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抗磷脂抗体循环的女性的受精结局。

fertilization outcomes in women with antiphospholipid antibodies circulation.

机构信息

Obstetrics and Gynecology Department #2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.

出版信息

J Matern Fetal Neonatal Med. 2020 Jun;33(12):1988-1993. doi: 10.1080/14767058.2018.1535586. Epub 2018 Dec 2.

Abstract

Antiphospholipid antibodies (aPL) have a multifaceted effect on the hemostatic system, damaging all its protective links. To study the effect of APA on outcomes of assisted reproductive technologies (ART). We examined 267 women with infertility, who planned pregnancy using ART. They included 178 women with IVF failure (I group) and 89 women with pregnancy after the IVF program (II group). The comparison group consisted of 80 pregnant women after IVF (male factor); a control group included 80 pregnant women with physiological pregnancy. Results of study demonstrated a high frequency of aPL circulation in a group of women with IVF failures. Overall, the proportion of aPL among all 267 women who planned pregnancy with ART was 32.6%. Elevated levels of aPL in the structure of causes of IVF failures (group I) were observed in 42.1% of them. Among women whose pregnancy occurred with ART (II group) the rate of APA was 19.1%. In the comparison group, in 6.3% of cases, aPL circulation was observed. In the control group, the rate was 3.4%. Considering the high percentage of aPL circulation in the case of IVF failures, authors think that high titers of aPL are a temporary contraindication for IVF. Patients with a history of aPL circulation are required to receive anticoagulant therapy from the first days of the hormonal protocol. The drug of choice is a group of low molecular weight heparins (LMWH). An individual approach is extremely important with the possible identification of causes of IVF failures and selective therapy, which leads to a significant improvement in the outcomes of the IVF program.

摘要

抗磷脂抗体 (aPL) 对止血系统有多种影响,破坏其所有保护环节。为了研究 APA 对辅助生殖技术 (ART) 结局的影响。我们检查了 267 名计划使用 ART 妊娠的不孕妇女。其中包括 178 名 IVF 失败的妇女(I 组)和 89 名 IVF 后妊娠的妇女(II 组)。对照组由 80 名 IVF 后妊娠的孕妇(男性因素)组成;对照组包括 80 名生理性妊娠的孕妇。研究结果表明,IVF 失败组妇女中 aPL 循环的频率较高。总体而言,所有计划进行 ART 妊娠的 267 名妇女中,aPL 的比例为 32.6%。在导致 IVF 失败的原因中(I 组),aPL 水平升高的比例为 42.1%。在接受 ART 妊娠的妇女(II 组)中,APA 的发生率为 19.1%。在对照组中,有 6.3%的病例观察到 aPL 循环。在对照组中,这一比例为 3.4%。鉴于 IVF 失败病例中 aPL 循环的高百分比,作者认为高滴度的 aPL 是 IVF 的临时禁忌症。有 aPL 循环病史的患者需要从激素方案的第一天开始接受抗凝治疗。首选药物是低分子量肝素 (LMWH) 类药物。个体化治疗非常重要,可能会确定 IVF 失败的原因并进行选择性治疗,这可以显著改善 IVF 方案的结局。

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