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Koshak E, Atwah A, Aljedani R, Aljaied Y, Gaddoury MA. Common Autoimmune Antibodies in Unexplained Infertile Female Patients in Saudi Arabia. Cureus 2022; 14:e31724. [DOI: 10.7759/cureus.31724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
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Gao R, Zeng R, Qing P, Meng C, Cheng K, Zhang S, Chen H, Jin X, Qin L, Li T. Antiphospholipid antibodies and pregnancy outcome of assisted reproductive treatment: A systematic review and meta-analysis. Am J Reprod Immunol 2021; 86:e13470. [PMID: 34018271 DOI: 10.1111/aji.13470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023] Open
Abstract
PROBLEM Antiphospholipid antibodies (aPLs) are a group of autoantibodies associated with a variety of pregnancy complications, but the impact of aPL on the outcomes of assisted fertility treatment (ART) is controversial. This systematic review and meta-analysis were designed to explore the association between aPL and ART outcomes and to explore in which stages does aPL play a role. METHOD OF STUDY PubMed and Cochrane database were systematically retrieved, and odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated in a random-effect model or fixed-effect model according to the heterogenicity assessed by the Cochran Q and I2 statistic test. Of 246 records identified by the search, 10 case-control studies and 13 cohort studies that explored the association between aPL and in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) were analyzed. RESULTS The results showed that aPL positive rate was higher in females who failed in IVF/ICSI than those who succeeded in IVF/ICSI (OR: 3.62, 95% CI: 1.95-6.74). This study also indicated that females positive for aPL have a higher miscarriage rate (RR: 1.68, 95% CI: 1.24-2.28) than those negative for aPL, but live birth rate, biochemical pregnancy rate, and clinical pregnancy rate were similar between two groups (RR: 1.01, 95% CI: 0.91-1.12; RR: 1.18, 95% CI: 0.57-2.43 and RR: 0.95, 95% CI: 0.80-1.13). CONCLUSIONS There was higher aPL prevalence in females with adverse IVF/ICSI outcomes. It seems that aPL mainly affects the miscarriage rate, but has little effect on live birth rate, biochemical pregnancy rate, and clinical pregnancy rate. Routine detection of aPL before IVF/ICSI treatment is meaningful.
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Affiliation(s)
- Rui Gao
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Rujun Zeng
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Pingying Qing
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Meng
- Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.,Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kemin Cheng
- Department of Outpatients, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Sirui Zhang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Hanxiao Chen
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaolei Jin
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Lang Qin
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.,Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
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3
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Abstract
Antiphospholipid syndrome is a systemic autoimmune disease associated with obstetric complications along with vascular events affecting multiple organ systems in patients having positive titers of antiphospholipid antibodies. Eight to 20% of infertility cases have an unknown cause, part of which could be due to antiphospholipid syndrome. Although still debatable, many studies have addressed the relation between reproductive failure and antiphospholipid antibodies through the relation between antiphospholipid antibodies and unexplained infertility as well as the effect of antiphospholipid antibodies on the outcome of in vitro fertilization–embryo transfer. Few studies and cases have associated the presence of antiphospholipid antibodies with male infertility, describing morphofunctional penile abnormalities and testicular infarction. There are not enough data to support the routine practice of testing antiphospholipid antibodies in patients with infertility.
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Affiliation(s)
- G El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - I Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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4
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D'Ippolito S, Ticconi C, Tersigni C, Garofalo S, Martino C, Lanzone A, Scambia G, Di Simone N. The pathogenic role of autoantibodies in recurrent pregnancy loss. Am J Reprod Immunol 2019; 83:e13200. [PMID: 31633847 DOI: 10.1111/aji.13200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 12/20/2022] Open
Abstract
In the present manuscript, we review the recent research investigating the pathogenic association between most studied autoantibodies and recurrent pregnancy loss. Pregnancy loss represents a common obstetric complication occurring in about 15%-25% of all clinically recognized pregnancies. The recurrence of pregnancy loss identifies a distinct clinical entity, that is recurrent pregnancy loss (RPL), affecting about 2%-4% of couples. Several factors, including age, chromosomal abnormalities, uterine anomalies, thrombophilic disorders, endocrinopathies, hormonal and metabolic disorders, infections, sperm quality, and lifestyle issues, are involved in RPL. The role of autoantibodies in RPL is only partially determined. In some cases (antiphospholipid antibodies [aPL]), their involvement is well established. In other cases (anti-thyroid autoantibodies, antinuclear, anti-transglutaminase, and anti-endomysial antibodies), it is still debated, despite multiple, although not fully conclusive, evidences strongly suggest a possible involvement in RPL. Further extensive research is needed to definitively confirm or exclude their actual role.
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Affiliation(s)
- Silvia D'Ippolito
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Ticconi
- Section of Gynecology and Obstetrics, Department of Surgical Sciences, University Tor Vergata, Rome, Italy
| | - Chiara Tersigni
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serafina Garofalo
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carmelinda Martino
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Lanzone
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicoletta Di Simone
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
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5
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Zeng M, Wen P, Duan J. Association of antinuclear antibody with clinical outcome of patients undergoing in vitro fertilization/intracytoplasmic sperm injection treatment: A meta-analysis. Am J Reprod Immunol 2019; 82:e13158. [PMID: 31206895 DOI: 10.1111/aji.13158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/02/2019] [Accepted: 06/05/2019] [Indexed: 12/14/2022] Open
Abstract
PROBLEM Several recent studies have investigated the relationship between antinuclear antibodies (ANAs) and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes. This meta-analysis evaluated the effect of ANA on clinical outcome for patients undergoing IVF/ICSI treatment. METHOD OF STUDY A systemic survey of the literature was performed using PubMed, EMBASE and the Cochrane Library databases, through January 2019. Evaluated outcomes included clinical pregnancy rate (CPR), miscarriage rate (MR) and implantation rate (IR). Relative risk ratio (RR) and 95% confidence intervals (95% CI) were used for dichotomous data. Meta-analyses were performed with Review Manager 5.3 software. RESULTS Eleven eligible studies were found. For IVF/ICSI cycles, compared with an ANA(-) group, infertile patients with ANA(+) had significantly reduced incidence of CPR (RR 0.66, 95% CI 0.56-0.79; I2 = 60%) and IR (RR 0.61, 95% CI 0.49-0.76; I2 = 75%), and had a higher MR (RR 1.81, 95% CI 1.40-2.36; I2 = 48%). CONCLUSION This study suggested that ANA might cause poor pregnancy outcomes for infertile women undergoing IVF/ICSI treatment.
