Possible Effect of Extended Use of Hormonal Contraception on Increased Levels of Antiphospholipid Antibodies in Infertile Women

Abstract

Purpose: Increased levels of antiphosholipid antibodies (aPLs) are associated with the autoimmune disorder antiphospholipid syndrome (APS) and are known to play a role in infertility. We investigated the possible effect of prolonged use of hormonal contraception (HC) on autoimmunity after discontinuing HC in women with infertility problems. Material and Methods: We analyzed hormonal status including ovulation and the humoral autoimmune response to eight phospholipids detected by ELISA in 1190 infertile women aged 21–46 (mean age: 29.3) years. Results: Long-term HC did not affect ovulation, but in the absence of ovulation HC masked the hormonal disorders. The majority of patients taking HC for more than 10 years with fertility failure had significantly higher levels of aPLs of the IgG isotype against phosphatidylinositol and phosphatidylserine (p > 0.001) than against β2-glycoprotein I and annexin V. Discussion: Thus, high levels of aPLs are significant for the anticoagulant treatment before and during pregnancy to prevent pregnancy loss.

Zusammenfassung

Zielsetzung: Das erhöhte Auftreten von Antiphospholipid-Antikörpern im Blut ist mit der Autoimmunerkrankung Antiphospholipid-Syndrom (APS) assoziiert und spielt bekanntlich eine Rolle bei Infertilität. In Frauen mit Fertilitätsproblemen wurde die mögliche Auswirkung der Langzeiteinnahme hormoneller Empfängnisverhütungsmittel auf die Autoimmunität untersucht, die auch nach Absetzen des Mittels fortbesteht. Methoden: In 1190 unfruchtbaren Frauen im Alter von 21–46 (Durchschnittsalter: 29,3) Jahren wurden Hormonstatus und Eisprung sowie die durch ELISA ermittelte humorale Immunreaktion auf 8 Phospholipide untersucht. Ergebnisse: Die Langzeiteinnahme hormoneller Empfängnisverhütungsmittel hatte keine Auswirkung auf den Eisprung, aber bei Ausbleiben des Eisprungs hat die hormonelle Empfängnisverhütung die Hormonstörung überdeckt. Die Mehrheit der Patientinnen mit Fertilitätsproblemen, die Hormonpräparate zur Empfängnisverhütung über einen Zeitraum von mehr als 10 Jahren einnahmen, wiesen signifikant höhere Antiphospholipid-Antikörper-Spiegel des IgG-Isotyps gegen Phosphatidylinositol und Phosphatidylserin (p > 0,001) auf als gegen β2-Glykoprotein I und Annexin V. Diskussion: Hohe Antiphospholipid-Antikörper-Spiegel erweisen sich also als signifikant für die antikoagulatorische Therapie vor und während der Schwangerschaft, um einem frühzeitigen Ende der Schwangerschaft vorzubeugen.

Key words

infertility - hormonal contraception - antiphospholipid antibodies - antiphospholipid syndrome

Schlüsselwörter

Infertilität - hormonelle Empfängnisverhütung - Antiphospholipid-Antikörper - Antiphospholipid-Syndrom

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