Antiphospholipid antibodies and infertility

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.

SAT0280 A ten-year survival analysis of filipino patients with systemic lupus erythematosus at the national kidney and transplant institute (philippines)

“…Infertility is defined as the inability of a couple practicing frequent intercourse and not using contraception to conceive a child after 12 months. Autoimmune diseases are not inclued among major causes of infertility, despite defective embryonic implantation could be considered an aspect of recurrent fetal losses in patients with positive antiphospholipid antibodies, due to their capabilities to reduce trophoblast prolipheration and growth (2). Objectives: The aim of our study was to evaluate the prevalence of aPLs and pregnancy outcome in a population of women undergoing in vitro fertilization.…”

Roles of Antiphospholipid Antibodies, Antithyroid Antibodies and Antisperm Antibodies in Female Reproductive Health

“…The proportion of abortions associated with APS is difficult to calculate for several reasons: the definition of recurrent abortion is variable, the assays for detecting APAs are not well standardized, and the inclusion of patients in the study group according to their antibody titer is highly subjective. Recent studies suggest an association of APS not only with recurrent abortions but also with infertility [4,20]. …”

“…Nevertheless, there are still many unknown and uncharacterized factors that undoubtedly play important roles in unexplained infertility and recurrent miscarriages. Autoantibodies are thought to be widely implicated in infertility [3,4,5,6,7]. These non-tissue-specific antibodies are highly prevalent in female infertility as well as other complicated endocrine disorders, such as endometriosis and polycystic ovary syndrome (PCOS) (table 1).…”

Safety and Efficacy of in Vitro Fertilization in Women with Systemic Lupus Erythematosus and Antiphospholipid Syndrome

“…Infertility rates in SLE, with some exceptions, are similar to those of the general population 3 , and claims that antiphospholipid antibodies (aPL) could contribute to infertility are largely unsubstantiated 4 . Because SLE is an estrogen-sensitive disease, hormonal manipulation carries an inherent risk of SLE flares, hypercoagulability, and ovarian hyperstimulation syndrome (OHSS).…”