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Affiliation(s)
- MeiFang Zeng
- Reproductive Medical Center, Hospital of Chinese People's Liberation Army, Guilin, China
| | - Ping Wen
- Reproductive Medical Center, Hospital of Chinese People's Liberation Army, Guilin, China
| | - JinLiang Duan
- Reproductive Medical Center, Hospital of Chinese People's Liberation Army, Guilin, China
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Cheloufi M, Wackenheim C, Dumestre-Pérard C, Gueniffey A, Equy V, Thong-Vanh C, Dunand-Faure C, Hoffmann P, Deroux A. [Use of hydroxychloroquine and prednisone in the presence of serum autoimmunity in female infertility]. ACTA ACUST UNITED AC 2018; 46:112-117. [PMID: 29398524 DOI: 10.1016/j.gofs.2017.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Presence of non-specific autoimmunity (antinuclear antibodies without antigenic specificities and/or antiphospholipid antibodies without criteria of antiphospholipid syndrome) seems to be associated with unexplained female infertility. The objective is to study the characteristics of patients who undergone treatment for non-specific antibodies in Medically Assisted Procreation (MAP). METHODS Ten patients were prospectively followed at MAP center of Grenoble University Hospital. Patient characteristics were collected and evaluated. All patients had a consultation in internal medicine unit as well as an autoimmune assessment (antinuclear antibodies, APL especially) in search of defined autoimmune disease (exclusion criterion). The treatments undertaken were at clinician' discretion. RESULTS One patient received quadritherapy (heparin, platelet antiaggregant, prednisone and hydroxychloroquine), 5 received triple therapy, 3 had dual therapy, and one patient had prednisone only. The 10 patients had a pregnancy under treatment, 8 of which were completed without complications. The control of autoimmunity under treatment appears to show a decrease in serum antibody levels. Tolerance was good (delayed hypersensitivity to hydrochloroquine resulted in discontinuation of therapy in only one patient). CONCLUSION The presence of non-specific serum autoimmunity in a context of infertility appears to be pathogenic and immunomodulatory treatments are clinically and/or biologically effective. A prospective and interventional study with a larger number of patients is needed to assess the efficacy of such treatments in patients with unexplained infertility.
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Affiliation(s)
- M Cheloufi
- Service de procréation médicalement assistée et de gynécologie obstétrique, centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
| | - C Wackenheim
- Service de médecine interne, centre hospitalier universitaire Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - C Dumestre-Pérard
- Laboratoire d'immunologie, pole de biologie, centre hospitalier universitaire Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - A Gueniffey
- Service de procréation médicalement assistée et de gynécologie obstétrique, centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - V Equy
- Service de procréation médicalement assistée et de gynécologie obstétrique, centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - C Thong-Vanh
- Service de procréation médicalement assistée et de gynécologie obstétrique, centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - C Dunand-Faure
- Service de procréation médicalement assistée et de gynécologie obstétrique, centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - P Hoffmann
- Service de procréation médicalement assistée et de gynécologie obstétrique, centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - A Deroux
- Service de médecine interne, centre hospitalier universitaire Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
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7
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Lambert M, Hocké C, Jimenez C, Frantz S, Papaxanthos A, Creux H. Échecs répétés de fécondation in vitro : anomalies retrouvées sur le bilan diagnostique. ACTA ACUST UNITED AC 2016; 44:565-571. [DOI: 10.1016/j.gyobfe.2016.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/22/2016] [Indexed: 11/25/2022]
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8
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9
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Fan J, Zhong Y, Chen C. Combined treatment of prednisone and aspirin, starting before ovulation induction, may improve reproductive outcomes in ANA-positive patients. Am J Reprod Immunol 2016; 76:391-395. [PMID: 27618792 DOI: 10.1111/aji.12559] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/09/2016] [Indexed: 11/28/2022] Open
Abstract
LABELED PROBLEM Antinuclear antibody (ANA) could cause reproductive failure. But treatment for women with antinuclear antibody was controversial. METHODS One hundred and thirty-three ANA+ women with one-time in vitro fertilization (IVF) implantation failure were divided into two groups randomly. The study group comprised 60 sero-positive for antinuclear antibody. These patients were treated with prednisone (10 mg/day) and aspirin (100 mg/day) starting 3 months before induction of ovulation in 60 IVF cycles. Seventy-three patients were included in untreated group. RESULTS Fertilization rate, pregnancy rate, and implantation rate were significantly higher in treatment group, while abortion rate was markedly higher in non-treatment group by randomized controlled trial. Same conclusions were also proved between cycles of 60 ANA+ women with therapy and their former cycles without any treatment. CONCLUSION Combined treatment of prednisone for immunosuppression and aspirin as an antithrombotic agent, starting 3 months before ovulation induction, may improve reproductive outcomes in ANA+ patients.
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Affiliation(s)
- Jiao Fan
- Key Laboratory of Reproductive Medicine of Guangdong Province, Reproductive Medicine Center for The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yiping Zhong
- Key Laboratory of Reproductive Medicine of Guangdong Province, Reproductive Medicine Center for The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Cuina Chen
- Key Laboratory of Reproductive Medicine of Guangdong Province, Reproductive Medicine Center for The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Veglia M, D'Ippolito S, Marana R, Di Nicuolo F, Castellani R, Bruno V, Fiorelli A, Ria F, Maulucci G, De Spirito M, Migliara G, Scambia G, Di Simone N. Human IgG Antinuclear Antibodies Induce Pregnancy Loss in Mice by Increasing Immune Complex Deposition in Placental Tissue: In Vivo Study. Am J Reprod Immunol 2015; 74:542-52. [PMID: 26388133 DOI: 10.1111/aji.12429] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 12/18/2022] Open
Abstract
PROBLEM A threefold higher prevalence of antinuclear antibodies (ANA) has been reported in patients with recurrent pregnancy loss (RPL). Nevertheless, the role of ANA in reproductive failure is still unclear. The aim of this study was to investigate the role of ANA during early pregnancy in vivo. METHOD OF STUDY We used pregnant mice treated with immunoglobulin G (IgG) obtained from normal healthy subjects (NHS); ANA(+) sera of patients with RPL; and ANA(+) sera from women with uncomplicated pregnancies (HW). Placental immunohistochemical/immunofluorescence staining was performed to detect complement and immune complex deposition. ELISA was performed to evaluate complement levels. RESULTS ANA(+) IgG from RPL women significantly increased embryo resorption rate, reduced C3, and increased C3a serum levels compared to NHS IgG or ANA(+) -HW IgG. Increased C3 deposition and increased immune complex staining in placental tissues from mice treated with ANA(+) -RPL IgG fraction compared to NHS- and ANA(+) -HW-IgG-treated mice were found. CONCLUSION ANA(+) IgG injection in mice is able to induce fetal resorption and complement activation. The presence on placental tissues of immune complexes and complement fragments suggests the complement activation as a possible mechanism of placental damage.
