Low‐dose aspirin for in vitro fertilization or intracytoplasmic sperm injection: a systematic review and a meta‐analysis of the literature

Dentali, Francesco; Ageno, Walter; Rezoagli, Emanuele; Rancan, Elena; Squizzato, Alessandro; Middeldorp, Saskia; Margaglione, Maurizio; Grandone, Elvira

doi:10.1111/j.1538-7836.2012.04886.x

Cited by 51 publications

(36 citation statements)

References 53 publications

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“…19–20 A systematic review with less stringent quality criteria found that although pregnancy rates were increased with LDA (OR 1·19, 95% CI: 1·01, 1·39), live birth rates were not affected (OR 1·08, 95% CI: 0·82, 1·68). 21 Our study is the first and largest to show that LDA does not decrease pregnancy loss when initiated preconception among women with a history of only one to two prior pregnancy losses. Taken together with previous findings, LDA alone has not been shown to reduce rates of pregnancy loss in any population.…”

Section: Discussionmentioning

confidence: 69%

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Preconception low-dose aspirin and pregnancy outcomes: results from the EAGeR randomised trial

et al. 2014

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Background Our objective was to determine whether preconception-initiated low dose aspirin (LDA) improved live birth rates in women with one to two prior pregnancy losses. Methods This multi-center, block-randomized, double-blind, placebo-controlled trial recruited from four medical centers in the US (2006–2012). Women aged 18–40 years attempting pregnancy were stratified by eligibility criteria: “original”: women with one loss <20 weeks’ gestation during the past year; or “expanded”: women with one to two prior losses regardless of gestational length or time of loss. Women were block-randomized (615 LDA, 613 placebo) by center and eligibility stratum. Preconception-initiated daily LDA (81 mg/day) was compared with placebo for up to six menstrual cycles; for those who conceived, study treatment continued until 36 weeks’ gestation. The primary outcome was live birth rate. The trial was registered on ClinicalTrials.gov (#NCT00467363). Findings Overall, 1078 women completed the trial (LDA 535, placebo 543). Live birth rates were 58% (309/535) in women assigned LDA vs. 53% placebo (286/543; risk difference [RD] 5%; 95% confidence interval [CI] −0·8, 11). Pregnancy loss rates were similar between groups (13% [68/535] LDA, 12% [65/543] placebo; p=0·7812). In the original stratum, live birth rates were 62% (151/242) LDA vs. 53% (133/250) placebo (RD 9%; 95% CI 0·5, 18), and in the expanded, 54% (158/293) LDA vs. 52% (153/293) placebo (RD 2%; 95% CI −6, 10). Major adverse events were similar between treatment arms. LDA was associated with increased bleeding per vaginam, but this was not associated with losses. Interpretation Preconception-initiated LDA was not significantly associated with live birth or pregnancy loss among women with one to two prior losses. However, higher live birth rates were observed among women with a single documented loss at <20 weeks’ gestation during the previous year. LDA is not recommended for the prevention of pregnancy loss.

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Section: Discussionmentioning

confidence: 69%

“…These data indicate that LDA may have a favorable effect on fecundity or implantation for a sub-group of women, and is not inconsistent with some IVF studies showing effects on implantation 15 but not live birth rates. 21 …”

Section: Discussionmentioning

confidence: 99%

Preconception low-dose aspirin and pregnancy outcomes: results from the EAGeR randomised trial

et al. 2014

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“…The use of aspirin in the improvement of IVF/ICSI outcomes has been tested in many RCTs and has been reviewed in two recent systematic reviews and meta-analyses, including 17 and 13 trials, respectively. Findings clearly show that aspirin treatment is not efficacious to improve the number of live births [93,94].…”

Section: Intervention In Assisted Reproductive Technologiesmentioning

confidence: 97%

Aspirin and heparin in pregnancy

Villani

Tiscia

2015

Expert Opinion on Pharmacotherapy

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“…Two recent meta-analyses examined this issue. 12,13 Randomized controlled studies comparing aspirin with placebo or no treatment in women undergoing in vitro fertilization or intracytoplasmic sperm injection were eligible for both; however, the inclusion and exclusion criteria, as well as the analysis methods, differed between the 2 systematic reviews. The timing, dose, and duration of aspirin use varied between individual studies.…”

Section: Antithrombotic Therapy To Enhance the Likelihood Of Success mentioning

confidence: 99%

“…Both meta-analyses concluded that there was no good evidence that aspirin improved live birth rate compared with placebo or no treatment. 12,13 Although one systematic review showed a small but statistically significant increase in pregnancy rate in women randomized to low-dose aspirin, this difference was not maintained when high-quality studies alone were analyzed. 13 Therefore, at this time, the routine use of aspirin in patients undergoing assisted reproduction cannot be recommended.…”

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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Low‐dose aspirin for in vitro fertilization or intracytoplasmic sperm injection: a systematic review and a meta‐analysis of the literature

Cited by 51 publications

References 53 publications

Preconception low-dose aspirin and pregnancy outcomes: results from the EAGeR randomised trial

Preconception low-dose aspirin and pregnancy outcomes: results from the EAGeR randomised trial

Aspirin and heparin in pregnancy

Anticoagulation and in vitro fertilization and ovarian stimulation

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