By Dr. Victoria Verdú (Licensed Gynaecologist No. 282847366).
Antiphospholipid syndrome is one of those lesser-known conditions that can nevertheless have a direct impact on fertility and the course of pregnancy. It is an autoimmune disorder in which the body produces antibodies against certain components of cell membranes, phospholipids, thereby altering the normal mechanisms of blood coagulation.
This syndrome is associated with difficulties in achieving pregnancy, as well as with complications during gestation, so identifying it correctly can help to establish medical strategies that improve reproductive prognosis.
Antiphospholipid syndrome, also known as APS, is characterised by the presence of antiphospholipid antibodies in the blood, mainly lupus anticoagulant, anticardiolipin antibodies and anti-beta-2 glycoprotein I antibodies. These antibodies promote the formation of blood clots and alter blood circulation.
APS can go unnoticed for years in many people, as it does not always cause obvious symptoms. It is usually diagnosed when a woman is trying to conceive and experiences recurrent miscarriages, implantation failure or complications after achieving pregnancy.
In fact, the main problem associated with antiphospholipid syndrome is related to embryo implantation and early pregnancy development. The formation of microthrombi in the blood vessels of the endometrium and placenta can make it difficult for the embryo to implant properly or to receive an adequate supply of oxygen and nutrients during the first weeks. For this reason, APS particularly affects the first trimester, although it may also be involved in later pregnancy losses, preeclampsia or fetal growth restriction.
Antiphospholipid syndrome may also be behind some cases of repeated implantation failure in in vitro fertilisation treatments. In these situations, embryo quality is usually adequate, but the embryo is unable to implant stably in the uterus.
Given this type of history, it is necessary to carry out an immunological and haematological study to detect the presence of antiphospholipid antibodies. This allows the medical team to adjust treatment and reduce the risks associated with the reproductive process.
The diagnosis of antiphospholipid syndrome is based on a combination of clinical and laboratory criteria. In the reproductive setting, it is usually suspected in cases of recurrent miscarriage, unexplained fetal losses or implantation failure without an apparent cause.
The diagnosis of antiphospholipid syndrome (APS) requires the combination of at least one clinical criterion (vascular thrombosis or obstetric complications) and one laboratory criterion (positive antiphospholipid antibodies). In this context, obstetric complications related to APS include:
Laboratory confirmation requires the detection of antiphospholipid antibodies in at least two determinations separated over time, as their presence must be persistent to establish the diagnosis. Even when all diagnostic criteria are not met, the presence of some of them may hinder the achievement of pregnancy. For this reason, a thorough and individualised medical evaluation is essential.
Although antiphospholipid syndrome has no cure, being aware of its presence and attempting to control it can improve the chances of achieving pregnancy. The most common treatment combines anticoagulant and antiplatelet drugs, such as low-molecular-weight heparin and low-dose acetylsalicylic acid, always under medical supervision.
In this way, blood circulation at the uterine and placental level is improved, favouring embryo implantation and pregnancy development. In women undergoing assisted reproduction techniques, treatment is adapted to the stage of the cycle and the type of procedure performed.
The presence of antiphospholipid syndrome does not, in itself, prevent achieving pregnancy or having a healthy baby. This is why early diagnosis and close monitoring of the condition are so important. Many women with APS manage to become pregnant not only through assisted reproduction treatments, but also naturally.
Antiphospholipid syndrome is a clear example of how certain immune system alterations can affect fertility without causing obvious symptoms. Therefore, in cases of complex reproductive histories, having a specialised and individualised evaluation can make a significant difference.
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