routine aspirin 75 for in vitro fertilization

[Dr.Vad]

Fertil Steril. 2004 Jun;81(6):1560-4.

Low-dose aspirin in a short regimen as standard treatment in in vitro fertilization: a randomized, prospective study.

Waldenstrom U, Hellberg D, Nilsson S.

In Vitro Fertilization Unit, Falun Hospital, Falun, Sweden.

OBJECTIVE: To determine if treatment with low-dose aspirin in a short regimen improves the outcome in a nonselected IVF population as compared with no treatment. DESIGN: Prospective, randomized study where IVF patients were given aspirin or received no treatment. SETTING: IVF clinic. PATIENT(S): The study included 1,380 consecutive IVF cycles. INTERVENTION(S): Women undergoing IVF were randomly assigned to treatment with aspirin 75 mg daily from the day of embryo transfer (ET) until pregnancy test or no treatment in an open study. MAIN OUTCOME MEASURE(S): Birth rate per ET. RESULT(S): Background characteristics were similar in the two groups studied except for a minor difference in number of embryos transferred (2.1 vs. 2.0). Birth rate was 27.2% in the aspirin group as compared with 23.2% in the nontreated group, giving an odds ratio, adjusted for number of embryos transferred, of 1.2 (95% confidence interval, 1.0-1.6). CONCLUSION(S): The increased birth rate with aspirin compared with no treatment was significant. Given the importance of every birth in IVF, especially when taking into account the limited number of IVF cycles that are normally performed in an individual woman, any treatment to improve birth rate is important.

[Борис Каменецкий]

Ув. Dr. Vad!

Мне не совсем понятно с чем связана Ваша публикация???
Это призыв? рекомендация? или Вас интересует мнение специалистов?

[Dr.Vad]

Уважаемый Борис Александрович!

Скорее инфо для размышления специалистaм, хотя личный опыт/мнение тоже интересно было бы услышать. Около 2 лет назад попалось мнение Ваших коллег о селективности выбора дозы аспирина в зависимости от решаемых задач, где эта доза (75 мг) обосновывалась как оптимальная для IVF, теперь же есть клин. подтверждение в рациональности такого подхода:

...we can postulate that clinical benefit of aspirin critically depends on the dosage and timing of the regimen in relation to the underlying pathology of impaired tissue perfusion. The following propositions for clinical practice are drawn up on this assumption.

The presence of APA with or without antiphospholipid antibody syndrome (APS) does not appear to affect the establishment of pregnancy. Therefore, early attempts to improve uterine perfusion are not required in such women whose fertility is not impaired at the implantation stage. However, anti-thrombotic activity becomes crucially important in the placental development stage once implantation is complete. In such cases with APS, higher doses of aspirin can achieve improved outcomes that are further improved with the concomitant use of heparin. This indicates the need for a higher anti-thrombotic effect. Therefore, the dose of aspirin should be adjusted for maximum anti-thrombotic effect, even if it means lower prostacyclin concentrations. This requires doses much higher than the conventionally recognized low dose of 75 mg per day. Treatment should be started before 8 weeks gestation, but not necessarily before conception, in order to establish an adequate anti-platelet effect in the developing intervillous compartment.

In cases where fertility is impaired at the implantation stage, as in the IVF population, improvement of tissue perfusion is important at the earliest stages of implantation. In this setting, where the perfusion is impaired by vascular rather than intravascular pathologies, lower doses of aspirin, (75 mg daily) are required to achieve a better PGI2/TXA2 ratio and lower vascular tone. For maximum benefit, treatment should be started before conception.

Из Hum Reprod. 2002 May;17(5):1146-8.
Aspirin dilemma. Remodelling the hypothesis from a fertility perspective.
Ozturk O, Greaves M, Templeton A.
Department of Obstetrics and Gynaecology, University of Aberdeen, UK.

[Борис Каменецкий]

Ув. Dr. Vad!

Применение антитромботических препаратов в программах эко действительно не новость, а вот дозы и длительность применения вопросы обсуждаемые. В своей практике я применяю Аспирин-Кардио в стандартной дозировке за 3-4 дня до планируемого переноса эмрионов.

С ув. Б.Какменецкий