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CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(10): 621-627
DOI: 10.1055/s-0039-1697982
Review Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Antiphospholipid Antibody Syndrome and Infertility

Síndrome Anticorpo Antifosfolípide e Infertilidade
Vivian de Oliveira Rodrigues
1   Gynecology Department, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
,
Adriana de Góes e Silva Soligo
2   Post Graduate Department, Associação Instituto Sapientiae, São Paulo, SP, Brazil
,
Gabriel Duque Pannain 
1   Gynecology Department, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
› Author Affiliations
Further Information

Publication History

20 March 2019

24 July 2019

Publication Date:
28 October 2019 (online)

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Abstract

Antiphospholipid antibody syndrome (APS) is a systemic, autoimmune, prothrombotic disease characterized by persistent antiphospholipid antibodies (aPLs), thrombosis, recurrent abortion, complications during pregnancy, and occasionally thrombocytopenia. The objective of the present study was to review the pathophysiology of APS and its association with female infertility. A bibliographic review of articles of the past 20 years was performed at the PubMed, Scielo, and Bireme databases. Antiphospholipid antibody syndrome may be associated with primary infertility, interfering with endometrial decidualization and with decreased ovarian reserve. Antiphospholipid antibodies also have direct negative effects on placentation, when they bind to the trophoblast, reducing their capacity for invasion, and proinflammatory effects, such as complement activation and neutrophil recruitment, contributing to placental insufficiency, restricted intrauterine growth, and fetal loss. In relation to thrombosis, APS results in a diffuse thrombotic diathesis, with global and diffuse dysregulation of the homeostatic balance. Knowing the pathophysiology of APS, which is closely linked to female infertility, is essential for new therapeutic approaches, specialized in immunomodulation and inflammatory signaling pathways, to provide important advances in its treatment.

Resumo

A Síndrome do anticorpo antifosfolípide (SAF) é uma doença sistêmica, autoimune e pró-trombótica caracterizada por anticorpos antifosfolípides, trombose, aborto recorrente, complicações durante a gestação, e, ocasionalmente, trombocitopenia. O objetivo do presente estudo foi revisar a fisiopatologia da SAF e sua associação com a infertilidade feminina. Foi feita uma revisão bibliográfica dos últimos 20 anos nas bases de dados PubMed, Scielo e Bireme. A SAF pode estar associada à infertilidade primária, interferindo na decidualização endometrial e com baixas reservas ovarianas. Os anticorpos antifosfolípides também apresentam efeito negativo direto na placentação, se ligando ao trofoblasto e diminuindo sua capacidade de invasão, além de efeitos pró-inflamatórios, tais como ativação do sistema de complemento e recrutamento de neutrófilos, contribuindo para a insuficiência placentária, crescimento intrauterino restrito e perda fetal. Quanto a trombose, a SAF resulta em distúrbios trombóticos difusos, com uma desregulação do balanço homeostático. Conhecer a fisiopatologia da SAF, que apresenta associação importante com a infertilidade feminina, é essencial para novas abordagens terapêuticas, principalmente no que tange imunomodulação e os caminhos de ativação inflamatórios.

Keywords

antiphospholipid antibody syndrome - infertility - recurrent abortion - antiphospholipid antibody

Palavras-chave

síndrome do anticorpo antifosfolípide - infertilidade - aborto de repetição - anticorpo antifosfolípide
 

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