OBJECTIVE: Determination of aPLs in ovulatory mucus and in seminal plasma in 18 infertile couples (women, median age 33.2, range 28-39 years; men, median age 36.4, range 29-46 years) with repeated unexplained miscarriages (four to nine spontaneous abortions). Women with high levels of aPLs in sera were excluded from the study. METHODS: aPL screening included cardiolipin (Sevac Prague), L-alpha-phosphatidic acid, L-alpha-phosphatidylethanolamine, L-alpha-phosphatidyl-DL-glycerol, L-alpha-phosphatidylinositol, and L-alpha-phosphatidyl/serine (Sigma, USA). These were determined in isotypes IgG and IgA by an ELISA method. Statistical analysis of aPL results was made by cut-off levels of aPLs for both Ig isotypes by using 3 SD or 95th percentile calculated by STATGRAPHICS. Control group was created from four fertile healthy couples. RESULTS: Levels of aPLs in ovulatory cervical mucus were in the majority very low, except for IgA-aPLs-inositol. Very high interindividual differences in aPLs were found in seminal plasma. IgA-aPL-ethanolamine and -DL-glycerol, and IgG-aPL-L-serine and -DL-glycerol predominated in seminal plasma. Extremely high IgA levels of aPLs in all above-mentioned antigens, except cardiolipin, were found in one man of an infertile couple. CONCLUSION: The passage of abnormal aPLs levels from seminal plasma into the site of conception during often repeated, unprotected intercourses is supported by the findings.

Department of Obstetrics and Gynecology Faculty Hospital Charles University Pilsen Czech Republic

The role of antiphospholipid antibodies (aPls) in infertile women: the long-lasting experience