Is there a benefit of low-dose aspirin in assisted reproduction?

PURPOSE OF REVIEW: Assisted reproduction is an effective treatment for infertile women but, despite advances in ovarian stimulation and laboratory techniques, overall pregnancy rates are still relatively low suggesting that methods to improve implantation are required. One strategy is to increase the blood flow to the uterus with low-dose aspirin. The objective of this review is to determine if low-dose aspirin improves clinical pregnancy rates when administered to infertile women undergoing treatment with assisted reproduction. RECENT FINDINGS: A retrospective review was unable to demonstrate improved pregnancy rates when low-dose aspirin was compared with no treatment. Such studies, however, have limited value in clinical decision-making because of poor methodological quality. A recent high-quality randomized, placebo-controlled trial of low-dose aspirin was also unable to demonstrate any benefit, a finding supported by a meta-analysis of 10 trials that collectively had sufficient power to detect a clinically relevant improvement in clinical pregnancy rate. Evidence also exists that low-dose aspirin is potentially harmful, because of increased bleeding problems, miscarriage and congenital anomalies. SUMMARY: Given the lack of efficacy and the potential for harmful effects to both the patient and her offspring, low-dose aspirin should not be administered to infertile women undergoing treatment with assisted reproduction.