Is aspirin effective in women undergoing in vitro fertilization (IVF)? Results from an individual patient data meta-analysis (IPD MA)

Groeneveld, E.; Broeze, Kimiko A.; Lambers, M.J.; Haapsamo, Mervi; Dirckx, Kaatje; Schoot, Benedictus C.; Salle, Bruno; Duvan, Candan İltemir; Schats, R.; Mol, Ben Willem; Hompes, Peter G.A.

doi:10.1093/humupd/dmr007

Cited by 27 publications

(18 citation statements)

References 31 publications

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“…The inclusion rate is adequate compared with other published IPD metaanalyses with inclusion rates of 12-24% 40,41 ; 1 study included 6 of 10 eligible studies that added up to an inclusion rate of 60%. 41 The number of IPD in our study on the other hand was much higher than in other IPDs, mostly containing several thousands of participants. [40][41][42] The reason for this is our inclusion of nationwide registry based studies.…”

Section: Strengths and Weaknessescontrasting

confidence: 53%

“…41 The number of IPD in our study on the other hand was much higher than in other IPDs, mostly containing several thousands of participants. [40][41][42] The reason for this is our inclusion of nationwide registry based studies. Our combined database includes 99,415 women with a subsequent pregnancy, which is 69% of the 143,659 women who could be included in our regular metaanalysis of the 88 eligible studies.…”

Section: Strengths and Weaknessescontrasting

confidence: 53%

See 1 more Smart Citation

Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis

Oostwaard

Langenveld

Schuit

et al. 2015

American Journal of Obstetrics and Gynecology

123

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Section: Strengths and Weaknessescontrasting

confidence: 53%

Section: Strengths and Weaknessescontrasting

confidence: 53%

Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis

Oostwaard

Langenveld

Schuit

et al. 2015

American Journal of Obstetrics and Gynecology

123

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“…Two recent meta-analyses found that LDA had no significant effect on the clinical pregnancy rate(RR 1·03, 95% CI: 0·91, 1·17) or live birth rate (RR 0·91, 95% CI: 0·72, 1·15) in women undergoing IVF. 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.…”

Section: Discussionmentioning

confidence: 99%

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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“…Previous meta‐analyses assessing the efficacy of aspirin have shown apparently conflicting results [15,16,53]. Khairy et al.…”

Section: Discussionmentioning

confidence: 99%

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

Dentali

Ageno

Rezoagli

et al. 2012

Journal of Thrombosis and Haemostasis

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vitro fertilization or intracytoplasmic sperm injection: a systematic review and a meta-analysis of the literature. J Thromb Haemost 2012; 10: 2075- 85.Summary. Background: It was hypothesized that low-dose aspirin could improve implantation rates in subsequent pregnancies in women undergoing in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI). Previous studies have shown inconclusive results or focused on surrogate endpoints. We therefore conducted a systematic review and meta-analysis of the literature investigating the effect of low-dose aspirin on hard outcomes, including live birth rate, pregnancy rate and miscarriage. Methods: MEDLINE and EMBASE databases were searched up to November 2011. Randomized controlled trials comparing low-dose aspirin with placebo/no treatment in IVF/ICSI women were included. Pooled odds ratios (ORs) and 95%confidence intervals (CIs) were calculated. Results: Seventeen studies with 6403 patients were included. The use of aspirin did not improve live birth pregnancy rate compared with placebo or no treatment (1.08; 95% CI, 0.90, 1.29). Pregnancy rates were significantly increased in patients randomized to lowdose aspirin (OR, 1.19; 95% CI, 1.01, 1.39), but miscarriage rates were not (OR, 1.18; 95% CI, 0.82, 1.68). Results of sensitivity analyses including high-quality studies did not show statistically significant differences in all considered endpoints. Conclusions: The results of this study do not show a substantial efficacy of aspirin inwomen undergoing IVF/ICSI and do not support the use of low-dose aspirin to improve the success of IVF/ICSI in terms of pregnancy outcomes. Further high-quality studies evaluating the possible efficacy of aspirin in selected groups of patients are warranted.

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Is aspirin effective in women undergoing in vitro fertilization (IVF)? Results from an individual patient data meta-analysis (IPD MA)

Abstract: Aspirin does not improve pregnancy rates after IVF.

Cited by 27 publications

References 31 publications

Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis

Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis

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

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

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