The rationale of the administration of low-molecular-weight heparin in patients with repeated implantation failure

Abstract

Ponavljani implantacijski neuspjeh (RIF) definira se kao nemogućnost postizanja trudnoće nakon 3 uzastopna IVF postupka s transferom najmanje 4 visoko kvalitetna embrija. Uzroci RIF-a mogu biti od strane majke i od strane embrija. Jedan od češćih uzroka RIF-a je nasljedna trombofilija. U velikom broju slučajeva uzrok je još uvijek nepoznat. Niskomolekularni heparin se koristi kao rutinska terapija kod bolesnica s nasljednom trombofilijom zbog njegovog antikoagulacijskog učinka. Mnoga istraživanja utvrdila su njegov učinak u procesu implantacije. Cilj ovog istraživanja bio je prikazati opravdanost primjene LMWH kod bolesnica s problemima sa začećem ili iznošenjem trudnoće, hospitaliziranih na Klinici za ženske bolesti i porođaje KBC-a Zagreb od 2013. do 2017. godine s naglaskom na bolesnice s ponavljanim implantacijskim neuspjesima. Primjena LMWH u najvećem je broju slučajeva bila povezana s pozitivnim ishodom trudnoće, odnosno porođajem zdravog novorođenčeta u terminu. Nije bilo značajnih razlika između bolesnica koje su prolazile postupak potpomognute oplodnje i bolesnica koje su zanijele spontanim putem. Pitanje opravdanosti primjene LMWH kod bolesnica s ponavljanim implantacijskih neuspjesima zahtjeva daljnju obradu s obzirom na oprečne rezultate različitih studija.Reccurent implantation failure (RIF) is defined as inability to achieve pregnancy after 3 consecutive IVFs with at least 4 high-quality embryo transfer. RIF can be due to mother causes and embryo causes. One of the most common causes of RIF is inherited thrombophilia. In a large number of cases the cause is still unknown. Low-molecular-weight heparin (LMWH) is used as a routine therapy in patients with hereditary thrombophilia due to its anticoagulant effect. Many studies have determined its effect on the implantation process. The aim of this study was to show the rationale of the use of LMWH in patients with inability to conceive or to carry to term who were hospitalized at the Department of Women's Diseases and Births of UHC Zagreb from 2013 to 2017 with emphasis on patients with reccurent implantation failure. The use of LMWH in most cases was associated with a positive pregnancy outcome. There were no significant differences between the patients who underwent the process of IVF and the patients who concieved spontaneously. The question of the rationale of the administration of LMWH in patients with reccurent implantation failure requires further research due to the contradictory results of different studies