Antiphospholipid Antibody Syndrome: Diagnosis and Treatment

I will not be able to give you details about specific sperm selection procedures, as in our hospital this is a multidisciplinary process involving the IVF specialist and the andrology laboratory. But in terms of the genetic implications: above the age of 50, there is a high chance that sperm quality is reduced, and the sperm DNA fragmentation index is likely to be elevated. Unless we specifically test for it, we do not know the exact level, but even without testing, there is a significant chance that sperm DNA quality is impaired, which can result in recurrent pregnancy loss or implantation failure. Testing the sperm DNA fragmentation index in men above 50 with a history of recurrent pregnancy loss or implantation failure would be worthwhile.

Metformin should be started at least 2 to 3 months before conception. It is safe to continue in pregnancy and is generally continued through the first trimester and sometimes beyond. It should be monitored with GTT as well as regular HbA1c and blood sugar checks throughout.

Diagnosis requires meeting both a clinical and a laboratory criterion.

Three or more unexplained losses under 10 weeks, one or more losses at or beyond 10 weeks, or a preterm birth from placental insufficiency or severe pre-eclampsia, alongside a history of vascular or deep vein thrombosis.

Anticardiolipin, lupus anticoagulant, and beta-2 glycoprotein, tested for both IgM and IgG, with levels above the 99th percentile confirmed positive on two occasions 12 weeks apart.

Testing must wait at least 6 weeks after a pregnancy loss, since the physiological changes that follow a loss can produce false positives.

Treatment starts with low-dose aspirin in the preconception period; once pregnancy is confirmed, prophylactic heparin is added and continued through the pregnancy.