The Selective Use of Heparin/Aspirin Therapy, Alone or in Combination with Intravenous Immunoglobulin G, in the Management of Antiphospholipid Antibody‐Positive Women Undergoing In Vitro Fertilization

Abstract

The treatment of APA+ women with H/A alone improves IVF birthrates. This benefit is selective in that it does not apply in cases in which IgG- or IgM-related APAs are directed against PE or PS. In such cases, the addition of IVIg significantly improves the outcome.

Is intravenous immunoglobulins (IVIG) efficacious in early pregnancy failure? A critical review and meta-analysis for patients who fail in vitro fertilization and embryo transfer (IVF)

“…Could such patients have been at a higher risk of failure after embryo transfer? It has been controversial whether patients with anti-phospholipid antibodies such as anticardiolipin (ACL) have a worse prognosis with IVF (possibly due to differences in anticardiolipin antibody assays in different centers), but presence of anti-phospholipid antibodies does seem to identify a subgroup more likely to benefit from treatments such as HA and IVIG (21)(22)(23)(24). The success rate in the IVIG-treated patients was also higher in the RCT of Sher et al where the patients had been selected on the basis of anti-thyroid antibodies.…”

Anticoagulation and in vitro fertilization and ovarian stimulation

“…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).…”

“…[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.…”

Indications for intra-venous immunoglobulin treatment in rheumatic diseases

“…È interessante notare come il trattamento con IVIG si è dimostrato più efficace in un sottogruppo di pazienti in cui gli aPL erano diretti verso la fosfatidilserina e la fosfatidiletanolamina rispetto alle pazienti con altri tipi di aPL. In queste ultime, le IVIG sostanzialmente non apportavano ulteriori miglioramenti al trattamento con ASA ed eparina, in termini di gravidanze portate a termine (40). Il primo studio controllato multicentrico pubblicato è del 2000, in cui vengono studiate 16 donne con APS, 9 delle quali trattate con 81 mg/die di ASA, 5000 U s.c. x 2 di eparina non frazionata e placebo e 7 trattate con 1 g/kg di IVIG per due giorni consecutivi ogni 4 settimane per tutta la durata della gestazione in aggiunta alla terapia con ASA ed eparina.…”