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Affiliation(s)
- Manuela Veglia
- Department of Obstetrics and Gynecology, Policlinico A. Gemelli, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Silvia D'Ippolito
- Department of Obstetrics and Gynecology, Policlinico A. Gemelli, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Riccardo Marana
- Department of Obstetrics and Gynecology, Policlinico A. Gemelli, Università Cattolica Del Sacro Cuore, Rome, Italy.,International Scientific Institute Paolo VI, ISI, Università Cattolica Del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy
| | - Fiorella Di Nicuolo
- Department of Obstetrics and Gynecology, Policlinico A. Gemelli, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Roberta Castellani
- Department of Obstetrics and Gynecology, Policlinico A. Gemelli, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Valentina Bruno
- Section of Gynecology and Obstetrics, Department of Surgical Sciences, Università di Tor Vergata, Rome, Italy
| | - Alessia Fiorelli
- Department of Obstetrics and Gynecology, Policlinico A. Gemelli, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Francesco Ria
- Institute of General Pathology, Università Cattolica Del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy
| | - Giuseppe Maulucci
- Institute of Physics, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Marco De Spirito
- Institute of Physics, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giuseppe Migliara
- Institute of General Pathology, Università Cattolica Del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Policlinico A. Gemelli, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Nicoletta Di Simone
- Department of Obstetrics and Gynecology, Policlinico A. Gemelli, Università Cattolica Del Sacro Cuore, Rome, Italy
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Abstract
Since the late 1980s some publications have proposed that antiphospholipid antibodies (aPL) may have some relationship with infertility, considering reported deleterious effects that aPL exert on trophoblast proliferation and growth. Although not included in current classification criteria for antiphospholipid syndrome, many physicians investigate for aPL in patients with a history of infertility, including antibodies not listed in classification criteria, and most of those patients will receive anticoagulant therapy if any of those antibodies have a result considered positive. A review of literature was conducted searching for studies that investigated the association of aPL and infertility and if aPL positivity alters in vitro fertilization (IVF) outcome. The definition of infertility, routine work-up to exclude other causes of infertility, definition of IVF failure as inclusion criteria and control populations were heterogeneous among studies. Most of them enrolled women over 40 years of age, and exclusion of other confounding factors was also inconsistent. Of 29 studies that assessed aPL positivity rates in infertile women, the majority had small sample sizes, implying a lack of power, and 13 (44.8%) reported higher frequency of aPL in infertile patients compared to controls, but most of them investigated a panel of non-criteria aPL tests, whose clinical significance is highly controversial. Only two studies investigated all three criteria tests, and medium-high titer of anticardiolipin cut-off conforming to international guidelines was used in one study. Considering IVF outcome, there was also disparity in this definition: few studies assessed the live birth rate, others the implantation rate. Of 14 publications that addressed the relationship between aPL and IVF outcome, only two described a detrimental effect of these autoantibodies. In conclusion, available data do not support an association between aPL and infertility, and aPL positivity does not seem to influence IVF outcome. Well-designed clinical studies recruiting women with a clear diagnosis of infertility and a high-risk aPL profile should be performed to test whether clinically relevant aPL do-or not-exert an effect on human fertility.
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Affiliation(s)
- C B Chighizola
- Department of Clinical Sciences and Community Health, University of Milan, Italy Immunorheumatological Research Laboratory, Istituto Auxologico Italiano, Italy
| | - G R de Jesus
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Brazil
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12
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Agenor A, Bhattacharya S. Infertility and miscarriage: common pathways in manifestation and management. ACTA ACUST UNITED AC 2015; 11:527-41. [PMID: 26238301 DOI: 10.2217/whe.15.19] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The relationship between miscarriage and fertility is complex. While most healthcare settings treat miscarriage as a problem of subfertility in assisted reproduction units, others believe that miscarriage occurs in super-fertile women. Infertile women undergoing assisted reproduction are at a greater risk of having a miscarriage especially at an advanced age compared with women conceiving naturally. Aberrant expression of immunological factors and chromosomal abnormalities underlie both infertility and miscarriage. Common risk factors include increased maternal age, obesity, smoking, alcohol, pre-existing medical conditions and anatomical abnormalities of the reproductive system. Management pathways of both conditions may be similar with pre-implantation genetic testing and assisted reproductive technology used in both conditions. This paper discusses the synergies and differences between the two conditions in terms of their epidemiology, etiopathogenesis, risk factors and management strategies. The two conditions are related as degrees of severity of reproductive failure with common pathways in manifestation and management.
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Affiliation(s)
- Angena Agenor
- Department of Obstetrics & Gynaecology, University of Aberdeen Medical School, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Sohinee Bhattacharya
- Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen, AB25 2ZL, UK
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13
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de Jesus GR, Agmon-Levin N, Andrade CA, Andreoli L, Chighizola CB, Porter TF, Salmon J, Silver RM, Tincani A, Branch DW. 14th International Congress on Antiphospholipid Antibodies Task Force report on obstetric antiphospholipid syndrome. Autoimmun Rev 2014; 13:795-813. [PMID: 24650941 DOI: 10.1016/j.autrev.2014.02.003] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 02/17/2014] [Indexed: 01/12/2023]
Abstract
Pregnancy morbidity is one of the clinical manifestations used for classification criteria of antiphospholipid syndrome (APS). During the 14th International Congress on Antiphospholipid Antibodies (aPL), a Task Force with internationally-known experts was created to carry out a critical appraisal of the literature available regarding the association of aPL with obstetric manifestations present in actual classification criteria (recurrent early miscarriage, fetal death, preeclampsia and placental insufficiency) and the quality of the evidence that treatment(s) provide benefit in terms of avoiding recurrent adverse obstetric outcomes. The association of infertility with aPL and the effectiveness of the treatment of patients with infertility and positive aPL was also investigated. This report presents current knowledge and limitations of published studies regarding pregnancy morbidity, infertility and aPL, identifying areas that need better investigative efforts and proposing how critical flaws could be avoided in future studies, as suggested by participants of the Task Force. Except for fetal death, there are limitations in the quality of the data supporting the association of aPL with obstetric complications included in the current APS classification criteria. Recommended treatments for all pregnancy morbidity associated to APS also lack well-designed studies to confirm its efficacy. APL does not seem to be associated with infertility and treatment does not improve the outcomes in infertile patients with aPL. In another section of the Task Force, Dr. Jane Salmon reviewed complement-mediated inflammation in reproductive failure in APS, considering new therapeutic targets to obstetric APS (Ob APS).
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Affiliation(s)
- Guilherme R de Jesus
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Nancy Agmon-Levin
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Carlos A Andrade
- Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Laura Andreoli
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, Spedali Civili, University of Brescia, Brescia, Italy
| | - Cecilia B Chighizola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Immunorheumatological Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - T Flint Porter
- Department of Obstetrics and Gynecology, University of UT, Salt Lake City, USA; Intermountain Healthcare, Salt Lake City, USA
| | - Jane Salmon
- Hospital For Special Surgery, Weill Cornell Medical College, NY, USA; Kirkland Center for Lupus Research, NY, USA; Lupus and APS Center of Excellence, NY, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of UT, Salt Lake City, USA
| | - Angela Tincani
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, Spedali Civili, University of Brescia, Brescia, Italy
| | - D Ware Branch
- Department of Obstetrics and Gynecology, University of UT, Salt Lake City, USA; Intermountain Healthcare, Salt Lake City, USA
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Coughlan C, Ledger W, Wang Q, Liu F, Demirol A, Gurgan T, Cutting R, Ong K, Sallam H, Li T. Recurrent implantation failure: definition and management. Reprod Biomed Online 2014; 28:14-38. [DOI: 10.1016/j.rbmo.2013.08.011] [Citation(s) in RCA: 331] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 05/05/2013] [Accepted: 08/06/2013] [Indexed: 12/29/2022]
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15
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Ying Y, Zhong YP, Zhou CQ, Xu YW, Miao BY, Wang Q, Li J. Preliminary investigation of the impact of anticentromere antibody on oocyte maturation and embryo cleavage. Fertil Steril 2013; 100:1585-9. [PMID: 24044934 DOI: 10.1016/j.fertnstert.2013.07.1998] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/24/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To explore whether anticentromere antibody (ACA) is the most significant antibody among antinuclear antibodies (ANA), which adversely affect oocyte maturation, embryo cleavage, and pregnancy outcome in women undergoing an intracytoplasmic sperm injection program. DESIGN Retrospective, nested case-control study. SETTING Center for reproductive medicine, university hospital. PATIENT(S) A total of 187 women receiving the first intracytoplasmic sperm injection cycle were enrolled in this study, including 20 women with positive ACA and ANA (ACA[+]/ANA[+] group), 51 women with negative ACA and positive ANA(ACA[-]/ANA[+] group), and 116 patients with negative ACA and ANA (ACA[-]/ANA[-] group). Patients in the three groups were age-matched. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Percentages of germinal vesicle, metaphase I, and metaphase II oocytes, embryo cleavage rate, number of high-quality embryos, and rates of pregnancy and implantation. RESULT(S) The metaphase I oocyte percentage was markedly higher and the metaphase II oocyte percentage and the normal cleavage rate were significantly lower in the ACA[+]/ANA[+] group as compared with the ACA[-]/ANA[+] group. Furthermore, statistically significant differences were found in rates of pregnancy and implantation among the three groups. However, no significant difference was found between any two groups owing to the small sample size, except for a significantly lower implantation rate being found in the ACA[+]/ANA[+] group when compared with the ACA[-]/ANA[-] group. CONCLUSION(S) Our data suggest that ACA may be the essential marker for defective oocytes or embryos in infertile women with any type of ANA.
