BACKGROUND: Recurrent reproductive failure (RRF), encompassing repeated implantation failure and pregnancy loss, remains a major challenge in assisted reproductive technology (ART). Autoimmune factors have been implicated in adverse reproductive outcomes, but the combined impact of antinuclear antibodies (ANA) and antiphospholipid antibodies (aPL) on ART success in women with RRF is unclear. METHODS: This retrospective cohort study analyzed 682 women with RRF who underwent IVF or ICSI between April 2019 and April 2024. Participants were classified into four groups based on ANA and aPL status. Clinical characteristics, laboratory indices, and ART outcomes were compared. Univariable and multivariable logistic regression analyses were conducted to identify predictors of live birth. RESULTS: Live birth rates differed significantly across groups (p = 0.001), with the ANA-/aPL- group showing the highest rate (36.3%) and lower rates in women positive for either or both autoantibodies. Clinical pregnancy rates were also lower in the ANA+/aPL+ group (30.6% vs. 49.8%, p = 0.050). Multivariable analysis confirmed ANA positivity (adjusted OR 0.57, 95% CI 0.38-0.86) and longer infertility duration as independent predictors of reduced live birth rates. No significant differences were observed between single and multiple ANA specificities in terms of reproductive outcomes. CONCLUSIONS: The concurrent presence of ANA and aPL is associated with significantly poorer IVF outcomes in women with unexplained RRF. These findings suggest that comprehensive autoantibody profiling may help identify a specific high-risk subset of RRF patients. Further prospective studies are warranted to determine whether this subgroup benefits from targeted immunomodulatory interventions.
Fang et al. (Fri,) studied this question.