Aspirin dilemma. Remodelling the hypothesis from a fertility perspective

Many clinical trials in obstetrics have failed to demonstrate improved outcomes with low-dose aspirin. This is not entirely surprising as prescribing aspirin for compromised tissue perfusion without insight into underlying pathology inevitably leads to suboptimal outcomes. We argue that a mismatch between the aspirin dose and the underlying pathology of altered tissue perfusion is the key factor to this failure. Based on this groundwork, we address the question of how best to optimize the dose of aspirin for use in fertility management, by providing examples from the assisted conception and recurrent miscarriage settings.