Antiphospholipid antibodies and infertility

Area of Science:

• Reproductive Immunology
• Obstetrics and Gynecology
• Clinical Medicine

Background:

• Antiphospholipid antibodies (aPL) have been investigated for potential links to infertility due to proposed adverse effects on trophoblast function.
• Despite lacking inclusion in antiphospholipid syndrome classification criteria, aPL testing is common in infertile patients, often leading to anticoagulant therapy.
• The clinical significance of non-criteria aPL and their impact on reproductive outcomes remains controversial and requires further investigation.

Purpose of the Study:

• To review existing literature on the association between antiphospholipid antibodies (aPL) and infertility.
• To evaluate the impact of aPL positivity on in vitro fertilization (IVF) outcomes based on published studies.
• To assess the quality and consistency of evidence regarding aPL and reproductive success.

Main Methods:

• A comprehensive literature review was conducted, searching for studies investigating the relationship between aPL and infertility.
• Studies examining the effect of aPL positivity on in vitro fertilization (IVF) outcomes were also included.
• Analysis considered heterogeneity in definitions of infertility, IVF failure, inclusion criteria, control populations, and antibody testing methodologies.

Main Results:

• Most studies assessing aPL in infertile women had small sample sizes and inconsistent methodologies, limiting statistical power.
• While 44.8% of studies reported higher aPL frequencies in infertile patients, many used controversial non-criteria aPL tests.
• Only two studies indicated a detrimental effect of aPL on IVF outcomes, with significant disparities in outcome definitions (e.g., live birth vs. implantation rates).

Conclusions:

• Current scientific data do not establish a significant association between antiphospholipid antibodies (aPL) and infertility.
• Antiphospholipid antibody positivity does not appear to negatively influence in vitro fertilization (IVF) success rates.
• Further well-designed clinical studies are needed to definitively ascertain the role of specific, high-risk aPL profiles in human fertility.