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Affiliation(s)
- Ying Ying
- Reproductive Medicine Center for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province, Guangzhou, People's Republic of China
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16
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Ying Y, Zhong YP, Zhou CQ, Xu YW, Ding CH, Wang Q, Li J, Shen XT. A Further Exploration of the Impact of Antinuclear Antibodies onIn VitroFertilization-Embryo Transfer Outcome. Am J Reprod Immunol 2013; 70:221-9. [PMID: 23480310 DOI: 10.1111/aji.12111] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 02/07/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ying Ying
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Yi-Ping Zhong
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Can-Quan Zhou
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Yan-Wen Xu
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Chen-Hui Ding
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Qiong Wang
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Jie Li
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Xiao-Ting Shen
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
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17
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Mariee NG, Tuckerman E, Laird S, Li TC. The correlation of autoantibodies and uNK cells in women with reproductive failure. J Reprod Immunol 2012; 95:59-66. [PMID: 22884101 DOI: 10.1016/j.jri.2012.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 04/16/2012] [Accepted: 04/23/2012] [Indexed: 12/19/2022]
Abstract
There is conflicting evidence on the role of autoimmune disorders in reproductive failure, including recurrent miscarriage (RM) and recurrent implantation failure (RIF), after in vitro fertilisation (IVF). Several commonly studied autoimmune markers in women with reproductive failure include antiphospholipid antibodies (APAs), thyroid peroxidase antibodies (TPA) and uterine natural killer (uNK) cells. However, there have not been any studies that have examined the correlation of these markers in women with reproductive failure. To determine if women who tested positive for autoantibodies (APA and thyroid peroxidase antibodies) have significantly higher uNK cell numbers than women who tested negative for these antibodies, the percentage of stromal cells that stained positive for CD56 was identified by immunocytochemistry in endometrial biopsies from 42 women with unexplained RM (29 women tested negative for autoantibodies and 13 women tested positive for autoantibodies) and 40 women with unexplained RIF (30 women tested negative for autoantibodies and 10 women tested positive for autoantibodies). Biopsies were obtained on days LH+7 to LH+9. There was no significant difference in uNK cell numbers between women with unexplained RM who tested negative and those who tested positive for autoantibodies. Similarly, there was no significant difference in uNK cell numbers between women with unexplained RIF who tested negative and those who tested positive for autoantibodies. In women with reproductive failure the presence of autoantibodies does not appear to affect the numbers of uNK cells in the endometrium around the time of implantation.
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Affiliation(s)
- N G Mariee
- Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield S10 2SF, UK.
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18
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A retrospective study on IVF outcome in patients with anticardiolipin antibody: effects of methylprednisolone plus low-dose aspirin adjuvant treatment. J Reprod Immunol 2012; 94:196-201. [DOI: 10.1016/j.jri.2012.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 03/16/2012] [Accepted: 04/04/2012] [Indexed: 11/19/2022]
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19
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Ying Y, Zhong YP, Zhou CQ, Xu YW, Wang Q, Li J, Shen XT, Wu HT. Antinuclear Antibodies Predicts a Poor IVF-ET Outcome: Impaired Egg and Embryo Development and Reduced Pregnancy Rate. Immunol Invest 2012; 41:458-68. [DOI: 10.3109/08820139.2012.660266] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Coulam CB, Acacio B. Does Immunotherapy for Treatment of Reproductive Failure Enhance Live Births? Am J Reprod Immunol 2012; 67:296-304. [DOI: 10.1111/j.1600-0897.2012.01111.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 01/23/2012] [Indexed: 02/03/2023] Open
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21
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Lopera-Vallejo AF, Alijotas-Reig J. Anticuerpos antifosfolipídicos y fracaso implantatorio recurrente en fertilización in vitro. El debate continúa. Med Clin (Barc) 2011; 137:697-701. [DOI: 10.1016/j.medcli.2010.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 09/13/2010] [Accepted: 09/14/2010] [Indexed: 11/28/2022]
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22
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Thrombophilia and outcomes of assisted reproduction technologies: a systematic review and meta-analysis. Blood 2011; 118:2670-8. [DOI: 10.1182/blood-2011-03-340216] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Abstract
Thrombophilia has been associated with pregnancy complications and recurrent miscarriage. The aim of this systematic review was to evaluate the controversial association between thrombophilia and failures of assisted reproduction technology (ART). A systematic search of the literature for studies reporting on thrombophilia in women undergoing ART up to April 2011 yielded 33 studies (23 evaluating anti-phospholipid antibodies, 5 inherited thrombophilia, and 5 both) involving 6092 patients. Overall, methodologic quality of the studies was poor. Combined results from case-control studies showed that factor V Leiden was significantly more prevalent among women with ART failure compared with fertile parous women or those achieving pregnancy after ART (odds ratio = 3.08; 95% confidence interval, 1.77-5.36). The prothrombin mutation, methylenetetrahydrofolate reductase mutation, deficiency of protein S, protein C, or anti-thrombin were all not associated with ART failure. Women with ART failure tested more frequently positive for anti-phospholipids antibodies (odds ratio = 3.33; 95% confidence interval, 1.77-6.26) with evidence of high degree of between-study heterogeneity (I2 = 75%; P < .00001). Prospective cohort studies did not show significant associations between thrombophilia and ART outcomes. Although case-control studies suggest that women experiencing ART failures are more frequently positive for factor V Leiden and anti-phospholipid antibodies, the evidence is inconclusive and not supported by cohort studies.
