What's the evidence for this recommendation? Doubtless, compelling articles like these:
* Low-dose aspirin does not improve ovarian stimulation, endometrial response, or pregnancy rates for in vitro fertilization.
J Exp Clin Assist Reprod. 2005 May 31;2:8.
Oh, oops, those must be the wrong ones. Maybe the good doctors were thinking of this paper:
* Low dose aspirin and IVF: 'Is it time for a meta-analysis' continued?
Hum Reprod Update. 2008 Sep-Oct;14(5):537-8.
Offerchreissakes, people. Let me help you out: YES it's time for a meta-analysis, NO you're not going to find any effect of low-dose aspirin.
Either I am psychic, or a marginally successful PubMed user, because lo and behold:
JG Bromer and friends publish this timely (pour moi) meta-analysis. Abstract:
So to recap: Some studies have shown that low-dose aspirin increases IVF success, with the hypothesized mechanism being increased blood flow to the uterus. Meanwhile, several more studies have shown that (a) aspirin does not increase blood flow to the uterus, and (b) actually aspirin doesn't improve IVF success at all. AND MIGHT KILL YOU. But whatever!
Meanwhile, of course, my doctors still recommend it. And when I say "recommend," I mean the same way they "recommend" I don't drink while trying to get knocked up.
What's a girl to do?
Go with the doctors? Or go with the evidence?
Do what she's told? Or think for herself?
Cave to the Establishment? Or be free, free like the motherfucking wind?
Yeah, you guessed right, I'm taking the aspirin. As Dr Hyde helpfully points out, "You won't die of stroke that month."
The thing is, aspirin is one of the world's oldest drugs. I know it's safe, which is a lot more than I can say for the cow hormones I'll be injecting into my ass.
And frankly, given the giant headache this is going to be, a little aspirin might be nice.
* Low-dose aspirin use does not improve in vitro fertilization outcomes in poor responders.
Fertil Steril. 2008 May;89(5):1113-7.
Oh, oops, those must be the wrong ones. Maybe the good doctors were thinking of this paper:
* Low-dose aspirin does not improve ovarian responsiveness or pregnancy rate in IVF and ICSI patients: a randomized, placebo-controlled double-blind study.
No, crap, I meant to cite:
Erm. And under the category of "Articles that make you think scientists have too much damn time on their hands":Hum Reprod. 2005 Aug;20(8):2211-4.
No, crap, I meant to cite:
* Pregnancy-related death associated with heparin and aspirin treatment for infertility, 1996.
MMWR Morb Mortal Wkly Rep. 1998 May 15;47(18):368-71.* Evidence of absence or absence of evidence? A reanalysis of the effects of low-dose aspirin in in vitro fertilization.
Fertil Steril. 2008 Jul;90(1):71-6.* Low dose aspirin and IVF: 'Is it time for a meta-analysis' continued?
Hum Reprod Update. 2008 Sep-Oct;14(5):537-8.
Offerchreissakes, people. Let me help you out: YES it's time for a meta-analysis, NO you're not going to find any effect of low-dose aspirin.
Either I am psychic, or a marginally successful PubMed user, because lo and behold:
* Pretreatments before the induction of ovulation in assisted reproduction technologies: evidence-based medicine in 2007.
Ann N Y Acad Sci. 2008 Apr;1127:31-40. Review.
JG Bromer and friends publish this timely (pour moi) meta-analysis. Abstract:
Studies were limited to women treated prior to undergoing controlled ovarian hyperstimulation in IVF cycles with low-dose aspirin, metformin, growth hormone, oral contraceptives, or corticosteroid supplementation versus placebo or no supplementation.... We conclude that, currently, no clear evidence indicates that using any of these pretreatment modalities is superior to no treatment in IVF cycles.
So to recap: Some studies have shown that low-dose aspirin increases IVF success, with the hypothesized mechanism being increased blood flow to the uterus. Meanwhile, several more studies have shown that (a) aspirin does not increase blood flow to the uterus, and (b) actually aspirin doesn't improve IVF success at all. AND MIGHT KILL YOU. But whatever!
Meanwhile, of course, my doctors still recommend it. And when I say "recommend," I mean the same way they "recommend" I don't drink while trying to get knocked up.
What's a girl to do?
Go with the doctors? Or go with the evidence?
Do what she's told? Or think for herself?
Cave to the Establishment? Or be free, free like the motherfucking wind?
Yeah, you guessed right, I'm taking the aspirin. As Dr Hyde helpfully points out, "You won't die of stroke that month."
The thing is, aspirin is one of the world's oldest drugs. I know it's safe, which is a lot more than I can say for the cow hormones I'll be injecting into my ass.
And frankly, given the giant headache this is going to be, a little aspirin might be nice.
13 comments:
Best of luck. Both of ours (well, the one running crazily around, and the one jumping around inside the wife) were IVF babies. And both were successes right as we were about to give up from the stress. So, it can work.
And yeah, evidence based medicine? Not so much.
Way to analyze away your placebo effect!
My guess is the doctors assumed it won't hurt (or they are just not up to date).
And in fairness to that way of thinking, even after a lot of meta-analysis, things that seem not to pass muster with controlled trails do prove to make a substantial difference in some sub-population.
Wishing you good luck anyway!!!
I certainly don't care if no controlled trial supports the wishing of good luck :-P
Thanks both. That's great news, Nat!
Sometimes I hesitate to mention it, only because I well remember the days that my wife and I would want to run up and stab every frickin pregnant lady, out of sheer jealousy (gawds, when we were trying, it seemed like the whole damn world was out to show us how they were fertile. Bastards). But, there is always reason to hope.
FWIW, for the last attempt during the second go-round, my wife did do the accupunture. So there's your ancedotal case. Evidence schmevidence.
Fingers crossed.
we perpetuate the low-dose aspirin woo, sad to say. friend of the family- 2 baby aspirin successful pregnancies interleaved with 3 non-aspirin miscarriages. I think this particular brand of aspirin woo had to do with maintaining once implanted, not for 'ovarian stimulation'.
The decision would be harder if the medication wasn't aspirin. As it as, I agree with you that it is very unlikely to hurt your cause. Makes you have to wonder what kind of logic goes on in the heads of doctors, though. Thinking of you and hoping for the best.
My fingers are crossed!
Good luck!
Thank you all. Nat--my tally of who's gotten preggers while we've been trying reads: Dr H's sister, my brother + his wife, three women in my lab, 1 high school friend, Dr H's best friend, and probably some other people I'm forgetting. Oh, and Jenny F Scientist, who I would totally hate if she weren't so entertaining. Seriously, I dread every "good news" subject line in email.
BikeM, that's quite funny.
@candid: if you ever saw how doctors treat addict babies you'd never apply any logic to their decisions ever again.
Best of luck to you! As said before, aspirin can't hurt, and the mental angst you might have created about not taking the aspirin may well have lead to poor results.
Care to expand re: addict babies, hermitage?
Yeah, hermitage, I'm interested also. Let us know if you blog about it! (or feel free to expound here...)
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