Antiphospholipid antibodies in women with recurrent embryo implantation failure: A systematic review and meta-analysis

Objective: Antiphospholipid antibodies (aPL) are related to poor pregnancy outcomes, but their effect on embryo implantation is unclear. We aimed to assess the prevalence of different aPL in women with recurrent implantation failure (RIF). Methods: We searched studies in PubMed (MEDLINE), Scopus and Cochrane Library. Quality of studies was scored by the Newcastle-Ottawa Scale and risk of bias assessment by items described in RevMan5 software. Statistical analyses were made using random-effects model and presented as pooled Odds Ratio (OR), 95% confidence interval (CI). Heterogeneity was assessed by I2% and D2%. Results: This systematic review and meta-analysis included 17 studies and showed a high degree of variability in aPL positivity in RIF. In the latter, the risk of bias assessment suggested unclear bias on study performance with a median sample size and interquartile range for RIF patients and fertile women of 96 (57-417) and 100 (60.5-202.5), respectively. Among the criteria aPL, IgG anticardiolipin autoantibodies (OR 5.02, 95% CI [1.95, 12.93]) were associated with RIF. Within the non-criteria aPL, anti-beta 2 glycoprotein I-IgA (OR 64.8, 95% CI [9.74, 431.0]), and antiphosphatidylglycerol-IgG and IgM (OR 10.74, 95% CI [5.25, 22.0]; OR 4.26, 95% CI [1.76,10.31]; respectively) were associated with RIF, too. Conclusions: Anticardiolipin-IgG is a prevalent autoantibody in women with RIF. Three other non-criteria aPL, a beta 2GP I-IgA, aPG-IgG and aPG-IgM also present a positive rate in RIF. Overall, these results advise about testing them as indicators of RIF risk in women seeking IVF treatment.

Automated summary

Through a systematic review and meta-analysis, we found that different types of antiphospholipid antibodies are present in women with recurrent implantation failure. Among them, IgG anticardiolipin autoantibodies are associated with recurrent implantation failure. Additionally, anti-beta 2 glycoprotein I-IgA, antiphosphatidylglycerol-IgG, and antiphosphatidylglycerol-IgM are also associated with recurrent implantation failure.