attempts were 19 pregnancies (34%): 4 early miscarriages (7%) and 15 so far uncomplicated pregnancies (27%). The only woman with an elevated anti-annexin V (IgG) level had had 7 IVF before and received 40 mg Enoxaparin (Lovenox) subcutaneously once daily during the 8(th) IVF, which resulted in a healthy pregnancy.


CONCLUSIONS
Our findings suggest that among women with recurrent IVF failures anti-annexin V antibody positivity is less prevalent than APC-resistance, lupus anticoagulant (LA) or elevated levels of antibodies against cardiolipin, beta(2)-glycoprotein-1 and that the IVF-result of women with APC-R, LA or with elevated levels of antibodies against annexin V, cardiolipin or beta(2)-glycoprotein might be positively influenced by low molecular weight heparin.
Halbmayer
W M
WM
michael@halbmayer.at
Feichtinger
W
W
Kindermann
C
C
Prendinger
B
B
Böhm
M
M
D000026:Abortion, Habitual / Q000453:epidemiology* / Q000276:immunology*; D000328:Adult; D017304:Annexin A5 / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood*; D002308:Cardiolipins / Q000276:immunology*; D005260:Female; D005307:Fertilization in Vitro; D006023:Glycoproteins / Q000276:immunology*; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D017211:Treatment Failure; D053482:beta 2-Glycoprotein I
D017304:Annexin A5; D001323:Autoantibodies; D002308:Cardiolipins; D006023:Glycoproteins; D053482:beta 2-Glycoprotein I