A retrospective study on IVF/ICSI outcome in patients with anti-nuclear antibodies: the effects of prednisone plus low-dose aspirin adjuvant treatment

Abstract

BackgroundAnti-nuclear antibodies (ANA) are suspected of having relevance to adverse reproductive events.MethodsThis study aims to investigate the potential effect of ANA on IVF/ICSI outcome and the therapeutic role of prednisone plus low-dose aspirin (P + A) adjuvant treatment in ANA + patients. The first IVF/ICSI cycles without P + A of sixty-six ANA + women were enrolled as the ANA + group, and the 233 first IVF/ICSI cycles of matched ANA- women served as the ANA- group. The ANA + group was divided into the Titre < =1:320 subgroup and the Titre > 1:320 subgroup. Twenty-one ANA + women with adverse outcomes in their first cycles (ANA + cycles without P + A) received P + A adjuvant treatment for three months before the second IVF/ICSI cycle (ANA + cycles with P + A). The clinical characteristics and the IVF/ICSI outcomes were compared, respectively, between 1) the ANA + group and the ANA- group, 2) the Titre < =1:320 subgroup and the Titre > 1:320 subgroup, and 3) the ANA + cycles without P + A and the ANA + cycles with P + A.ResultsNo significant differences were observed between each of the two-group pairs in the clinical characteristics. The ANA + group exhibited significantly lower MII oocytes rate, normal fertilisation, pregnancy and implantation rates, as well as remarkably higher abnormal fertilisation and early miscarriage rates. The Titre < =1:320 subgroup’s IVF/ICSI outcomes were as poor as those of the Titre > 1:320 subgroup. After the P + A adjuvant treatment, the number of two pro-nuclei, perfect embryos and available embryos, and the implantation rate increased significantly.ConclusionsThese observations suggest that ANA could exert a detrimental effect on IVF/ICSI outcome that might not be titre-dependent, and P + A adjuvant treatment could be useful for ANA + patients. This hypothesis should be verified in further prospective randomised studies.

Successful Pregnancy Following Assisted Reproduction in Woman With Systemic Lupus Erythematosus and Hypertension

“…Combined treatment of prednisone for immunosuppression and aspirin or LMWH as antithrombotic, starting before ovulation induction, may improve pregnancy rate in patients who have had repeated assisted reproductive failures. 25 – 27 Our case indicates that concurrent immunosuppressant and antithrombotic treatment throughout the pregnancy is safe.…”

Short-term dexamethasone plus acetylsalicylic acid treatment during in vitro fertilization procedure

“…Prednisolone plus ASA treatment was reported to improve IVF outcome in women with autoimmune conditions [28,29]. Ten mg of prednisolone plus 100 mg of aspirin for three months before IVF were useful for antinuclear antibodies positive patients [13]. Also, anti-thyroid antibodies (ATA) are determined in 10.5% in euthyroid infertile women and 13.9% those with idiopathic infertility [28,30].…”

“…IVF patients treated with levothyroxine, prednisolone, and ASA had significantly higher pregnancy and implantation rates than untreated or only levothyroxine treated ATA positive patients [28,31]. Doses of prednisolone or dexamethasone that had been used as an adjuvant IVF therapy are not sufficient to cause reduction of autoantibody titres [13]. However, there is no proof that antibodies can directly harm pregnancy in human but rather be a sign of a dysregulated immune response [1].…”

“…[3,12]. There is no general agreement about the dosage, time to start, and the length of the GCs or ASA treatment [7,13]. Thus, it is important to determine an effective and safe protocol that would be optimal to improve the outcome of IVF and minimize the chances of side effects.…”

Precise Personalized Medicine in Gynecology Cancer and Infertility

“…Associated with higher abnormal fertilization and early miscarriage rates, a detrimental effect on IVF/ICSI outcome (Zhu et al, 2013).…”