Effect of antiphospholipid antibodies in women undergoing in-vitro fertilization: role of heparin and aspirin

Kutteh, William H.; Yetman, Deborah L.; Chantilis, S.J.; Crain, J.L.

doi:10.1093/humrep/12.6.1171

Cited by 142 publications

(88 citation statements)

References 6 publications

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“…Sher et al suggested that heparin and aspirin treatment during IVF cycles in aPL-positive women improves success rates (29), but Kutteh et al showed no difference in implantation or pregnancy rates between primary APS patients pretreated with heparin plus aspirin versus those who received aspirin alone (30). Intravenous immunoglobulin, another treatment option, was used in only 1 of our patients.…”

Section: Discussionmentioning

confidence: 69%

Ovulation induction and in vitro fertilization in systemic lupus erythematosus and antiphospholipid syndrome

Guballa

Sammaritano

Schwartzman

et al. 2000

Arthritis & Rheumatism

143

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Objective. During ovulation induction (OI), ovarian stimulation is accomplished by hormonal manipulation, which includes administration of gonadotropins, gonadotropin-releasing hormone agonists, folliclestimulating hormone, and luteinizing hormone. In in vitro fertilization (IVF), progesterone is often added. Because of the possibility of hormone-associated flare or thrombosis, patients with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (primary APS) undergoing OI/IVF are potentially at increased risk. The present study was conducted in order to assess this risk.Methods. Nineteen women who underwent 68 cycles of OI/IVF were studied by interview and retrospective chart review.Results. Four OI/IVF cycles (25%) in SLE patients resulted in increased lupus activity and 2 (13%) in ovarian hyperstimulation syndrome. One patient with primary APS who was given heparin during multiple cycles developed osteopenia. No thrombosis occurred. Pregnancy complications included toxemia, lupus flare, gastrointestinal hemorrhage due to Mallory-Weiss tear, polygestation, and diabetes. Postpartum complications included nephritis flare, costochondritis, and suicidal depression. Lupus flares occurred at expected rates. Five of 16 cycles (31%) in 7 SLE patients, 5 of 48 cycles (10%) in 10 primary APS patients, and 0 of 5 cycles in 2 women with antiphospholipid antibody (without SLE or primary APS) resulted in liveborn children, including multiple gestations (3 twin sets with 4 surviving infants and 2 triplet sets with 3 surviving infants). Seven of 14 living children (50%) were premature, 3 had neonatal lupus, and 1 had pulmonic stenosis. Five surviving infants (38%) had complications unrelated to prematurity.Conclusion. Although OI/IVF can be successful in SLE and primary APS patients, rates of fetal and maternal complications are high.

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Section: Discussionmentioning

confidence: 69%

Ovulation induction and in vitro fertilization in systemic lupus erythematosus and antiphospholipid syndrome

Guballa

Sammaritano

Schwartzman

et al. 2000

Arthritis & Rheumatism

143

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“…Kutteh et al [40] reported a higher implantation rate in the group of women treated with heparin and aspirin (25 vs. 19.4%) but no statistically significant differences were detected in implantation, pregnancy and ongoing pregnancy rates between those who received standard therapy and those treated with heparin and aspirin. In contrast, Sher et al [41] reported that treatment with aspirin and heparin was associated with a significant beneficial effect (rate of ongoing pregnancy: 49 vs. 16%, respectively).…”

Section: Do Apl Have a Pathogenic Role In Infertility?mentioning

confidence: 96%

Is there a Role for Antithrombotic Therapy in the Prevention of Pregnancy Loss?