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23
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Involvement of anticentromere antibody in interference with oocyte meiosis and embryo cleavage. Fertil Steril 2011; 95:2729-31. [PMID: 21295298 DOI: 10.1016/j.fertnstert.2011.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 12/22/2010] [Accepted: 01/07/2011] [Indexed: 11/22/2022]
Abstract
The aim of this study was to investigate the clinical significance of anticentromere antibody (ACA) among types of antinuclear antibody (ANA) in the properties of oocytes retrieved from infertile women. The rate of metaphase II oocytes or embryo cleavage was significantly decreased in patients with positive ACA compared with patients with negative ACA, suggesting that ACA is an essential marker for flawed oocytes in infertile women with any type of ANA.
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24
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HEPARIN IN HUMAN PLACENTAL DEVELOPMENT AND THE PREVENTION OF PLACENTAL COMPLICATIONS OF PREGNANCY. ACTA ACUST UNITED AC 2010. [DOI: 10.1017/s0965539510000070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The development of effective anticoagulant drugs available for use in pregnancy has resulted in dramatic improvements for a number of potentially life-threatening conditions. These include the treatment and prevention of venous thromboembolism and the thrombotic complications of antiphospholipid antibody syndrome, as well as the management of pregnant women with mechanical heart valves. The most commonly used class of drug includes heparin, a highly-charged macro-molecule that does not cross the placenta, in contrast to the potentially teratogenic and fetotoxic oral drug warfarin. This review will focus on our current lack of understanding of the wider actions of heparin and examines the possibility that large numbers of pregnant women are presently being treated inappropriately with heparin.
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25
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Nardo LG, Granne I, Stewart J, On Behalf of the Policy Practice Co. Medical adjuncts in IVF: evidence for clinical practice. HUM FERTIL 2009; 12:1-13. [DOI: 10.1080/14647270802692169] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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26
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Buckingham K, Chamley L. A critical assessment of the role of antiphospholipid antibodies in infertility. J Reprod Immunol 2009; 80:132-45. [DOI: 10.1016/j.jri.2008.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 11/07/2008] [Indexed: 10/21/2022]
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27
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28
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Nelson SM. Prophylaxis of VTE in women – during assisted reproductive techniques. Thromb Res 2009; 123 Suppl 3:S8-S15. [DOI: 10.1016/s0049-3848(09)70127-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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29
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Abstract
The assessment of anti-phospholipid antibodies (APA) is not indicated among couples undergoing IVF, and therapy is not justified on the basis of existing data.
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30
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Nelson SM, Greer IA. The potential role of heparin in assisted conception. Hum Reprod Update 2008; 14:623-45. [DOI: 10.1093/humupd/dmn031] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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31
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Abstract
Low dose aspirin therapy is one of the anticoagulant treatments used during pregnancy. Anticoagulant agents may be useful for several disorders, such as recurrent miscarriage, pre-eclampsia, fetal growth restriction and infertility. However, it is unclear whether anticoagulant therapy can increase the live birth rate in all of these cases. Recent data suggest that a low-dose aspirin and heparin combination therapy is effective in the prevention of recurrent pregnancy loss in women with antiphospholipid syndrome. Thrombogenic diseases, for example, protein C deficiency, protein S deficiency, factor XII deficiency and hyperhomocysteinemia, may cause pregnancy loss. The etiology of recurrent miscarriage is often unclear and may be multifactorial, with much controversy regarding diagnosis and treatment. Although 70% of recurrent pregnancy losses are unexplained, anticoagulant therapy is effective in maintaining pregnancy without antiphospholipid antibody syndrome. We conclude that a low-dose aspirin and heparin combination therapy can be useful for unexplained cases of recurrent pregnancy loss without antiphospholipid antibody syndrome. (Reprod Med Biol 2008; 7: 1-10).
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Affiliation(s)
- Aiko Makino
- Department of Obstetrics and Gynecology, Nagoya City University Medical School, Mizuho-ku Nagoya 467-8601, Japan
| | - Mayumi Sugiura-Ogasawara
- Department of Obstetrics and Gynecology, Nagoya City University Medical School, Mizuho-ku Nagoya 467-8601, Japan
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32
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Lee SR, Park EJ, Kim SH, Chae H, Kim CH, Kang BM. Influence of antiphospholipid antibodies on pregnancy outcome in women undergoing in vitro fertilization and embryo transfer. Am J Reprod Immunol 2007; 57:34-9. [PMID: 17156189 DOI: 10.1111/j.1600-0897.2006.00437.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Antiphospholipid antibodies (APA) are thought to be involved in recurrent pregnancy loss. Therefore, we investigated the impact of APA on pregnancy outcome in women undergoing in vitro fertilization and embryo transfer (IVF-ET). METHOD OF STUDY Blood samples taken from 54 Korean women referred for IVF were tested for the presence of APA, anticardiolipin antibody IgG and IgM and lupus anticoagulant. The standard gonadotropin-releasing hormone agonist long protocol was used for ovarian stimulation. RESULTS Nine patients (16.7%) were positive and 45 (83.3%) were negative for APA. There were no significant differences between the two groups in clinical characteristics such as age, infertility duration, and response to controlled ovarian hyperstimulation. However, pregnancy outcome significantly differed between the two groups (p < 0.05). The APA positive group and APA negative group had abortion rates of 62.5% and 20.0%, respectively and delivery rates of 37.5% and 80.0%, respectively. CONCLUSION The presence of APA in women undergoing IVF-ET was associated with a poor pregnancy outcome.
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Affiliation(s)
- Sa-Ra Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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33
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34
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Qublan HS, Eid SS, Ababneh HA, Amarin ZO, Smadi AZ, Al-Khafaji FF, Khader YS. Acquired and inherited thrombophilia: implication in recurrent IVF and embryo transfer failure. Hum Reprod 2006; 21:2694-8. [PMID: 16835215 DOI: 10.1093/humrep/del203] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Hussein S Qublan
- Department of Obstetrics and Gynecology, Royal Medical Services, Jordan Armed Forces, Irbid, Jordan.
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35
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Matsubayashi H, Sugi T, Arai T, Shida M, Kondo A, Suzuki T, Izumi SI, McIntyre JA. IgG-antiphospholipid antibodies in follicular fluid of IVF-ET patients are related to low fertilization rate of their oocytes. ACTA ACUST UNITED AC 2006; 55:341-8. [PMID: 16635208 DOI: 10.1111/j.1600-0897.2006.00374.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PROBLEM Patients undergoing in vitro fertilization and embryo transfer (IVF-ET) failures show an increased incidence of antiphospholipid antibodies (aPL) in their blood. The physiological manifestations of aPL in this patient group are nonetheless controversial. Pathological effects of aPL on embryos in vitro have been documented. We questioned whether aPL if found in follicular fluids (FFs) could result in embryonic damage. METHOD OF STUDY Blood from 44 patients with three or more IVF-ET failures were tested by enzyme-linked immunosorbent assays (ELISA) for the presence of immunoglobulin (Ig)G, IgM and IgA aPL. Both the 29 aPL-positive and 15 aPL-negative patients gave permission for FF collection during their next IVF-ET attempt for additional aPL determinations. RESULTS Patients with no aPL in their blood, had no aPL in their FFs. Patients with IgG and/or IgM aPL in their blood had IgG but not IgM in their respective FFs. CONCLUSIONS The presence of IgG aPL in FFs and increased infertility length were significantly related to lower fertilization rates, independently. Follicular fluid IgG aPL appears as a risk factor in association with successful IVF-ET outcomes.
