Drugs used to aid in-vitro pregnancies may have led to death

May 14, 1998
Web posted at: 8:03 p.m. EDT (0003 GMT)

ATLANTA (CNN) -- A drug combination increasingly used to help prevent miscarriages in women undergoing in-vitro fertilization may have led to the death of a pregnant woman in 1996, the federal Centers for Disease Control and Prevention announced Thursday.

The 38-year-old woman was taking a combination of aspirin and heparin, a blood thinner, when she suffered a fatal cerebral hemorrhage. At the time, she was nine weeks pregnant with triplets conceived through in-vitro fertilization.

It was later determined that the woman had a congenital malformation in her brain. While the CDC stopped short of directly attributing the woman's death to the combination of the drugs and the malformation, the agency is now questioning whether the benefits of the drug combination outweigh the risks for some women.

"Our main emphasis is to put up a yellow flag to physicians and scientists and patients," said Dr. Fred Hopkins, a CDC epidemiologist. "People are really excited about this [treatment], they're pressuring physicians to get more information about it, when there's really not much scientific evidence of its benefits."

Researchers and doctors have found that the use of aspirin and heparin can prevent the risk of miscarriage early in an in-vitro pregnancy, in which a woman's eggs are fertilized in a laboratory and transferred into her uterus. The drugs counteract blood clotting caused by antibodies in some women that can induce miscarriages.

Heparin is a blood thinner commonly given to patients after surgery to prevent blood clots. Aspirin inhibits the body's formation of platelets, which also play a major rule in clotting.

"This is a common and very effective therapy for women who have suffered repeat, spontaneous miscarriages," said Dr. Andrew Toledo of Reproductive Biology Associates, a fertility clinic in Atlanta. "We've never seen a serious problem with this treatment, and any woman on this therapy should be monitored closely for potential complications."

However, the Food and Drug Administration has never approved the use of the drug combination to aid in-vitro fertilization, and the CDC says the data on the risks and benefits of the treatment are limited.

Dr. Benjamin Younger, executive director of the American Society for Reproductive Medicine, agrees there is little evidence to show that the drugs help women who haven't had multiple miscarriages.

But he said many patients might be willing to take the drugs anyway, especially if their insurance doesn't cover in-vitro fertilization and they only have enough money for one try.

"Under that arrangement, people make choices that perhaps they wouldn't make otherwise -- 'Doc, do anything you can to give me the best chance of getting pregnant,'" Younger said.

Correspondent Rhonda Rowland andReuters contributed to this report.

Related sites:

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• American Society for Reproductive Medicine
• Centers for Disease Control and Prevention Home Page

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