A Rational Basis for the Use of Combined Heparin/Aspirin and IVIG Immunotherapy in the Treatment of Recurrent IVF Failure Associated with Antiphospholipid Antibodies

Sher, Geoffrey; Zouves, Christo; Feinman, Michael; Maassarani, Ghanima; Matzner, William; Chong, Penny; Ching, Wendell

doi:10.1111/j.1600-0897.1998.tb00375.x

Cited by 62 publications

(32 citation statements)

References 11 publications

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“…It is plausible that a Th1 shift in women with infertility may be induced by repeated COH or that a preexisting Th1 shift can be even further aggravated while they are on COH with GnRH Ag. Preconception treatment of high-dose immunoglobulin G, which suppresses Th1 immune responses [49], has been reported to improve implantation rate and pregnancy outcome [50]. Further investigation may open new therapeutic approaches for women with Th1 shift and infertility of implantation failures.…”

Section: Cytokine Regulation In Women With Infertilitymentioning

confidence: 98%

T Helper 1 and 2 Immune Responses in Relationship to Pregnancy, Nonpregnancy, Recurrent Spontaneous Abortions and Infertility of Repeated Implantation Failures

Kwak‐Kim

Gilman‐Sachs

Kim

2005

Chemical Immunology and Allergy, 2005

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It is becoming clear that during each developmental stage of pregnancy, different immunological conditions exist and may even be necessary for success. The widely accepted T helper (Th) 1 and 2 concept has some limitations if applied to the various developmental stages of pregnancy. During the implantation period, a multidirectional cytokine network is necessary with the blastocyst producing cytokines and other factors and the endometrium synthesizing factors necessary for the embryonic development. Improper immune responses and an unbalanced cytokine network may be related to implantation failures, pregnancy losses and obstetrical complications. A propensity to Th1 immune responses has been reported in these conditions systemically or locally. The presence of elevated Th1:Th2 cell ratios, high concentration of Th1 cytokines secreted by peripheral blood mononuclear cells, elevated NK cell cytotoxicity and levels, and emergence of various autoantibodies are the supporting evidence. The underlying immunopathology for the preponderance of Th1 is unknown. Genetic, environmental, and hormonal etiologies need to be explored further in the future. The purpose of this review is to give an overview of what is known about the immune response in women with reproductive failures and provide an update of some of the most recent findings in this field.

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Section: Cytokine Regulation In Women With Infertilitymentioning

confidence: 98%

T Helper 1 and 2 Immune Responses in Relationship to Pregnancy, Nonpregnancy, Recurrent Spontaneous Abortions and Infertility of Repeated Implantation Failures

Kwak‐Kim

Gilman‐Sachs

Kim

2005

Chemical Immunology and Allergy, 2005

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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: 89%

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

Guballa

Sammaritano

Schwartzman

et al. 2000

Arthritis & Rheumatism

139

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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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“…In this study, the live birth rate was 27% with aspirin and 23% in the control population, with an odds ratio 1.2 (95% CI 1.0-1.6). A noncontrolled study found that IVF outcome was significantly improved when aspirin, heparin, and intravenous immunoglobulin therapy was administered to women with repeat IVF failures and antiphospholipid antibodies, but not to women with negative antiphospholipid antibodies [8]. Other studies have also found a beneficial effect with aspirin/heparin, and aspirin plus prednisolone in IVF patients [9][10][11][12][13].…”

Section: Resultsmentioning

confidence: 99%

Low-dose aspirin does not improve ovarian stimulation, endometrial response, or pregnancy rates for in vitro fertilization

Tassa¹,

Marshburn

Papadakis

et al. 2002

Fertility and Sterility

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A Rational Basis for the Use of Combined Heparin/Aspirin and IVIG Immunotherapy in the Treatment of Recurrent IVF Failure Associated with Antiphospholipid Antibodies

Abstract: IVF outcome is significantly improved when H/A and IVIG are administered to APA+ women with repeat IVF failures. APA- women do not seem to benefit from such treatment.

Cited by 62 publications

References 11 publications

T Helper 1 and 2 Immune Responses in Relationship to Pregnancy, Nonpregnancy, Recurrent Spontaneous Abortions and Infertility of Repeated Implantation Failures

T Helper 1 and 2 Immune Responses in Relationship to Pregnancy, Nonpregnancy, Recurrent Spontaneous Abortions and Infertility of Repeated Implantation Failures

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

Low-dose aspirin does not improve ovarian stimulation, endometrial response, or pregnancy rates for in vitro fertilization

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