Prophylactic low‐molecular‐weight heparin in women with thrombophilia undergoing in vitro fertilization

• Published in: International journal of gynecology and obstetrics 2024-01, Vol.164 (1), p.242-248
• Main Authors: Lambert, José Roberto, Ueno, Joji, Fernandes, César Eduardo, Pompei, Luciano Melo
• Format: Article
• Language: English
• Subjects: abortion; Abortion, Spontaneous; Cross-Sectional Studies; enoxaparin; Female; female infertility; Fertilization in Vitro; Heparin, Low-Molecular-Weight - therapeutic use; Humans; in vitro fertilization; Male; Pregnancy; Pregnancy Rate; Semen; thrombophilia; Thrombophilia - complications; Thrombophilia - drug therapy
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.15005

Objective To verify whether low‐molecular‐weight heparin (LMWH) could increase pregnancy rates and/or decrease abortion rates in women with thrombophilia undergoing assisted reproduction cycles. Methods Cross‐sectional study with patients undergoing in vitro fertilization (IVF) (N = 104). Women without thrombophilia (control group, n = 20), women with thrombophilia who did not receive LMWH (untreated group, n = 30), and women with thrombophilia, treated with daily enoxaparin from the day of embryo transfer until week 36 of gestation (treated group, n = 54). All women underwent controlled ovarian hyperstimulation. IVF was performed by intracytoplasmic sperm injection, and embryos were transferred on day 3. Pregnancy was detected by β‐human chorionic gonadotropin (biochemical pregnancy) and fetal heartbeat at week 5 to 6. Ongoing pregnancy was determined by ultrasound on week 12. Results Patients in the untreated thrombophilia group presented with significantly lower ongoing pregnancy rates and live birth rates and significantly higher early pregnancy loss and abortion rates when compared with the control and the treated thrombophilia groups. Conclusions In women with diagnosed coagulation disorders, use of LMWH is important to avoid miscarriages. Synopsis Women with thrombophilia who undergo in vitro fertilization present with increased early pregnancy loss and abortion rates, which is reversed by enoxaparin treatment following embryo transfer.