Питах, но конкретен отговор няма.Предавам точно думите: "Стига с тези глупости .Тези вливания нямат нищо общо и отношение, когато става въпрос за ин витро."
Аз зададох подобен въпрос преди време и получих точен и изчерпателен отговор в писмен вид. Същият този лекар, човек многоопитен, многоучен и неспиращ да се усъвършенства в професията си, ми предостави статия с мнението на The Practice Committee of the American Society for Reproductive Medicine. Становищата на този комитет, както е добре известно, са закон божи за творците на IVF – изкуство.
Имам доброто желание да споделя въпросната статия с вас.
Enjoy!
Anti-phospholipid antibodies do not affect
IVF successThe Practice Committee of the American Society for Reproductive Medicine
American Society for Reproductive Medicine, Birmingham, Alabama
BACKGROUND
Anti-phospholipid antibodies (APA) including anticardiolipin
antibody, lupus anticoagulant, and anti-phosphatidyl serine
have been associated with recurrent pregnancy loss. Contro-
versy exists regarding a possible association between these
abnormalities and in vitro fertilization (IVF) failure (1–3).
The proposed mechanism of such failure includes abnormal
implantation, placentation, and early embryonic vascular
compromise. Intravenous immunoglobulin (IVIG) and anti-
thrombogenic therapy including aspirin and heparin have
been proposed as treatments in the expectation of improving
implantation or placentation (2, 3). Evidence for the associ-
ation between APA and IVF failure can best be derived from
studies in which one can compare IVF outcomes among
APA-positive and -negative subjects who were free from any
APA-related treatment. This document addresses the rela-
tionship between the presence of anti-phospholipid antibod-
ies and successful IVF.
Committee Opinion
Reviewed June 2006.
Revised and released October 1999.
Correspondence to: Practice Committee, American Society for Repro-
ductive Medicine, 1209 Montgomery Highway, Birmingham, Alabama
35216
METHODS
A current literature searchusing the identifier APA, IVF, and
related terms located 16 studies. Of these, three included
only treated subjects (2, 4, 5), three lacked cohorts of IVF
couples (6–8), two commentaries included no original data
(1, 9), and one included no IVF outcome data (10). From the
remaining seven studies, we abstracted data on the patients
with and without APA who underwent IVF therapy and did
not receive APA-related therapy (3, 11–16). All but two
included data on live birth or ongoing pregnancy as well as
clinical pregnancy (3, 16). The definition of APA positivity
was one or more abnormal results on anti-cardiolipin or
anti-phosphatidyl serine (11, 13, 15), additional anti-phos-
pholipids (3, 12, 14, 16), and various other autoantibodies
(11, 13, 14). Three studies appeared to be prospective cohort
studies (11, 12, 16), while the remainder appeared to be
retrospective cohort studies.
The relevant studies were examined for estimates of the
relative likelihood of pregnancy and live birth in APA-
negative and positive IVF-treated infertile couples. The pub-
lished data were combined by taking the average of the
logarithms of the individual odds ratios, each weighted by the
inverse of its variance. Confidence intervals and heterogeneity
of the estimates were evaluated by standard means (17).
RESULTS
The APA and IVF outcome studies involved 2,053 patients,
of whom 703 (34%) were APA positive. The aggregate
clinical pregnancy rates and live birth rates were 57.0% and
46.0% in the APA positive patients and 49.2% and 42.9% in
the APA negative patients, respectively. None of the studies
revealed a significant effect of presence of APA on IVF
success. Studies evaluating more antibody types were more
likely to find a nonsignificant reduction in the likelihood of
IVF conception. Overall, anti-phospholipid antibody abnor-
malities were not associated with IVF success as estimated
by clinical pregnancy rate in seven studies(OR0.99,95%CI
0.64, 1.53) or by live birth in five studies (OR 1.07, 95% CI
0.66, 1.75) (Table 1).
CONCLUSION
Although an association between APA abnormalities and
IVF failure has been suggested in some retrospective studies,
no association is present in the prospective studies summa-
rized here. However, these studies may not be representative
of typical IVF candidates: 34% were APA positive and the
live birth rate was 45%. Nevertheless, the assessment of
APA is not indicated among couples undergoing IVF. Ther-
apy is not justified on the basis of existing data.REFERENCES
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