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Affiliation(s)
- Hidehiko Matsubayashi
- Department of Obstetrics and Gynecology, Specialized Clinical Science, Tokai University School of Medicine, Kanagawa, Japan.
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36
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Fernández-Llanio N, Alegre-Sancho JJ, Chalmeta-Verdejo C, Fernández-Carballido C, Román-Ivorra JA. [Hormone therapy, fertility and pregnancy in antiphospholipid syndrome]. REUMATOLOGIA CLINICA 2006; 2:90-106. [PMID: 21794309 DOI: 10.1016/s1699-258x(06)73027-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Accepted: 09/05/2005] [Indexed: 05/31/2023]
Abstract
Antiphospholipid syndrome (APS) carries a risk of thrombosis and infertility. Consequently the use of any type of hormone therapy and pregnancy in APS requires special considerations. The present article provides a broad review of all these issues. The use of contraception, hormone replacement therapy and selective estrogen receptor modulators in APS are described. In vitro fertilization/embryo transfer and ovarian induction in these patients are reviewed. Lastly, the possible fetal and maternal complications that can occur during pregnancy are described and, based on the literature, recommendations for the management of pregnancy in women with APS are provided.
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Affiliation(s)
- N Fernández-Llanio
- Sección de Reumatología. Hospital Universitario Dr. Peset. Valencia. España
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37
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Christiansen OB, Nielsen HS, Kolte AM. Future directions of failed implantation and recurrent miscarriage research. Reprod Biomed Online 2006; 13:71-83. [PMID: 16820113 DOI: 10.1016/s1472-6483(10)62018-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Recurrent implantation failure is today the major reason for women completing several IVF/intracytoplasmic sperm injection attempts without having achieved a child, and is probably also the explanation for many cases of unexplained infertility. Most causes of recurrent miscarriage are still poorly elucidated, but from a theoretical point of view recurrent implantation failure and recurrent miscarriage are suggested to have partly overlapping causes. Recent research has indeed documented that both syndromes can be caused by the same embryonic chromosomal abnormalities and the same maternal endocrine, thrombophilic and immunological disturbances. Consequently, many treatments attempting to normalize these abnormalities have been tested or are currently used in women with both recurrent implantation failure and recurrent miscarriage. However, no treatment for the two syndromes is at the moment sufficiently documented to justify its routine use. In this review, an overview is given regarding present knowledge about causes that may be common for recurrent implantation failure and recurrent miscarriage, and suggestions are put forward for future research that may significantly improve understanding and treatment options for the syndromes.
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Affiliation(s)
- Ole B Christiansen
- Fertility Clinic 4071, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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38
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Stern C, Chamley L. Antiphospholipid antibodies and coagulation defects in women with implantation failure after IVF and recurrent miscarriage. Reprod Biomed Online 2006; 13:29-37. [PMID: 16820106 DOI: 10.1016/s1472-6483(10)62013-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evaluation of patients with IVF implantation failure or recurrent miscarriage often frustratingly fails to elicit any particular cause for their problem. Testing for antiphospholipid antibodies or thrombophilia is commonly carried out, and interpretation of results in the light of the current evidence is extremely difficult. This paper reviews the purported pathogenetic mechanisms and clinical associations between both antiphospholipid antibodies and inherited thrombophilias, and reproductive failure. The current management strategies are also critically evaluated and recommendations are made for optimal, evidence-based clinical practice.
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Affiliation(s)
- Catharyn Stern
- Royal Women's Hospital and Melbourne IVF, Melbourne, Australia.
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39
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Buckingham KL, Stone PR, Smith JF, Chamley LW. Antiphospholipid antibodies in serum and follicular fluid--is there a correlation with IVF implantation failure? Hum Reprod 2005; 21:728-34. [PMID: 16253967 DOI: 10.1093/humrep/dei369] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antiphospholipid antibodies (aPLs) are associated with infertility, but the mechanism underlying this statistical association is currently obscure. We aimed to investigate the finding that aPLs are concentrated in follicular fluid and to establish if this is associated with a poorer outcome from IVF. METHODS AND RESULTS In 19.2% of 99 women undergoing IVF, at least one aPL was detected in their serum and/or follicular fluids, but the antibody levels in follicular fluid were not higher than in serum. Women with aPLs had a lower implantation rate (14%) than women without these antibodies (24.1%), but this difference was not significant (P=0.127). There was also a non-significant reduction in the live birth rate for women with aPLs. In a parallel investigation, 10 sheep immunized with beta2 glycoprotein I (beta2GPI) or irrelevant control antigens showed strong immune responses, but there were no significant differences between the levels of antibodies in the follicular fluid or serum from beta2GPI or control immunized sheep. CONCLUSION aPLs do not appear to be selectively concentrated in follicular fluids and, when present, do not adversely affect the reproductive outcome of women undergoing IVF.
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Affiliation(s)
- K L Buckingham
- Department of Obstetrics and Gynaecology, University of Auckland, and Fertility Plus, Greenlane Clinical Centre, Private Bag 92189, Auckland 1003, New Zealand.
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40
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Urman B, Yakin K, Balaban B. Recurrent implantation failure in assisted reproduction: how to counsel and manage. B. Treatment options that have not been proven to benefit the couple. Reprod Biomed Online 2005; 11:382-91. [PMID: 16176683 DOI: 10.1016/s1472-6483(10)60847-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The success of assisted reproduction, although gradually increasing over the years, is still less than satisfactory. Many couples have benefited from this treatment; however, many have also been left frustrated following multiple failed attempts. Couples who fail to conceive after multiple IVF/intracytoplasmic sperm injection (ICSI) treatments often seek treatment options that are new and that have not been offered before. Some of these include immunological testing and treatment, allogenic lymphocyte therapy, intratubal transfer of zygotes and embryos, blastocyst transfer, sequential embryo transfer, assisted hatching, co-cultures, and preimplantation genetic screening for aneuploidy. Although the evidence behind some of these is more robust, most suffer from lack of well designed randomized trials comparing them with other treatment options. Randomized studies are extremely difficult to conduct, as couples will resist being randomized into a treatment group where previously failed procedures will be repeated. In the mean time, assisted reproduction programmes should resist offering treatment options that are not evidence based, or at least they should share with the couple the information that is available and should stress that none of these is a panacea for their problem.
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Affiliation(s)
- Bulent Urman
- Assisted Reproduction Unit, American Hospital of Istanbul, Turkey.
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Ozturk O, Saridogan E, Jauniaux E. Drug intervention in early pregnancy after assisted reproductive technology. Reprod Biomed Online 2004; 9:452-65. [PMID: 15511349 DOI: 10.1016/s1472-6483(10)61283-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Implantation in humans is a complex, closely regulated, highly selective and relatively poorly understood process. Humans have the highest rate of miscarriage in mammals and various pharmacological manipulations have been used to minimize pregnancy losses in both spontaneous pregnancies and pregnancies resulting from assisted reproduction technology. The widespread application of protocols using numerous drugs in assisted reproduction treatment has led to an increasing number of pregnancies exposed to these drugs. The vast majority of these protocols have been based on data from a few observational and often retrospective clinical studies. This paper reviews the recent literature on drug interventions in early pregnancy after assisted reproduction treatment. It is concluded that there are still numerous issues about the safety of most drugs for both the women and their fetus. In many cases, the benefits are theoretical and the possible long-term side-effects are untested. There is an urgent need for more epidemiological studies and randomized controlled trials to explore the use, efficacy and side-effects of both old and new drugs in early pregnancy after assisted reproduction treatment.
