Birkenfeld A, Mukaida T, Minichiello L, Jackson M, Kase N G, Yemini M
Diamond Institute, Irvington, New Jersey 07111.
Am J Reprod Immunol. 1994 Mar-Apr;31(2-3):65-8. doi: 10.1111/j.1600-0897.1994.tb00848.x.
The presence of antiphospholipid antibodies lupus anticoagulant (LAC), anticardiolipin antibody (ACA) as well as antinuclear antibody (ANA) has been associated with early spontaneous pregnancy loss and adverse pregnancy outcome. The purpose of this study was to investigate the possible role of autoimmune antibodies (LAC, ACA, and ANA) as a cause of implantation failure following embryo transfer (ET) after in vitro fertilization (IVF).
Three groups were studied: Group I, 56 patients who failed to conceive following ET; group II, 14 patients who have conceived following IVF-ET and delivered or are carrying an uncomplicated ongoing pregnancy; and group III, 69 patients who were new candidates for IVF-ET.
Eighteen out of 56 (32.1%) of patients who failed to conceive following previous IVF-ET cycle (group I) tested positive for one or more of the autoimmune antibodies. None of the 14 patients of group II tested positive for autoimmune antibodies (P < .02). Seven out of the 69 patients (10%) of group III were found positive to one or more of the autoimmune factor. This rate is significantly lower than the rate of positive autoimmune antibodies detected in group I (P < .003). Fifteen patients of the 18 who tested positive for autoimmune antibodies and who had previously failed to conceive following ET underwent a subsequent IVF-ET cycle while being treated with prednisone and aspirin. Seven out of the 15 (46.6%) conceived and were able to sustain a clinical ongoing pregnancy.
Patients receiving ET are carrying viable embryos within the intrauterine environment. Therefore, in this unique group of patients, failure to demonstrate a positive pregnancy test represents an implantation failure or a very early postimplantation loss. The results of this study suggest that periimplantation events may be affected by autoimmune antibodies. Very early miscarriage or implantation failure may be related to the same pathophysiological mechanism that causes recurrent miscarriages and is diagnosed incorrectly as infertility.
抗磷脂抗体（狼疮抗凝物[LAC]、抗心磷脂抗体[ACA]）以及抗核抗体（ANA）的存在与早期自然流产和不良妊娠结局相关。本研究的目的是调查自身免疫抗体（LAC、ACA和ANA）作为体外受精（IVF）后胚胎移植（ET）失败原因的可能作用。
研究分为三组：第一组，56例ET后未受孕的患者；第二组，14例IVF-ET后受孕并分娩或正在进行无并发症妊娠的患者；第三组，69例IVF-ET的新候选患者。
在前次IVF-ET周期后未受孕的56例患者（第一组）中，18例（32.1%）一种或多种自身免疫抗体检测呈阳性。第二组的14例患者中无一例自身免疫抗体检测呈阳性（P < 0.02）。第三组的69例患者中有7例（10%）一种或多种自身免疫因子检测呈阳性。该比率显著低于第一组中检测到的自身免疫抗体阳性率（P < 0.003）。18例自身免疫抗体检测呈阳性且先前ET后未受孕的患者中有15例在接受泼尼松和阿司匹林治疗的同时进行了后续IVF-ET周期。15例中有7例（46.6%）受孕并能够维持临床持续妊娠。
接受ET的患者子宫内环境中有存活胚胎。因此，在这一特殊患者群体中，妊娠试验未呈阳性代表着床失败或着床后极早期丢失。本研究结果表明，着床期事件可能受自身免疫抗体影响。极早期流产或着床失败可能与导致复发性流产且被错误诊断为不孕症的相同病理生理机制有关。
