Low-dose aspirin for in vitro fertilization or intracytoplasmic sperm injection: a systematic review and a meta-analysis of the literature.
BACKGROUND
It was hypothesized that low-dose aspirin could improve implantation rates in subsequent pregnancies in women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Previous studies have shown inconclusive results or focused on surrogate endpoints. We therefore conducted a systematic review and meta-analysis of the literature investigating the effect of low-dose aspirin on hard outcomes, including live birth rate, pregnancy rate and miscarriage.


METHODS
MEDLINE and EMBASE databases were searched up to November 2011. Randomized controlled trials comparing low-dose aspirin with placebo/no treatment in IVF/ICSI women were included. Pooled odds ratios (ORs) and 95%confidence intervals (CIs) were calculated.


RESULTS
Seventeen studies with 6403 patients were included. The use of aspirin did not improve live birth pregnancy rate compared with placebo or no treatment (1.08; 95% CI, 0.90, 1.29). Pregnancy rates were significantly increased in patients randomized to low-dose aspirin (OR, 1.19; 95% CI, 1.01, 1.39), but miscarriage rates were not (OR, 1.18; 95% CI, 0.82, 1.68). Results of sensitivity analyses including high-quality studies did not show statistically significant differences in all considered endpoints.


CONCLUSIONS
The results of this study do not show a substantial efficacy of aspirin inwomen undergoing IVF/ICSI and do not support the use of low-dose aspirin to improve the success of IVF/ICSI in terms of pregnancy outcomes. Further high-quality studies evaluating the possible efficacy of aspirin in selected groups of patients are warranted.
Department of Clinical Medicine, University of Insubria, Varese, Italy. fdentali@libero.it
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F
Dentali
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W
Ageno
E
E
Rezoagli
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E
Rancan
A
A
Squizzato
S
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Middeldorp
M
M
Margaglione
E
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Grandone
D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D001241:Aspirin / Q000008:administration & dosage*; D010064:Embryo Implantation / Q000187:drug effects; D005260:Female; D005299:Fertility Agents / Q000008:administration & dosage*; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D050498:Live Birth; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects
D005299:Fertility Agents; D001241:Aspirin