https://doi.org/10.5812/fga-133582

Starting Aspirin in the First Trimester of Pregnancy May be Beneficial in Women with Thin Endometrium Candidates for IVF

authors:

avatar Sedigheh Hantoushzadeh ORCID 1 , avatar Aida Najafian 2 , avatar Fatemeh Asadi 1 , avatar Marjan Ghaemi ORCID 1 , *

Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Department of Gynecology and Obstetrics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Fertility, Gynecology and Andrology: Vol.2, issue 1; e133582
published online: December 14, 2022
article type: Letter
received: November 29, 2022
accepted: November 29, 2022

How To Cite Hantoushzadeh S, Najafian A, Asadi F, Ghaemi M. Starting Aspirin in the First Trimester of Pregnancy May be Beneficial in Women with Thin Endometrium Candidates for IVF. Fertil Gynecol Androl. 2022;2(1):e133582. https://doi.org/10.5812/fga-133582.

Dear Editor,

Uterine blood flow prepares the uterine environment for a normal placental function to support fetal growth and development. Defective placentation is characterized by a significantly increased number of junctional zone spiral arteries (1) that can be identified by partial or absence of transformation, (and) obstructive lesions (2).

On the other hand, endometrial thickness (ET) and endometrial pattern have been widely accepted as prognostic indicators for endometrial receptivity. The high blood flow impedance of uterine radial arteries impairs the growth of the glandular epithelium, causing poor vascular development, which in turn decreases blood flow in the endometrium; and this vicious circle leads to a thin endometrium (3). Low ET is associated with decreased pregnancy, implantation, and live birth rate (LBR) in in vitro fertilization (IVF) (4). These results were confirmed by Liao et al. in the thin endometrium lower than 7 mm (5). As confirmed by Ganer Herman et al. (6), although ET below 7.5 mm did not affect placenta abruption and placenta previa for malplacentation (5), the rate of bilobated placentas was higher (6). However, the rate of placental-mediated obstetric complications due to inadequate vasculature such as preeclampsia, preterm delivery, placental abruption, or small for gestational age was significantly increased in the low ET group (6).

Aspirin is associated with the highest reduction in preeclampsia by modulation and reduction in hypoxia-related placental lesions (7). Low-dose aspirin also reduces spontaneous preterm birth below 34 weeks in low-risk women (8). For initiation time, it is considered beneficial before 12 weeks for preeclampsia and fetal growth restriction (FGR) without adverse events (9). Indeed, aspirin has been commonly used in frozen embryo transfer (FET) cycles for better endometrium preparation, implantation, and live birth rates without changing the uterine hemodynamics (10, 11). Considering that IVF is known as a high-risk pregnancy and many candidates have a thin endometrium, aspirin can be considered after the detection of a fetal heartbeat or at the time of embryo transfer to help better placentation.

References

  • 1.

    Espinoza J, Romero R, Mee Kim Y, Kusanovic JP, Hassan S, Erez O, et al. Normal and abnormal transformation of the spiral arteries during pregnancy. J Perinat Med. 2006;34(6):447-58. [PubMed ID: 17140293]. [PubMed Central ID: PMC7062302]. https://doi.org/10.1515/JPM.2006.089.

  • 2.

    Brosens I, Pijnenborg R, Vercruysse L, Romero R. The "Great Obstetrical Syndromes" are associated with disorders of deep placentation. Am J Obstet Gynecol. 2011;204(3):193-201. [PubMed ID: 21094932]. [PubMed Central ID: PMC3369813]. https://doi.org/10.1016/j.ajog.2010.08.009.

  • 3.

    Takasaki A, Tamura H, Miwa I, Taketani T, Shimamura K, Sugino N. Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium. Fertil Steril. 2010;93(6):1851-8. [PubMed ID: 19200982]. https://doi.org/10.1016/j.fertnstert.2008.12.062.

  • 4.

    Gao G, Cui X, Li S, Ding P, Zhang S, Zhang Y. Endometrial thickness and IVF cycle outcomes: a meta-analysis. Reprod Biomed Online. 2020;40(1):124-33. [PubMed ID: 31786047]. https://doi.org/10.1016/j.rbmo.2019.09.005.

  • 5.

    Liao Z, Liu C, Cai L, Shen L, Sui C, Zhang H, et al. The Effect of Endometrial Thickness on Pregnancy, Maternal, and Perinatal Outcomes of Women in Fresh Cycles After IVF/ICSI: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2021;12:814648. [PubMed ID: 35222264]. [PubMed Central ID: PMC8874279]. https://doi.org/10.3389/fendo.2021.814648.

  • 6.

    Ganer Herman H, Volodarsky-Perel A, Ton Nu TN, Machado-Gedeon A, Cui Y, Shaul J, et al. Pregnancy complications and placental histology following embryo transfer with a thinner endometrium. Hum Reprod. 2022;37(8):1739-45. [PubMed ID: 35771669]. https://doi.org/10.1093/humrep/deac148.

  • 7.

    Van Doorn R, Mukhtarova N, Flyke IP, Lasarev M, Kim K, Hennekens CH, et al. Dose of aspirin to prevent preterm preeclampsia in women with moderate or high-risk factors: A systematic review and meta-analysis. PLoS One. 2021;16(3). e0247782. [PubMed ID: 33690642]. [PubMed Central ID: PMC7943022]. https://doi.org/10.1371/journal.pone.0247782.

  • 8.

    Andrikopoulou M, Purisch SE, Handal-Orefice R, Gyamfi-Bannerman C. Low-dose aspirin is associated with reduced spontaneous preterm birth in nulliparous women. Am J Obstet Gynecol. 2018;219(4):399 e1-6. [PubMed ID: 29913174]. https://doi.org/10.1016/j.ajog.2018.06.011.

  • 9.

    Zhu J, Huang R, Zhang J, Ye W, Zhang J. A prophylactic low-dose aspirin earlier than 12 weeks until delivery should be considered to prevent preeclampsia. Med Hypotheses. 2018;121:127-30. [PubMed ID: 30396465]. https://doi.org/10.1016/j.mehy.2018.08.005.

  • 10.

    Madani T, Ahmadi F, Jahangiri N, Bahmanabadi A, Bagheri Lankarani N. Does low-dose aspirin improve pregnancy rate in women undergoing frozen-thawed embryo transfer cycle? A pilot double-blind, randomized placebo-controlled trial. J Obstet Gynaecol Res. 2019;45(1):156-63. [PubMed ID: 30178577]. https://doi.org/10.1111/jog.13802.

  • 11.

    Mourad A, Antaki R, Jamal W, Albaini O. Aspirin for Endometrial Preparation in Patients Undergoing IVF: A Systematic Review and Meta-analysis. J Obstet Gynaecol Can. 2021;43(8):984-992 e2. [PubMed ID: 33892182]. https://doi.org/10.1016/j.jogc.2021.03.018.