Diskussionnye voprosy vedeniya zhenshchin s antifosfolipidnymi antitelami pri primenenii VRT

Abstract

There are many controversies in the management antiphospholipid antibodies-positive women undergoing assisted reproductive technologies. Controversial and important is not only the effect of antiphospholipid antibodies (APA) on the success of IVF, but also approaches to the management of this group of women. The aim of this work was to study the prevalence of antiphospholipid antibodies in women with 3 or more IVF failures and effectiveness of IVF in women with APA treatment with membrane plasmapheresis before IVF and intravenous immunoglobulin during IVF. In women with 3 or more IVF implantation failure APA were detected in 35.95 % of cases. The use of intravenous immunoglobulin along with the standard therapy is a safe and effective for improvement of IVF outcomes in women with antiphospholipid syndrome (APS) or the presence of APA. The most effective is a combination of the membrane plasmapheresis therapy before IVF and intravenous immunoglobulin during IVF standard therapy including LMWH and low-dose aspirin in IVF protocol. This therapy in patients with the presence of APA increases the pregnancy rate after IVF to 46.15 %.

Keywords

antiphospholipid antibodies / IVF / antiphospholipid syndrome / intravenous immunoglobulin / plasmapheresis

References

[1] Воинов А. В. Эфферентная терапия. Мебранный плазмаферез. — СПб.: Эскулап, 2002. — 272 с.

[2] Очан А. С. Плазмаферез в подготовке женщин с трубно-перитонеальным бесплодием к проведению программы экстракорпорального оплодотворения и переносу эмбрионов в полость матки: автореф. дис…. канд. мед. наук. — М., 2003. — 28 с.

[3] Action of anticardiolipin and antibodies to beta2-glycoprotein-I on trophoblast proliferation a as a mechanism for fetal death / Chamley L. W., Duncalf A. M., Mitchell M. D. Johnson P. M. // Lancet. — 1998. — Vol. 352. — P. 1037–1038.

[4] Adverse effects of lupus nticoagulant positive blood sera on placental viability can be prevented by heparin in vitro / Bose P., Black S., Kadyrov M. [et al.] // Am. J. Obstet. Gynecol. — 2004. — Vol. 191. — P. 2125–2131.

[5] Antibodies to glycoprotein I are associated with in vitro fertilization implantation failure as well as recurrent miscarriage: results of a prevalence study / Stern C., Chamley L., Hale L. [et al.] // Fertil. Steril. — 1998. — Vol. 70. — P. 938–944.

[6] Antigenic Profile, Prevalence, and Clinical Significance of Antiphospholipid Antibodies in Women Referred for in Vitro Fertilization / Sanmarco M., Bardin N., Camoin L. [et al.] // Ann. N. Y. Acad. Sci. — 2007. — Vol.1108. — P. 457–465.

[7] Antinuclear Antibody Reduces the Pregnancy Rate in the First IVF-ET Treatment Cycle but Not the Cumulative Pregnancy Rate without Specific Medication / Kumiko Kikuchi, Hiroaki Shibahara, Yuki Hirano [et al.] / /AJRI. — 2003. — Vol. 50. — P. 363–367.

[8] Antiphospholipid antibodies and invitro fertilization success: a meta-analysis / Hornstein M., Davis O., Massey J. [et al.] // Fertil. Steril. — 2000. — Vol. 73. — P. 330–333.

[9] Antiphospholipid antibodies and pregnancy rates and outcome in IVF patients / Denis A. L., Guido M., Adler R. D. [et al.] // Fertil. Steril. — 1997. — Vol. 67. — P. 1084–1090.

[10] Antiphospholipid antibodies associated with implantation failure after IVF/ET / Coulam C., Kaider B., Janowicz P., Roussev R. // J. Assist. Reprod. Genet. — 1997. — Vol. 14. — P. 603–606.

[11] Antiphospholipid antibodies prevent extravillous trophoblast differentiation / Quenby S., Mountfield S., Cartwright J. E. [et al.] // Fertil. Steril. — 2005. — Vol. 83. — P. 691–698.

[12] Association between antiphospholipid antibodies andrecurrent fetal loss in women without autoimmune disease: a metaanalysis / Opartny L. [et al.] // J. Rheumatol. — 2006. — Vol. 33. — P. 2214–2221.

[13] Autoantibody profiles and immunoglobulin levels as predictors of IVF success / Gleicher N., Liu H., Dudkiewicz A. [et al.] //Am. J. Obstet. Gynecol. — 1994. — Vol. 170. — P. 1145–1149.

[14] Backos M., Rai R., Regan L. Antiphospholipid antibodies and infertility // Hum. Fertil. — 2002. — Vol. 5. — P. 30–34.

[15] Bleeker W. K., Teeling J. L., Hack C. E. Accelerated autoantibody clearance by intravenous immunoglobulin therapy: studies in experimental models to determine the magnitude and time course of the effect // Blood. — 2001. — Vol. 98, N 10. — P. 3136–3142.

[16] Circulating autoimmune antibodies may be responsible for implantation failure in in-vitro-fertilization / Geva E., Yaron Y., Lessing J. B. [et al.] // Fertil. Steril. — 1994. — Vol. 62. — P. 802–806.

