There was a study published about 13 years ago in which women undergoing IVF were randomly assigned to either low-dose aspirin or placebo during ovarian stimulation. The women receiving aspirin (it was 100 mg/day in the original study) had a better ovarian response (with almost twice as many eggs obtained in the treatment group) and significantly higher implantation and pregnancy rates.
When I first heard the findings presented at a fertility meeting (in Tours, France; ah, those were the days!), I was impressed - here is an inexpensive medicine that almost doubles the IVF pregnancy rate. The study seemed well designed and the results clear (but in reviewing the paper I see that although 298 patients were randomized, Table 1 in the manuscript reports the results on only 74 women). Here is the citation if you want to dig up the article yourself: Rubinstein M, Marazzi A, de Fried EP. Low-dose aspirin treatment improves ovarian responsiveness, uterine and ovarian blood flow velocity, implantation, and pregnancy rates in patients undergoing in vitro fertilization: a prospective, randomized, double-blind placebo-controlled assay. Fertility and Sterility 1999;71(5):825-829. The authors theorized that aspirin improved the blood flow to the ovaries and uterus, which led to the beneficial effects.
I suspect that within a year of this article being published, more than half the IVF patients in the US were on low-dose aspirin. Since then, at least 12 randomized controlled trials of aspirin treatment during IVF have been performed, and the conclusion is ... aspirin does nothing to improve the success of IVF. Here is a recent meta-analysis of all the studies: http://www2.cochrane.org/reviews/en/ab004832.html
It's too bad, really. It was such a nice story.
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Hi Dr. Steinkampf. Do you test/treat for possible immunologic causes of recurrent pregnancy loss? If not, do you plan to in the future? What are your thoughts on IVIG therapy? or neupogen as treatment?
I think intravenous immune globulin (IVIG) treatment for recurrent miscarriages has fallen from favor. Here is a link to the most recent review, which failed to show any benefit: http://www.ncbi.nlm.nih.gov/pubmed/21232738.
Neupogen is the brand name for granulocyte colony stimulating factor. It is used to reduce the risk of infection in patients undergoing cancer chemotherapy. There is one small study claiming benefit of G-CSF for treating recurrent miscarriage (Here is the link to the paper: http://humrep.oxfordjournals.org/content/24/11/2703.long), but I think it is way too early to be considering this drug for clinical use in these patients. Keep in mind that the history of recurrent miscarriage treatments is that a few small studies claim initial success with some new (and sometimes really weird or expensive) treatment, then larger studies fail to show benefit. I think it is wise to be cautious before accepting some new treatment for this condition.
mps
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