Background Obstetrical APS is defined by positive aPLs and a history of one or more unexplained deaths of morphologically normal fetus at or beyond the 10th week of gestation (WG) or one or more consecutive spontaneous abortions before the 10th WG. Also one or more premature birth before 34 WG because of eclampsia, severe pre-eclampsia, or recognized features of placental insufficiency represent one of the diagnostic criteria (1). Infertility is defined as the inability of a couple practicing frequent intercourse and not using contraception to conceive a child after 12 months. Autoimmune diseases are not inclued among major causes of infertility, despite defective embryonic implantation could be considered an aspect of recurrent fetal losses in patients with positive antiphospholipid antibodies, due to their capabilities to reduce trophoblast prolipheration and growth (2).
Objectives The aim of our study was to evaluate the prevalence of aPLs and pregnancy outcome in a population of women undergoing in vitro fertilization.
Methods from December 2012 to December 2016, we selected 75 consecutive patients undergoing in vitro fertilization and evidence positive autoantibodies. Each of them was evaluated for genetic, anatomic, hormonal and infective causes of infertility. Moreover antinuclear antibodies (ANA), anticardiolipin antibodies (aCL), anti-β2-glycoprotein I (GP1), lupus anticoagulant (LA) and extractable nuclear antigens (ENA) profile were assessed.
Results patients mean age was 41.38±4.87 years, ranging from 31 to 53 years. Prevalence of aPLs in our population was 68%. All women showed at least twice positive aPLs. aCL IgM and LA were the main antibody populations observed. ANA were positive in 50% of women, whereas SSA or SSB were positive in 4.17%. In 22.9% of patients a systemic autoimmune disease was newly diagnosed, mainly systemic lupus erythematosus. All patients with hystory of recurrent miscarriages and positive aPL were treated with subcutaneous low weight heparin plus daily oral acetylsalicylic acid (ASA 100 mg) (3). Full term pregnancy was obtained in 45.8% of patients.
Conclusions Prevalence of aPLs in the general population is 1–5%, whereas in our selected series positive aPLs were detected in 68% of the patients, suggesting that prevalence of aPLs may be increased in infertile patients (4). Moreover, a systemic autoimmune disease was newly diagnosed in 22.9% of patients suggesting that paucisimptomatic disease can be underestimated. Finally we would suggest that treating autoimmune co-morbidities ameliorates implantation rates in women undergoing in vitro fertilization (5).
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Disclosure of Interest None declared