Wechsler¹,

Dû²,

Piette³

1999

Pathophysiol Haemos Thromb

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The antiphospholipid syndrome (APS) is now emerging as an important cause of recurrent pregnancy loss. A variety of treatments, including steroids, aspirin, heparin and immunoglobulin, alone or in combination, have been assessed in experimental studies and in clinical trials. Steroids are no longer recommended as first-line therapy for patients with APS without overt lupus, because they are associated with significant foetal and maternal morbidity. Based on data from recent trials, heparin plus low-dose aspirin appears to be the regimen of choice for patients with APS who have a history of thrombosis or pregnancy losses with aspirin alone. Aspirin is safe in pregnancy. Subcutaneous heparin does not cross the placenta and therefore has no adverse effects on the foetus. For the mother, however, potential side effects of heparin treatment include bleeding, thrombocytopenia and osteoporosis. Warfarin must be avoided during the first trimester but may have a role to play subsequently in certain subsets of patients. Some studies have demonstrated that combined therapy with prednisone and aspirin, or with heparin and aspirin, may improve the outcome in women with autoimmune disorders who are undergoing in-vitro fertilization.

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“…1,6,15 The effect of unfractionated heparin (with aspirin therapy) on in vitro fertilization outcome has been evaluated in several studies, with inconsistent results. [16][17][18][19][20][21] Most of these studies enrolled women with antiphospholipid or other auto-antibodies and were observational in nature. 16,[18][19][20][21] However, one single-center double-blind randomized crossover trial that compared unfractionated heparin 5000 units subcutaneously twice daily and aspirin from the day of embryo transfer with negative pregnancy test or week 14 of pregnancy with placebo in women with recurrent implantation failure and at least one auto-antibody (antiphospholipid antibody or antinuclear antibody) reported no significant difference in pregnancy or implantation rates between treated and placebo cycles (Table 3).…”

Section: Antithrombotic Therapy To Enhance the Likelihood Of Success mentioning

confidence: 99%

“…[16][17][18][19][20][21] Most of these studies enrolled women with antiphospholipid or other auto-antibodies and were observational in nature. 16,[18][19][20][21] However, one single-center double-blind randomized crossover trial that compared unfractionated heparin 5000 units subcutaneously twice daily and aspirin from the day of embryo transfer with negative pregnancy test or week 14 of pregnancy with placebo in women with recurrent implantation failure and at least one auto-antibody (antiphospholipid antibody or antinuclear antibody) reported no significant difference in pregnancy or implantation rates between treated and placebo cycles (Table 3). 17 The results of 3 recent meta-analyses that investigated whether low-molecular-weight heparin (LMWH) administered around the time of implantation improves clinical outcomes in women undergoing assisted reproduction are shown in Table 2.…”

Section: Antithrombotic Therapy To Enhance the Likelihood Of Success mentioning

confidence: 99%

Anticoagulation and in vitro fertilization and ovarian stimulation

Bates

2014

Hematology

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Assisted reproductive technology is widely used to treat couples affected by infertility. Complications associated with assisted reproduction include venous thromboembolism, ovarian hyperstimulation syndrome, and recurrent implantation failure. It has also been proposed that thrombophilia may be associated with an increased likelihood of these events. Although data are limited, antithrombotic therapy is frequently used to enhance the likelihood of successful assisted reproduction. This chapter reviews the risks of venous and arterial thromboembolism associated with assisted reproduction, as well as available data regarding the impact of thrombophilia on the risks of thromboembolism and failure of implantation. The role of antithrombotic therapy in reducing the likelihood of these events, along with recommendations from various guidelines, are also discussed. Learning Objectives• To discuss the available data regarding the role of thrombophilia testing in women undergoing assisted reproduction • To describe the state of the evidence with respect to the use of antithrombotic therapy in women undergoing assisted reproduction

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Effect of antiphospholipid antibodies in women undergoing in-vitro fertilization: role of heparin and aspirin

Cited by 142 publications

References 6 publications

Ovulation induction and in vitro fertilization in systemic lupus erythematosus and antiphospholipid syndrome

Ovulation induction and in vitro fertilization in systemic lupus erythematosus and antiphospholipid syndrome

Is there a Role for Antithrombotic Therapy in the Prevention of Pregnancy Loss?

Anticoagulation and in vitro fertilization and ovarian stimulation

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