ANTIPHOSPHOLIPID ANTIBODIES AND INFERTILITY - FACT OR FALLACY

Some clinicians are convinced that antiphospholipid antibodies, includ ing antibodies to any one of five-to-seven phospholipid antigens, are associated with infertility. Additionally, some clinicians recommend t hat infertile women who have antiphospholipid antibodies and are under going in-vitro fertilization should be treated with heparin to improve the rate of pregnancy. However, experts disagree regarding the relati onship between antiphospholipid antibodies and infertility. There is a lso substantial evidence that treatment with heparin does not alter th e rate of pregnancy following in-vitro fertilization. Why the confusio n? Probable culprits include variation in study design and the selecti on of infertile patients. Another important problem is that assays for antiphospholipid antibodies other than anticardiolipin are not standa rdized. Before the real relationship between antiphospholipid antibodi es and infertility is discovered, assays for antiphospholipid antibodi es other than anticardiolipin must be standardized and properly design ed studies conducted. Randomized, controlled trials must be done to de termine if heparin should be recommended as an adjunctive treatment fo r in-vitro fertilization in women with antiphospholipid antibodies.