Obstet Gynecol Sci.  2018 May;61(3):359-366. 10.5468/ogs.2018.61.3.359.

Impact of presence of antiphospholipid antibodies on in vitro fertilization outcome

• Hong YH
• Kim SJ
• Moon KY
• Kim SK
• Jee BC
• Lee WD
• Kim SH

• KMID: 2416124
• DOI: http://doi.org/10.5468/ogs.2018.61.3.359

Abstract

OBJECTIVE
To investigate prevalence of antiphospholipid antibody (APA) in Korean infertile women undergoing the first in vitro fertilization (IVF) treatment and to evaluate the influence of APA on the subsequent IVF outcomes. METHOD: Two hundred nineteen infertile women who destined the first IVF were prospectively enrolled in 2 infertility centers. Male factor or uterine factor infertility and women with past or current endocrine or immunologic disorders were completely excluded. Plasma concentration of lupus anticoagulant was measured by clot-based method, and anticardiolipin antibody (IgG/IgM), and anti-β2-glycoprotein 1 antibody (IgG/IgM) was measured by enzyme-linked immunosorbent assay method before starting ovarian stimulation for IVF.
RESULTS
APA was positive in 13 women (5.9%). Lupus anticoagulant was positive in 2 women (0.9%), anticardiolipin antibody was positive in 7 women (3.2%), and anti-β2-glycoprotein 1 antibody was positive in 4 women (1.8%). In 193 women entering embryo transfer, clinical characteristics and stimulation outcomes were comparable between APA-positive (n=12) and APA-negative group (n=181). The clinical pregnancy rate (66.7% vs. 45.9%), ongoing pregnancy rate (58.3% vs. 37.0%), and miscarriage rate (12.5% vs. 19.3%) were all similar between APA-positive and APA-negative group.
CONCLUSION
The prevalence of APA is low in Korean infertile women undergoing the first IVF cycle, and the presence of APA appears to neither decrease their first IVF success nor increase abortion rate.

Keyword

Antiphospholipid antibody; In vitro fertilization; Infertility

MeSH Terms

Abortion, Induced
Abortion, Spontaneous
Antibodies, Anticardiolipin
Antibodies, Antiphospholipid*
Embryo Transfer
Enzyme-Linked Immunosorbent Assay
Female
Fertilization in Vitro*
Humans
In Vitro Techniques*
Infertility
Lupus Coagulation Inhibitor
Male
Methods
Ovulation Induction
Plasma
Pregnancy
Pregnancy Rate
Prevalence
Prospective Studies
Antibodies, Anticardiolipin
Antibodies, Antiphospholipid
Lupus Coagulation Inhibitor

Reference

1. Chighizola C, de Jesus G. Antiphospholipid antibodies and infertility. Lupus. 2014; 23:1232–1238.

2. Azem F, Geva E, Amit A, Lerner-Geva L, Shwartz T, Ben-Yosef D, et al. High levels of anticardiolipin antibodies in patients with abnormal embryo morphology who attended an in vitro fertilization program. Am J Reprod Immunol. 1998; 39:161–163.

3. Birdsall M, Lockwood G, Ledger W, Johnson P, Chamley L. Antiphospholipid antibodies in women having in-vitro fertilization. Hum Reprod. 1996; 11:1185–1189.

4. Buckingham K, Stone P, Smith J, Chamley L. Antiphospholipid antibodies in serum and follicular fluid - is there a correlation with IVF implantation failure? Hum Reprod. 2005; 21:728–734.

5. Caccavo D, Pellegrino N, Lorusso F, Capotorto M, Vacca M, Vimercati A, et al. Anticardiolipin antibody levels in women undergoing first in vitro fertilization/embryo transfer. Hum Reprod. 2007; 22:2494–2500.

6. Chilcott IT, Margara R, Cohen H, Rai R, Skull J, Pickering W, et al. Pregnancy outcome is not affected by antiphospholipid antibody status in women referred for in vitro fertilization. Fertil Steril. 2000; 73:526–530.

7. Kaider BD, Price DE, Roussev RG, Coulam CB. Antiphospholipid antibody prevalence in patients with IVF failure. Am J Reprod Immunol. 1996; 35:388–393.

8. Kutteh WH. Antiphospholipid antibodies and reproduction. J Reprod Immunol. 1997; 35:151–171.

9. Martinelli I, Taioli E, Ragni G, Levi-Setti P, Passamonti SM, Battaglioli T, et al. Embryo implantation after assisted reproductive procedures and maternal thrombophilia. Haematologica. 2003; 88:789–793.

10. Nip M, Taylor P, Rutherford A, Hancock K. Autoantibodies and antisperm antibodies in sera and follicular fluids of infertile patients; relation to reproductive outcome after in-vitro fertilization. Hum Reprod. 1995; 10:2564–2569.

