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Anti-phospholipid Syndrome and Coagulation Defects

We feel that some of our patient population has infertility in part on an autoimmune basis. Presently there is no good way to determine this. There have been publications suggesting that it is worthwhile to measure antiphospholipid antibodies prior to undertaking IVF. These antibodies are directed against the developing placenta. Although there is data supporting this approach, it is very limited. Recently several good large negative studies have been published (in the area of infertility, but not recurrent pregnancy loss). If anti-phospholipid antibodies are found and thought to be significant, then the treatment of choice is heparin and aspirin. This is a significant treatment during pregnancy and has even resulted in death. Presently, the data do not support taking on the risk of this treatment.

If the patient has a history of recurrent pregnancy loss, we also look for coagulation defects such as factor V abnormalities. Such defects may lead to abnormal clotting occurring within the placenta.