Effect Of Antiphospholipid Antibodies On In Vitro Fertilization-Embryo Transfer Outcomes

BackgroundAntiphospholipid syndrome(APS)is characterized by the presence of antiphospholipid antibodies(anti-PL),which increases the risk of obstetric complications,including recurrent abortion,fetal growth restriction,and preterm birth.Before or during pregnancy,obstetric antiphospholipid syndrome(OAPS)patients are treated with low-dose aspirin(LDA)plus low-molecular-weight heparin(LMWH)to improve pregnancy outcomes.Therefore,APS infertile patients undergoing in vitro fertilization-embryo transfer(IVF-ET)often receive prophylactic treatment to achieve better pregnancy outcomes.Since the positive rate of anti-PL in the general population is 1%-5%,the incidence of APS is only between 4 and 5 per 10,000,so there are a large number of asymptomatic anti-PL positive people.However,there is no consensus on whether prophylactic treatment should be given to asymptomatic anti-PL positive patients receiving IVF-ET.ObjectiveAnalyzing the relationship between anti-PL and IVF-ET outcomes,and the impact of individualized treatment on IVF-ET outcomes,in order to provide clinical decision-making for asymptomatic anti-PL positive infertility patients.Method1.We collected the data of patients who received IVF-ET treatment in the Reproductive Center of Luoyang Maternal and Child Health Hospital from January 2015 to September 2021.During this period,all patients were screened for anti-PL.Taking September 2017 as the time node,due to the change of clinical protocol,the previous asymptomatic anti-PL infertility patients had not received treatment at the time of the first transplantation,while the subsequent patients were all given individualized treatment.2.We analyzed 1691 cycles of fresh transplantation from January 2015 to September2017,there were 913 failed pregnancies and 778 successful pregnancies.Anti-cardiolipin antibody(anti-CL)or / and anti-β2 glycoprotein I(anti-β2GPI)antibody were used as the criteria for anti-PL positive,and the difference of anti-PL positive rate between the two groups was analyzed,in order to analyze the relationship between anti-PL positivity and IVF-ET outcome.3.Infertile patients from January 2015 to September 2017 were included in the study.Asymptomatic anti-PL positive patients during this period had not received individualized treatment at the time of first transplantation.With simple tubal infertility as the inclusion criteria,87 patients were included,including 37 asymptomatic anti-PL positive patients as the positive group,and 50 negative patients as the negative group.The differences in general conditions,IVF laboratory results,clinical outcomes and pregnancy complications between the two groups were compared,in order to analyze the effect of anti-PL positive on IVF-ET outcomes.4.Infertile patients from October 2017 to September 2021 were included in the study.During this period,all asymptomatic anti-PL patients received individualized treatment of low dose aspirin combined with low molecular weight heparin at the time of first transplantation.With simple tubal infertility as the inclusion criteria,112 patients were enrolled,including 52 asymptomatic anti-PL positive patients as the positive treatment group,and 60 negative patients as the negative control group.The differences in general conditions,IVF laboratory results,clinical outcomes and pregnancy complications between the two groups were compared,in order to analyze the effect of individualized treatment on IVF-ET outcomes in asymptomatic anti-PL positive patients.Results1.In 1691 fresh transplantation cycles,the positive rates of anti-PL in failed pregnancy group and successful pregnancy group were 13.80%(126/913)and 6.04%(47/778),the difference was statistically significant(P<0.05).2.In patients with simple tubal infertility,comparing the anti-PL positive group and the negative group,there were no significant differences in age,body mass index(BMI),anti-Mueller hormone(AMH),thyroid stimulating hormone(TSH),follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),homocysteine(Hcy),Gn days,Gn total amount,E2 value and P value on HCG day(P > 0.05);The results of IVF laboratory results showed that the number of retrieved oocytes,mature oocytes,cleavage,available embryos,high-quality embryo rate and blastocyst formation rate were similar between the two groups,and the differences were not statistically significant(P > 0.05);The clinical pregnancy rate of the anti-PL positive group was significantly lower than that of the negative group,while the abortion rate was significantly higher than those of the negative group(P < 0.05);There was no difference in the pregnancy complications rate between the two groups(P > 0.05).3.In patients with simple tubal infertility,there was no significant difference in general data between the positive treatment group and the negative control group(P >0.05);The results of IVF laboratory results showed that the number of retrieved oocytes,mature oocytes,cleavage,available embryos,high-quality embryo rate and blastocyst formation rate were similar between the two groups,and the differences were not statistically significant(P > 0.05);The clinical pregnancy rate,abortion rate and pregnancy complications rate of the two groups were similar,and the differences were not statistically significant(P > 0.05).ConclusionIn patients with simple tubal infertility,asymptomatic anti-PL positive patients had poor clinical outcomes of IVF-ET,and individualized treatment could improve the situation.