Management of Reproductive Failure in the Antiphospholipid Syndrome

Publisher Summary This chapter presents various management plans for reproductive failure in the antiphospholipid syndrome (APS). Despite the enormous amount of work on the APS, there are still various controversies regarding management of reproductive failure potentially associated with antiphospholipid antibodies (aPL). These controversies relate to decisions on treatment or no treatment in the patients with APS; selection of patients with aPL to be treated; management of patients presenting with infertility or repeated implantation failure after in vitro fertilization and having the LA and/or anticardiolipin antibodies (aCL); and management of recurrent pregnancy loss associated with aPL other than LA and aCL. There have been some claims supporting the view that the presence of aCL in women with recurrent miscarriage may result in a modest increase in the risk of fetal losses, and thus, the chance of a successful pregnancy even without anticoagulant treatment is still favorable. However, as the correlation between aPL and disease is rather imperfect, the treatment of the subjects presenting with definite clinical criteria for APS but having low levels of aCL remains controversial in daily clinical practice. As women with IgM only or low levels of IgG aCL comprise a population at less risk for aPL related disorders, such patients should not be treated with potentially dangerous medications such as prednisone and heparin, which are alleged to be efficacious for APS, since the balance between risk and benefit does not justifies therapy. Many clinicians recommend low-dose aspirin in women with low-titer aPL and the addition of heparin if levels increase once pregnancy is confirmed.