USE OF INTRAVENOUS IMMUNOGLOBULIN WITHIN THE IVF/ICSI PROTOCOL IN WOMEN WITH INFERTILITY AND ANTIPHOSPHOLIPID ANTIBODIES

Abstract

Introduction. Women with infertility and circulating antiphospholipid antibodies (APA) may be at risk of reproductive losses. A possible way to improve their in vitro fertilization (IVF) outcomes is the immunomodulating therapy using intravenous immunoglobulin (IVIG). Aim: to study the effecacy of IVIG in women with APA who undergo IVF (IVF/ICSI).Materials and methods. One hundred twenty eight APA-positive women were enrolled: 77 women were given IVIG during the IVF procedure at a course dose of 15 g (group 1), 55 women received no IVIG (group 2) and 63 women without APA scheduled for IVF made up the control group (group 3). Women in groups 1 and 2 received prophylactic doses of low weight heparins and reduced doses of acetylsalicylic acid. Women with poor quality embryos were excluded. The implantation rate (positive serum β-HCG), the clinical pregnancy rate (gestational sac and fetal heartbeat) and the live birth rate were used as the endpoints.Results. There were no differences in the implantation rate between groups 1, 2 and 3 (48.39%, 35.71% and 32%, respectively; p > 0.05). The clinical pregnancy rate was significantly higher in group 1 than in group 2 (45.16% and 21.43%; p < 0.05), in group 3 that was 32%. The difference in the live birth rate was not significant (33.3%, 19.05% and 24%; p > 0.05). Among women who received IVIG within the IVF (IVF/ICSI) protocol and during the subsequent pregnancy (prior to 12 weeks), the the live birth rate was 83.3% (15/18), which was 33,3% higher (p > 0.05) than for women who received IVIG only within the IVF (IVF/ICSI) – 50% (6/12).Conclusion. The use of IVIG in APA-positive women undergoing IVF (IVF/ICSI) significantly increases the clinical pregnancy rate, but does not increase the implantation rate and the live birth rate. Further studies are needed to evaluate the efficacy of IVIG within the IVF (IVF/ICSI) protocol and the continued therapy during pregnancy.

Keywords

• intravenous immunoglobulin
• in vitro fertilization
• antiphospholipid syndrome
• antiphospholipid antibodies