Serum autoantibodies and assisted reproduction: A systematic review.

In 30 seconds

This systematic review assessed observational studies of isolated antithyroid antibody (ATA), antiphospholipid antibody (APL), and antinuclear antibody (ANA) positivity in women without diagnosed autoimmune disease undergoing assisted reproductive technology (ART). It included 37 studies of ATA, nine of APL, and eight of ANA. ATA positivity did not appear to adversely affect ART outcomes overall, including live birth, although some studies reported more miscarriages. Limited evidence linked APL positivity to increased miscarriage risk; ANA positivity appeared associated with lower clinical pregnancy rates and higher miscarriage rates. The evidence was heterogeneous, and no pooled quantitative effect estimate was reported.

Key findings

• Across 37 studies, ATA positivity did not appear to adversely affect cumulative live birth or live birth rates.
• Some studies reported increased miscarriage rates with ATA positivity.
• Limited evidence suggested APL positivity may be associated with increased miscarriage risk.
• ANA positivity appeared associated with lower clinical pregnancy rates and higher miscarriage rates.

Why it matters

Isolated autoantibody results may arise during infertility evaluation, but their implications for ART outcomes differ by antibody type. The review suggests ATA positivity alone is unlikely to substantially impair outcomes, while possible associations involving APL and ANA warrant careful interpretation. Recognising the uncertainty can support balanced counseling without treating antibody positivity as a definitive predictor of reproductive outcome.

What to keep in mind

The evidence was heterogeneous and based on observational studies; the authors call for further well-designed studies.