[17] Coulam C. B., Acacio B. Does immunotherapy for treatment of reproductive failureen hance live births? // Am. J. Reprod.Immunol. — 2012. — Vol. 67. — P. 296–303.

[18] Detection of a procoagulable state during controlled ovarian hyperstimulation for in vitro fertilization with global assays of haemostasis / Westerlund E., Henriksson, Wallén H. [et al.] // Thromb Res. — 2012. — Vol. 130, N 4. — P. 649–653.

[19] Hemostasis parameters during ovarian stimulation for in vitro fertilization: results of a prospective study / Biron C., Galtier-Dereure F., Rabesandratana H. [et al.] // Fertil. Steril. — 1997. — Vol. 67. — P. 104–109.

[20] High fecundity rates following in vitro fertilization and embryo transfer in antiphospholipid antibody seropositive women treated with heparin and aspirin / Sher G., Feinman M., Zouves C. [et al.] // Hum. Reprod. — 1994. — Vol. 9. — P. 2278–2283.

[21] Hill J., Scott R. Immunological tests and IVF: «please, enough already» // Fertil. Steril. — 2000. — Vol. 74. — P. 439–442.

[22] Incidence of autoimmune antibodies in failed embryo transfer cycles / Birkenfeld A., Mukaida T., Minichiello L. [et al.] //Am. J. Reprod. Immunol. — 1994. — Vol. 31. — P. 65–68.

[23] Intravenous immunoglobulin treatment increased live birth rate in a spanish cohort of women with recurrent reproductive failure and expanded CD56+ cells / Moraru M., Javier C., Diana A. [et al.] // Am. J. Reprod. Immunol. — 2012. — Vol. 68. — P. 75–84.

[24] Kaider B. D., Coulam C. B., Roussev R. G. Murine embryos as a direct target for some human autoantibodies in vitro // Hum. Reprod. — 1999. — Vol. 10. — P. 2556–2561.

[25] Kessel A., Ammuri H., Peri R. Intravenous immunoglobulin therapy affects T regulatory cells by increasing their suppressive function // J. Immunology. — 2007. — Vol. 179, N 8. — P. 5571–5575.

[26] Midfollicular anticardiolipin and antiphosphatidylserine antibody titres do not correlate with in vitro fertilization outcome / Kowalik A., Vichnin M., Liu H. [et al.] // Fertil. Steril. — 1997. — Vol. 68. — P.298–304.

[27] Nelson S. M. Prophylaxis of VTE in women — during assisted reproductive techniques // Thromb. Res. — 2009. — Vol. 123. — P. 8–15.

[28] Nelson S. M., Greer I. A. The potential role of heparin in assisted conception // Human Reproduction Update. — 2008. — Vol. 14, N. 6. — P. 623–645.

[29] Pathogenic role of anti-beta 2-glycoprotein I antibodies in antiphospholipid associated fetal loss: characterisation of beta 2-glycoprotein I binding to trophoblast cells and functional effects of anti-beta 2-glycoprotein I antibodies in vitro / Di Simone N., Raschi E., Testoni C. [et al.] // Ann. Rheum. Dis. — 2005. — Vol. 64. — P. 462–467.

[30] Sewell W. A. C., Jolles S. Immunomodulatory action of intravenous immunoglobulin // Immunology. — 2002. — Vol. 107, N 4. — P. 387–393.

[31] The role of placental trophoblast in pathophysiology of the antiphospholipid antibody syndrome / Rote N. S., Vogt E., De Vere G. [et al.] // Am. J. Reprod. Immunol. — 1998. — Vol. 39. — P. 125–136.

[32] The selective use of heparin / aspirin therapy, alone or in combination with intravenous immunoglobulin G in the management of antiphospholipid antibody positive women undergoing in vitro fertilization / Sher G., Matzner W., Feinman M. [et al.] // AJRI. — 1998. — Vol. 40. — P. 74–82.

[33] Thrombophilia and outcomes of assisted reproduction technologies: a systematic review and meta-analysis / Di Nisio M., Rutjes A. W., Ferrante N. [et al.] // Blood. — 2011. — Vol. 118, N 10. — P. 2670–2678.

[34] Udoff L. C., Branch D. W. Management of patients with antiphospholipid antibodies undergoing in vitro fertilization // J. Autoimmunity. — 2000. — Vol. 15. — P. 209– 211.

[35] Virro M. R., Winger E. E., Reed J. L. Intravenous Immunoglobulin for Repeated IVF Failure and Unexplained Infertility //Am. J. Reprod. Immunol. — 2012. — Vol. 68. — P. 218–225.

[36] Clark D. A., Coulam C. B., Strickler R. B. Is intravenous immunoglobulins (IVIG) fficacious in early pregnancy failure? A critical review and meta-analysis for patients who fail in vitro fertilization and embryo transfer (IVF) // J. Assist. Reprod. Genet. — 2006. — Vol. 23. — P. 1–13.

RIGHTS & PERMISSIONS

Mirashvili M.I., Zainulina M.S., Selkov S.A., Gzgzyan A.M.