The Use of Combined Heparin/Aspirin and Immunoglobulin G Therapy in the Treatment of In Vitro Fertilization Patients With Antithyroid Antibodies

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

doi:10.1111/j.1600-0897.1998.tb00357.x

Cited by 54 publications

(34 citation statements)

References 8 publications

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“…Table I summarizes the results from three RCTs of IVIG in IVF failure/early pregnancy loss patients. The trial by de Placido et al achieved a one-tailed p < 0.05 in the original publication as did the trial by Sher et al rejecting the null hypothesis that IVIG did not increase the rate of pregnancy success (9,10). The Stephenson and Fluker trial did not, although one can see that the live birth rate was slightly higher in the IVIG-treated patients.…”

Section: Methodsmentioning

confidence: 81%

“…Stephenson and Fluker noted previous positive reports by Kleinstein et al in an abstract, and de Placido et al in a formal paper (8,9). We were also aware of an RCT done by Sher et al and two unpublished cohort-controlled trials the details of which had not been published (10)(11)(12). In this paper, we focus on the question whether there is controlled trial data to support a hypothesis that IVIG can improve the likelihood of a live birth in patients undergoing IVF?…”

Section: Introductionmentioning

confidence: 76%

“…A trial with a placebo arm is not acceptable to most women, and recruitment to a trial of IVIG in secondary recurrent miscarriage patients in Canada proved difficult; indeed, at least one patient who aborted and found out she had been receiving placebo, and one who did not achieve pregnancy after 6 months and was taken off trial were devastated. It is our thesis that a reasonable comparator would be heparin + aspirin, which represents potentially effective treatment and is inexpensive (10). A viable RCT for IVF failure and/or recurrent miscarriage patients would most likely include the combination as one of its arms and have IVIG + HA, and IVIG alone in the two other arms.…”

Section: Discussionmentioning

confidence: 98%

See 2 more Smart Citations

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)

Clark

Coulam

Stricker

2006

J Assist Reprod Genet

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Meta-analysis of three published randomized controlled trials (RCTs) of IVIG in IVF failure patients shows a significant increase in the live birth rate per woman (p = 0.012; Number Needed to Treat for 1 additional live birth, NNT = 6.0 women). Using live birth rate per embryo transferred, and adding data from two cohort-controlled trials to the meta-analysis further supports this conclusion (overall p = 0.000015, NNT = 3.7 women). Relevant variables appear to include properties and scheduling of the IVIG, and selection of patients with abnormal immune test results. Different IVIG preparations vary significantly in their ability to suppress NK activity in vitro. A rationale for use of IVIG is provided by a review of mechanisms of IVIG action and mechanisms underlying failure of chromosomally normal embryos.

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Section: Methodsmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

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)

Clark

Coulam

Stricker

2006

J Assist Reprod Genet

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“…In a recent study, only 27% of women in the group treated with heparin and aspirin achieved live births, compared with 51% in the group receiving concomitant treatment with intravenous immunoglobin G therapy [43].…”

Section: Is There a Role For Antithrombotic Therapy In Other Conditions?mentioning

confidence: 99%

Is there a Role for Antithrombotic Therapy in the Prevention of Pregnancy Loss?

Wechsler¹,

Dû²,

Piette³

1999

Pathophysiol Haemos Thromb

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The antiphospholipid syndrome (APS) is now emerging as an important cause of recurrent pregnancy loss. A variety of treatments, including steroids, aspirin, heparin and immunoglobulin, alone or in combination, have been assessed in experimental studies and in clinical trials. Steroids are no longer recommended as first-line therapy for patients with APS without overt lupus, because they are associated with significant foetal and maternal morbidity. Based on data from recent trials, heparin plus low-dose aspirin appears to be the regimen of choice for patients with APS who have a history of thrombosis or pregnancy losses with aspirin alone. Aspirin is safe in pregnancy. Subcutaneous heparin does not cross the placenta and therefore has no adverse effects on the foetus. For the mother, however, potential side effects of heparin treatment include bleeding, thrombocytopenia and osteoporosis. Warfarin must be avoided during the first trimester but may have a role to play subsequently in certain subsets of patients. Some studies have demonstrated that combined therapy with prednisone and aspirin, or with heparin and aspirin, may improve the outcome in women with autoimmune disorders who are undergoing in-vitro fertilization.

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“…52,53 In addition to this, the combination of immunoglobulin, heparin and aspirin had better results than the administration of only heparin and aspirin. 54 The first study in which thyroid hormone replacement therapy was applied was conducted by Vaquero et al 8 It was a prospective study in women with two or more previous first trimester miscarriages and positive thyroid autoantibodies. Eleven women were treated with intravenous immunoglobulin during pregnancy and 16 women were treated with thyroid hormone replacement therapy (66 mg of thyroid extract, started before conception and continued until the 20 th week).…”

Section: Possible Pathophysiological Mechanisms Of the Association Ofmentioning

confidence: 99%

Thyroid autoimmunity and miscarriage

Kaprara¹,

Krassas²

2008

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The relation of thyroid autoimmunity to miscarriage is an important issue that has attracted the interest of many investigators. A number of papers have been published so far, which include healthy women, women with recurrent miscarriage and those undergoing assisted reproductive techniques. Most studies have shown a significant positive association between the presence of thyroid autoantibodies and miscarriage rate. It is of interest that women with high titers do not show a higher miscarriage rate when compared with women having low titers, although, there is no general agreement on this issue. There are three possible explanations for the assumed association of thyroid autoimmunity with miscarriage: 1) pregnancy loss is an epiphenomenon and not a direct effect of the thyroid autoantibodies, the presence of thyroid autoantibodies reflecting a generalized activation of the immune system; 2) delayed conception from the presence of thyroid autoantibodies; hence, when women with thyroid autoimmunity become pregnant, face a higher risk of miscarriage because of older age; and 3) the pregnancy loss is secondary to a subtle deficiency in thyroid hormone concentrations or a lower capacity of the thyroid to adequately adapt to the demands of pregnancy.

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The Use of Combined Heparin/Aspirin and Immunoglobulin G Therapy in the Treatment of In Vitro Fertilization Patients With Antithyroid Antibodies

Abstract: We conclude that IVIg therapy significantly improves IVF success rates in ATA+ women.

Cited by 54 publications

References 8 publications

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)

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)

Is there a Role for Antithrombotic Therapy in the Prevention of Pregnancy Loss?

Thyroid autoimmunity and miscarriage

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