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MESH Headings
- Abortion, Habitual/etiology
- Abortion, Habitual/therapy
- Abortion, Spontaneous/epidemiology
- Abortion, Spontaneous/etiology
- Abortion, Spontaneous/prevention & control
- Antibodies, Antiphospholipid/blood
- Antiphospholipid Syndrome/complications
- Endometriosis/complications
- Endometriosis/therapy
- Female
- Humans
- Hyperprolactinemia/complications
- Hyperprolactinemia/physiopathology
- Hyperprolactinemia/therapy
- Infertility, Female/etiology
- Infertility, Female/immunology
- Infertility, Female/therapy
- Luteal Phase/physiology
- Oxidative Stress
- Polycystic Ovary Syndrome/complications
- Polycystic Ovary Syndrome/therapy
- Pregnancy
- Pregnancy Maintenance/drug effects
- Reproductive Techniques, Assisted
- Uterus/blood supply
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Affiliation(s)
- Ozkan Ozturk
- Academic Department of Obstetrics and Gynaecology, University College London Hospitals, 86-96 Chenies Mews, London, WC1E 6HX, UK
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Putowski L, Darmochwal-Kolarz D, Rolinski J, Oleszczuk J, Jakowicki J. The immunological profile of infertile women after repeated IVF failure (preliminary study). Eur J Obstet Gynecol Reprod Biol 2004; 112:192-6. [PMID: 14746958 DOI: 10.1016/j.ejogrb.2003.06.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this preliminary study was to estimate the immunological profile of patients after repeated IVF failures. MATERIALS AND METHODS Seventeen women after repeated IVF failure and 10 non-pregnant women with a history of successful IVF pregnancies were included in the study. We estimated the presence of the auto-antibodies, such as: antinuclear antibodies (ANA), antithyroid antibodies (ATA), antiphospolipid antibodies (APA), antismooth muscle antibodies (ASMA), and antisperm antibodies (ASA). Furthermore, we estimated the percentage of B-1 CD 19+5+ lymphocytes and NK cells using flow cytometry. RESULTS In the group of patients after IVF failure the percentage of B-1 CD 19+5+ lymphocytes was higher than 1.5% and significantly higher when compared to controls. Three patients after IVF failure had elevated percentages of peripheral blood NK cells. Fourteen infertile patients after IVF failure (82.3%) had at least one abnormal result on autoimmune testing. One patient from the study group had no positive results of immunological tests. CONCLUSION Our results suggest that immunological alterations may be involved in the etiopathogenesis of unexplained infertility. Furthermore, the results suggest that there is a need for immunological diagnostics in the group of patients with unexplained infertility A greater number of patients is needed for further investigations.
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Affiliation(s)
- Lechoslaw Putowski
- Department of Gynecology, University School of Medicine, 20-954 Lublin, ul Jaczewskiego 8, Poland.
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Kikuchi K, Shibahara H, Hirano Y, Kohno T, Hirashima C, Suzuki T, Takamizawa S, Suzuki M. Antinuclear Antibody Reduces the Pregnancy Rate in the First IVF-ET Treatment Cycle but Not the Cumulative Pregnancy Rate without Specific Medication. Am J Reprod Immunol 2003; 50:363-7. [PMID: 14672342 DOI: 10.1034/j.1600-0897.2003.00088.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PROBLEM It has been shown that the presence of antinuclear antibody (ANA) might reduce pregnancy rates after in vitro fertilization-embryo transfer (IVF-ET). However, the mechanism of implantation failure by ANA has not yet been clarified. This study was performed to investigate the impact of ANA on pregnancy rates after IVF-ET, and the necessity of specific medication for infertile women who have ANA in their sera. METHOD OF STUDY A total of 108 infertile women were treated by IVF-ET or intracytoplasmic sperm injection (ICSI)-ET. ANA was examined by an indirect fluorescent antibody procedure. Data from women under 40 years old were analyzed retrospectively. RESULTS The implantation rates per embryo transferred in the first treatment cycles were 14.8% (eight of 54) and 32.4% (33 of 102), in women with and without ANA, respectively. There was a significant difference in the implantation rates between the two groups (P < 0.05). The pregnancy rates per ET in the first treatment cycles were 28% (seven of 25) and 54.2% (26 of 48), respectively. There was also a significant difference in the pregnancy rates between the two groups (P < 0.05). Afterwards, treatments with IVF-ET or ICSI-ET were repeatedly performed for unsuccessful patients, without any specific medication for ANA. The average ET cycles were 1.80 +/- 1.13 and 1.27 +/- 0.54, in women with and without ANA, respectively. The cumulative pregnancy rates per patient were 68% (17 of 25) and 55.6% (35 of 63), respectively. There was no significant difference in the overall pregnancy rates between the two groups. CONCLUSIONS These findings suggest that ANA might have an impact on implantation failure in women treated by IVF-ET or ICSI-ET. ANA reduced the pregnancy rates in the first IVF-ET or ICSI-ET cycles but not the cumulative pregnancy rates without medication. This indicates that the mechanisms of implantation failure by ANA could be solved, and effective and safe medication should be developed for better implantation rates, especially in the first treatment cycle.
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Affiliation(s)
- Kumiko Kikuchi
- Department of Obstetrics and Gynecology, Jichi Medical School, Kawachi-gun, Tochigi, Japan
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Stern C, Chamley L, Norris H, Hale L, Baker HWG. A randomized, double-blind, placebo-controlled trial of heparin and aspirin for women with in vitro fertilization implantation failure and antiphospholipid or antinuclear antibodies. Fertil Steril 2003; 80:376-83. [PMID: 12909502 DOI: 10.1016/s0015-0282(03)00610-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether heparin and low-dose aspirin increase the pregnancy rate in antiphospholipid antibody or antinuclear antibody-seropositive women with IVF implantation failure. DESIGN A double-blind, randomized, transfer-by-transfer of fresh or cryopreserved embryos, crossover trial.A hospital infertility clinic and associated IVF service. PATIENT(S) Women seropositive for at least one antiphospholipid (APA), antinuclear (ANA), or beta(2) glycoprotein I autoantibody and >or=10 embryos transferred without achieving pregnancy (n = 143). INTERVENTION(S) Subcutaneous unfractionated heparin (5000 IU b.i.d.) and aspirin (100 mg daily) (158 transfers of 296 embryos) or placebo (142 transfers of 259 embryos) from the day of embryo transfer. MAIN OUTCOME MEASURE(S) Fetal heart per embryo transferred (implantation rate). RESULT(S) There was no significant difference in pregnancy rates or implantation rates between treated and placebo cycles; for example, fetal hearts per embryo transferred implantation rates were 6.8% (20/296) and 8.5% (22/259), respectively, and the generalized estimating equation covariate adjusted relative pregnancy rate was 0.65 (95% confidence interval, 0.33-1.28). The implantation rate for seropositive trial participants (42/555, 7.6%) compared favorably with that for IVF implantation-failure patients continuing treatment outside the trial (147/3237, 4.5%). CONCLUSION(S) Heparin and aspirin did not improve pregnancy or implantation rates for APA-positive or ANA-positive patients with IVF implantation failure.