11. Radojcić L, Marjanović S, Vićovac L, Kataranovski M. Anticardiolipin antibodies in women with unexplained infertility. Physiol Res. 2004; 53:91–96.

12. Sher G, Feinman M, Zouves C, Kuttner G, Maassarani G, Salem R, et al. High fecundity rates following in-vitro fertilization and embryo transfer in antiphospholipid antibody seropositive women treated with heparin and aspirin. Hum Reprod. 1994; 9:2278–2283.

13. Steinvil A, Raz R, Berliner S, Steinberg DM, Zeltser D, Levran D, et al. Association of common thrombophilias and antiphospholipid antibodies with success rate of in vitro fertilisation. Thromb Haemost. 2012; 108:1192–1197.

14. Lee SR, Park EJ, Kim SH, Chae H, Kim CH, Kang BM. Influence of antiphospholipid antibodies on pregnancy outcome in women undergoing in vitro fertilization and embryo transfer. Am J Reprod Immunol. 2007; 57:34–39.

15. Practice Committee of American Society for Reproductive Medicine. Anti-phospholipid antibodies do not affect IVF success. Fertil Steril. 2008; 90:S172–3.

16. Hornstein MD, Davis OK, Massey JB, Paulson RJ, Collins JA. Antiphospholipid antibodies and in vitro fertilization success: a meta-analysis. Fertil Steril. 2000; 73:330–333.

17. Zhong YP, Ying Y, Wu HT, Zhou CQ, Xu YW, Wang Q, et al. Impact of anticardiolipin antibody on the outcome of in vitro fertilization and embryo transfer. Am J Reprod Immunol. 2011; 66:504–509.

18. Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril. 2000; 73:1155–1158.

19. Lee KA, Koo JJ, Yoon TK, Do BR, Ko JJ, Cha KY. Immunosuppression by corticosteroid has no effect on the pregnancy rate in routine in-vitro fertilization/embryo transfer patients. Hum Reprod. 1994; 9:1832–1835.

20. Proietta M, Ferrero S, Del Porto F. Prevalence of antiphospholipid antibodies in patients with sterility undergoing ‘in vitro' fertilization. Lupus. 2014; 23:724–725.

21. Stern C, Chamley L, Hale L, Kloss M, Speirs A, Baker HG. Antibodies to beta2 glycoprotein I are associated with in vitro fertilization implantation failure as well as recurrent miscarriage: results of a prevalence study. Fertil Steril. 1998; 70:938–944.

22. Gleicher N, Harlow L, Zilberstein M. Regulatory effect of antiphospholipid antibodies on signal transduction: a possible model for autoantibody-induced reproductive failure. Am J Obstet Gynecol. 1992; 167:637–642.

23. Eldar-Geva T, Wood C, Lolatgis N, Rombauts L, Kovacs G, Fuscaldo J, et al. Cumulative pregnancy and live birth rates in women with antiphospholipid antibodies undergoing assisted reproduction. Hum Reprod. 1999; 14:1461–1466.

24. Ying Y, Zhong Yp, Zhou Cq, Xu Yw, Wang Q, Li J, et al. A retrospective study on IVF outcome in patients with anticardiolipin antibody: effects of methylprednisolone plus low-dose aspirin adjuvant treatment. J Reprod Immunol. 2012; 94:196–201.

25. El-roeiy A, Gleicher N, Friberg J, Confino E, Dudkiewicz A. Correlation between peripheral blood and follicular fluid autoantibodies and impact on in vitro fertilization. Obstet Gynecol. 1987; 70:163–170.

26. Gleicher N, Liu HC, Dudkiewicz A, Rosenwaks Z, Kaberlein G, Pratt D, et al. Autoantibody profiles and immunoglobulin levels as predictors of in vitro fertilization success. Am J Obstet Gynecol. 1994; 170:1145–1149.

27. Kowalik A, Vichnin M, Liu HC, Branch W, Berkeley AS. Midfollicular anticardiolipin and antiphosphatidylserine antibody titers do not correlate with in vitro fertilization outcome. Fertil Steril. 1997; 68:298–304.

28. Matsubayashi H, Sugi T, Arai T, Shida M, Kondo A, Suzuki T, et al. IgG-antiphospholipid antibodies in follicular fluid of IVF-ET patients are related to low fertilization rate of their oocytes. Am J Reprod Immunol. 2006; 55:341–348.

29. Sanmarco M, Bardin N, Camoin L, Beziane A. Antigenic profile, prevalence, and clinical significance of antiphospholipid antibodies in women referred for in vitro fertilization. Ann N Y Acad Sci. 2007; 1108:457–465.

30. Paulmyer-Lacroix O, Despierres L, Courbiere B, Bardin N. Antiphospholipid antibodies in women undergoing in vitro fertilization treatment: clinical value of IgA anti-β2glycoprotein I antibodies determination. Biomed Res Int. 2014; 2014:314704.