Antiphospholipid antibodies and IVF success rates
Medical article review and discussion
Title: Antiphospholipid antibodies and pregnancy rates and outcome in in vitro fertilization patients
Authors: A. Denis, M. Guido, R. Adler, P. Bergh, C. Brenner, R. Scott, Jr.
Source: Fertility and Sterility: June, 1997 (Vol. 67) Pages 1084-1090.
The relationship between "antibodies" and infertility and miscarriage is very controversial. There are some experts who believe that the presence of antiphospholipid antibodies in a woman may cause problems with conception, or may predispose to miscarriage.
This study tried to determine whether there was any relationship between the level of various antiphospholipid antibodies and outcome for in vitro fertilization (IVF). They looked at both initial pregnancy rates as well as miscarriage rates.
- Does the presence of these antibodies cause a lower chance for pregnancy from IVF?
- Does the presence of these antibodies cause an increased chance for miscarriage in a pregnancy from IVF?
How the study was done
This study was performed by drawing and freezing blood from 793 women having IVF at one center. Women with a history of recurrent pregnancy loss were excluded from the study.
After all of the IVF cycles were completed, the blood was assayed for levels of 21 different antibodies. In this way, the results of the assays could not influence treatment decisions for the IVF cycle.
No "immunity-related" treatments were used: no women were given glucocorticoids (e.g. Prednisone), aspirin, heparin, or immunoglobulin (Ig) therapy.
Pregnancy and miscarriage rates were then compared according to the antibody status of the women to determine if any relationship existed between antibody levels and IVF outcome.
There was no difference in pregnancy rates according to the antibody status.
There was no difference in miscarriage rates according to the antibody status.
In other words, the pregnancy rates for the 323 women with no antibodies detected was not different from the 470 women with positive tests for at least 1 of the antibodies. Also, the pregnancy rate was not different according to how many antibodies were detected in the woman - even for those women having 5 or more positive results.
The same lack of any association between antibody status and outcome was seen for miscarriage and live birth rates.
The authors concluded that "there is no relationship between antiphospholipid antibody levels and clinical pregnancy rates or pregnancy loss rates".
They further stated that "the clear lack of a relationship between these antibodies and reproductive outcome suggests that patients should not be treated based solely on the results of these assays. The expense and risks associated with the various agents used to treat this 'disorder' cannot be justified by the presence of an antibody that does not predict or compromise outcome".
Comments about this research study
This is a much-needed study in the field of reproductive medicine. As the authors of this article point out, although some programs are testing for antibodies and "treating" according to the results, there have not yet been well-controlled trials of treatment for "immune-related" infertility. Such research is needed before we "treat" women with infertility for "immune disorders".