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Abstract
PURPOSE OF REVIEW Much attention has been paid to the role of immunology in reproductive success or failure. Every step in the establishment of normal pregnancy has been implicated as a possible site of immune-mediated reproductive failure. The widespread testing of antiphospholipid, antinuclear, antithyroid, and antisperm antibodies, as well as generalized immune testing, have thus been employed to diagnose patients with otherwise unexplained infertility or recurrent pregnancy loss. Controversial data surrounding the widespread and variable use of immune testing in current fertility practice is reviewed to determine which tests are warranted based on sound scientific evidence. Because it is postulated that early miscarriage, when occult, could represent a failure of embryo implantation indistinguishable from unexplained infertility, this analysis of immune testing includes a discussion of patients with recurrent pregnancy loss. RECENT FINDINGS Despite the increased prevalence of abnormal immune testing associated with early reproductive failure, the most rigorous studies have not proven a cause and effect between these phenomena. There is wide variation and inconsistency regarding this association, depending upon which test(s) are employed, the study methodology used, and the patient population under study. The significance of selected immunological test abnormalities associated with early reproductive failure is uncertain. SUMMARY Great variability exists in identifying candidates for immune testing, determining which tests to order, interpreting the test results, and offering immunologic treatments. This review argues that the use of widespread immune testing in clinical practice can not be supported by existing data. The resulting therapies are similarly of unconfirmed benefit and may cause harm.
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Affiliation(s)
- Caleb B Kallen
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA
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Abstract
PROBLEM The amino phospholipids (PL), phosphatidylserine (PS) and phosphatidylethanolamine (PE) are distributed asymmetrically in the plasma membranes of eucaryotic cells. This arrangement involves active transport of PS and PE from the outer to inner membrane leaflet by an aminophospholipid translocase (flipase). Cell activation, injury and programmed cell death (apoptosis) cause collapse of the PS/PE asymmetry by activation of another enzyme system, scramblase. Unlike other cells, the developing trophoblast exteriorizes PS during its differentiation. METHODS OF STUDY An analysis of published and unpublished data. RESULTS The trophoblast is targeted by antiphospholipid antibodies (aPL), especially to PS (aPS). Cardiolipin is not present in the trophoblast plasma membrane, nonetheless, anticardiolipin (aCL) has been implicated in trophoblast pathology. The aPS and aCL are often crossreactive. Both animal and in vitro experimental models have shown monoclonal and polyclonal aPS and aCL to specifically destroy trophoblast, inhibit syncytium formation, halt human chorionic gonadatropin (hCG) production, and limit trophoblast invasion. Antibodies to PE (aPE) have not been well characterized, however, recent reports from several independent laboratories document that aPE are associated significantly with very early (embryonic) recurrent pregnancy loss (RPL). Umeda and coworkers have shown that during cytokinesis (late telophase) of Chinese hamster ovary (CHO) cells, formation of PE rafts in cleavage furrows is required for completion of cell division and formation of daughter cells. This raises the question whether aPE might interfere with implantation and cell division during embryogenesis. CONCLUSIONS A role for aPL in implantation failure and occult pregnancy loss constitutes the basis of this overview.
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Affiliation(s)
- J A McIntyre
- HLA-Vascular Biology Laboratory, St Francis Hospital and Health Centers, Indiana/Purdue Universities at Indianapolis, Indianapolis, IN 46107, USA.
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Balasch J, Cervera R. Reflections on the management of reproductive failure in the antiphospholipid syndrome--the clinician's perspective. Lupus 2003; 11:467-77. [PMID: 12220100 DOI: 10.1191/0961203302lu237ra] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
It is well known that women with systemic lupus erythematosus (SLE) who have antiphospholipid antibodies (aPL) are at increased risk for pregnancy loss. Additionally, other reproductive processes, such as unexplained infertility and implantation failure after in vitro fertilization and embryo transfer may be affected by aPL. Thus, clinical manifestations of the so-called 'gynaeco-obstetrical antiphospholipid syndrome' have been expanded into the concept of the 'reproductive autoimmune failure syndrome'. However, this is still a matter of debate with no general agreement with respect to both pathophysiological significance of the presence of aPL and patient management. This article analyses a number of controversies in the management of reproductive failure potentially associated with aPL in order to help clinicians dealing with such condition in daily clinical practice.
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Affiliation(s)
- J Balasch
- Institut Clinic of Gynaecology, Obstetrics and Neonatology, Catalonia, Spain.
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Allahbadia GN, Allahbadia SG. Low molecular weight heparin in immunological recurrent abortion--the incredible cure. J Assist Reprod Genet 2003; 20:82-90. [PMID: 12688592 PMCID: PMC3455788 DOI: 10.1023/a:1021792125123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The most compelling association between pregnancy loss and autoimmune phenomena has been with the presence of antiphospholipid antibodies (APA)--lupus anticoagulant and anticardiolipin antibody. The 'antiphospholipid antibody syndrome' has been described in women with a history of recurrent pregnancy loss or thrombosis with positive APA or lupus anticoagulant on two occasions. Although several treatments have been advocated, heparin and aspirin treatment is emerging as the treatment of choice for the APA syndrome associated with recurrent pregnancy loss. The rationale for prescribing aspirin in cases of recurrent reproductive failure associated with APA seropositivity is that aspirin may counter APA-mediated hypercoagulability in the choriodecidual space, a situation which if left unaddressed would traumatize the trophoblast and compromise feto-maternal exchange. Heparin on the other hand, through preventing APA from interfering with syncytialization of the early cytotrophoblast and by countering APA interference with phospholipid-decidual reactions that are vital to early implantation, might potentially promote both early implantation and subsequent placentation.
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Abstract
Antiphospholipid antibodies (aPL) are autoantibodies that are associated with recurrent reproductive failure and thrombotic disease. There are two well-characterised aPL, lupus anticoagulant and anticardiolipin antibodies. aPL were originally thought to bind to negatively-charged phospholipids but it is now clear that the title aPL is a misnomer and that the antigens for these autoantibodies are actually phospholipid-binding proteins. Chief amongst these phospholipid-binding proteins are prothrombin and beta(2) glycoprotein I. This review concentrates on the role of beta(2) glycoprotein I in the reproductive failure caused by aPL. Exactly how aPL cause reproductive failure remains unknown but there is emerging evidence that the antibodies may have several different adverse effects on trophoblasts. There is also evidence questioning the traditional hypothesis that fetal demise is secondary to thrombosis of the utero-placental circulation. Heparin is commonly used to treat pregnant women with aPL but if these antibodies do not cause fetal demise primarily by a thrombotic mechanism a question must be raised over the role of heparin. However, heparin binds to many proteins including beta(2) glycoprotein I and it is possible that the reported beneficial effects of heparin in aPL-affected pregnancies may be due to the ability of heparin to prevent the interaction of aPL and beta(2) glycoprotein I.
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Affiliation(s)
- L W Chamley
- Department of Obstetrics and Gynaecology, University of Auckland, National Women's Hospital, Epsom, New Zealand.
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