Administration of low-molecular-weight heparin in patients with two or more unsuccessful IVF/ICSI cycles: a multicenter cohort study

Abstract

To compare the effects of the administration of low-molecular-weight heparin (LMWH) in subfertile patients with two or more unsuccessful IVF/ICSI cycles. In this six-center two-arm retrospective cohort study, the study population (230 women) underwent a GnRH-antagonist protocol and was classified into two groups, according to the couse of LMWH or not. Groups were compared regarding the clinical and IVF/ICSI cycle characteristics and reproductive outcomes, whereas clinical pregnancy and miscarriage constituted the primary endpoints. Logistic regression analysis was performed to determine the potential predictors of clinical pregnancy, miscarriage and live birth rates using the Enter method. Baseline characteristics were comparable in the two groups. There was no statistically significant difference between the two study groups with regard neither to clinical pregnancy and miscarriage rates (33/133 vs. 20/97, p = .456 and 15/133 vs. 9/97, p = .624, respectively), nor to the secondary outcomes preset for this study (all p values >.05). Logistic regression revealed that age of the woman and ICSI and dose of gonadotrophins used were predictors of clinical pregnancy and live birth, respectively. In conclusion, there is no evidence to support the standard addition of LMWH in patients with two or more unsuccessful IVF/ICSI cycles.

Chinese abstract

比较两次及以上IVF/ICSI周期失败的生育力低下患者给予低分子量肝素（LMWH）的效果。在这项六个中心双臂回顾性队列研究中, 研究对象（230名女性）接受了GnRH拮抗剂方案, 并分成两组, 根据是否应用LMWH。比较各组临床和IVF/ICSI周期特征, 以临床妊娠和流产为主要终点。采用“进入”的方法进行逻辑回归分析以确定临床妊娠率、流产率和活产率的潜在预测因子。两组基线特征相当。两组间临床妊娠率和流产率无显著统计学差异（分别为33/133 vs. 20/97, p=.456和 15/133 vs. 9/97, p=.624）, 本研究的次要结局也无统计学差异（所有p>.05)。逻辑回归显示女性年龄和ICSI、促性腺激素剂量分别是临床妊娠和活产的预测因子。因此, 对于两次及以上IVF/ICSI周期失败的患者标准化添加LMWH尚无证据支持。

Keywords:

• Assisted reproductive techniques
• low-molecular-weight heparin
• implantation failure
• repeated implantation failure
• pregnancy rates

Acknowledgements

The authors wish to thank the clinical, paramedical and laboratory teams of the Assisted Reproduction Units of the University Centers (especially medical staff), George Anifandi, embryologist from the Assisted Reproduction Unit, Department of Obstetrics and Gynecology, University of Thessaly, and Vasilio Pergialioti, academic fellow from the Third Department of Obstetrics and Gynecology, ‘Attikon Hospital’, Medical School, National and Kapodistrian University of Athens for the data analysis and interpretation. There was no funding for the current work.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.