One pill typically contains 75 to mg of aspirin a standard pill is mg. Aspirin has long been used as a painkiller and anti-inflammatory drug, soothing many a hangover and general aches and pains. Taking a lower dose of aspirin can help various health conditions, from slashing the odds of a heart attack to minimising stroke. It was only a matter of time before researchers looked at its role in fertility and pregnancy.
This is a placental disorder with potentially life-threatening consequences. If you had high blood pressure before getting pregnant, or have another chronic health condition like severe diabetes, the risk is higher too. Women with Factor V Leiden or antiphospholipid syndrome are routinely prescribed blood thinners like baby aspirin or Clexane.
These may be taken throughout pregnancy. So could baby aspirin help with fertility? Studies are inconclusive. Typically, baby aspirin is taken when a fertility patient begins her stimulating medication. But starting on transfer day is not uncommon. Some doctors are sniffy about baby aspirin. Concealed allocation by computerized randomization was done by the central pharmacy of the hospital.
Daily oral administration of aspirin mg or placebo started before stimulation and was continued until confirmation of pregnancy by detection of fetal heart activity on ultrasound. The primary outcome measure assessed in this trial was clinical pregnancy rate per cycle. Aspirin acetylsalicylic acid is well known to have analgesic, anti-inflammatory and antipyretic properties. Aspirin and other salicylates act as inhibitors of the enzyme cyclo-oxygenase, resulting in the direct inhibition of the biosynthesis of prostaglandins and thromboxanes from arachidonic acid Martindale, In blood platelets, such inhibition prevents the synthesis of thromboxane, which is a vasoconstrictor that causes platelet aggregation and is thus potentially thrombotic.
In blood vessel walls, the enzyme inhibition prevents the synthesis of prostacyclin, which is a vasodilatator that has anti-aggregation properties and is potentially anti-thrombotic. Aspirin therefore appears to have paradoxical biological effects Martindale, The duration of these effects, however, is shorter in vascular cells, which regain the ability to regenerate prostacyclin in a few hours.
In platelets, cyclo-oxygenase is irreversibly inhibited, rendering them unable to re-synthesize new thromboxane. In this way, aspirin has an antiplatelet effect and causes a shift toward an increase in the synthesis of prostacyclin, responsible for vasodilatation and an improved blood perfusion in many organs. Low daily doses of aspirin, in the range of 75— mg, appear to have an equally antiplatelet effect Martindale, Aspirin's antiplatelet activity has led to its use and investigation in a variety of disorders.
There is evidence that low-dose aspirin plays an important role in the initial treatment and secondary prevention of myocardial infarction and ischemic stroke Keller et al. The combination of low-dose aspirin and unfractionated heparin appears to be of benefit in pregnant women with antiphospholipid antibodies and recurrent pregnancy loss not related to other causes Empson et al. Pre-eclampsia is associated with deficient intravascular production of prostacyclin and excessive production of thromboxane.
The administration of low-dose aspirin to women at risk leads to a significant reduction in the likelihood of developing pre-eclampsia, preterm birth, fetal or neonatal death and small-for-gestational age babies Duley et al. The above-mentioned facts have led to the hypothesis that low-dose aspirin may improve uterine and ovarian perfusion and that aspirin might enhance endometrial receptivity and ovarian responsiveness as well, which could result in better implantation and pregnancy rates after IVF or ICSI treatment.
The aim of the present study was to investigate the potential benefits of daily administration of low-dose aspirin, compared with placebo, on pregnancy rates in first and second IVF and ICSI cycles. The effect on the number of oocytes, embryo quality and miscarriage rate was also examined.
Therefore, our study contributes further to the existing literature. This study was a prospective, randomized, double-blind placebo controlled trial, performed in the Centre for Reproductive Medicine of the University Hospital of Ghent. Patients were included and randomized at the first consultation in our centre, before the start of the treatment. All patients could enter the study only once. Daily oral administration of aspirin mg or placebo was started together with the oral contraceptive pill prior to stimulation, and was continued until confirmation of pregnancy by detection of fetal heart activity on vaginal ultrasound at 6 weeks and 3 days of amenorrhea.
The choice of gonadotrophin was made by the clinician, although the majority of patients were treated with hMG. The dose was decided by the clinician, but age of the patient was taken into account.
Our centre uses these criteria since it appears that the number of adequate size follicles is more important than the size of the leading follicle s Wittmaack et al. Oocyte retrieval took place 35 h after hCG administration.
The quality of the embryos was scored on the day of transfer Day 3 and was based on the number of blastomeres, fragmentation rate and the absence of multinucleated blastomeres Van Royen et al. One or two embryos were transferred on Day 3 following oocyte retrieval. The number of embryos transferred was based on age of the patient and embryo quality. When there was a risk of ovarian hyperstimulation syndrome OHSS , i. Measurement of serum hCG was performed 12 days after embryo transfer. Transvaginal ultrasound was done at 6 weeks and 3 days amenorrhea to confirm clinical pregnancy by fetal heart activity and number of gestational sacs.
Women who were suffering from platelet dysfunction, thrombopenia, gastrointestinal ulcers, recurrent gastritis, aspirin hypersensitivity or who were on treatment with anticoagulants or aspirin were excluded from participation. Secondary outcome measures were number of oocytes retrieved, embryo quality, twins rate, miscarriage rate and live birth rate per cycle. This meant that patients had to be randomized in total according to the sample size calculation. The main reasons for cancellation were poor response or failure of fertilization Fig.
The number of cancelled patients during stimulation or before transfer was not significantly different between the two groups. The two groups did not differ significantly regarding age, cycle number or subfertility status. Also the use of different gonadotrophins, the variable starting dose of gonadotrophins and the use of different forms of luteal support was, due to the randomization, equally divided between the groups.
Mean duration of stimulation and mean total dose of gonadotrophins were not different for the two groups Table I. These patients were considered to be at risk for OHSS and received progesterone as luteal support. The mean number of oocytes In the aspirin group, 24 live births including three twins out of 29 pregnancies with known outcome were obtained versus 27 live births including four twins out of 28 pregnancies with known outcome in the placebo group.
The data of this prospective, randomized, double-blind placebo controlled trial show that low-dose aspirin does not improve clinical pregnancy rate in first or second IVF or ICSI cycles. As mentioned above, potential shortcomings of our study could have been the use of different forms of gonadotrophins, different starting doses of gonadotrophins or different forms of luteal support.
Also the criteria for hCG administration for triggering the final oocyte maturation may be subject to discussion. However, due to a correctly performed randomization both the aspirin and the placebo groups were quite comparable which is reassuring with regard to the results Tables I and II.
The review of Poustie et al. On the basis of the seven included RCTs, Khairy et al. However, they noted a trend, but with insufficient power, suggesting improvement in clinical pregnancy rates. Their review also showed no effect of aspirin on miscarriage or ectopic pregnancy rate.
Gelbaya et al. These authors also cited a review of the potential risks of aspirin therapy and mentioned its potential harm during pregnancy. The studies in the review included a total of 2, women undergoing IVF. Randomized controlled trials are considered the most reliable type of study. In most studies, women started taking aspirin at the beginning of the IVF process. The duration of the treatment varied from study to study.
One of the larger studies that looked only at pregnancy rates did suggest a benefit, the researchers note. Of women, the pregnancy rate among aspirin users was 45 percent, versus 28 percent of women not on aspirin. Like Siristatidis, Lobo too noted that many couples undergoing infertility treatment are desperate to try anything that could raise their chances of having a baby, even in theory.
0コメント