Kamel Ahmed Mohamed, El-Faissal Yahia, Aboulghar Mona, Mansour Ragaa, Serour Gamal I, Aboulghar Mohamed
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.; Egyptian IVF and ET Center, Cairo, Egypt.
Egyptian IVF and ET Center, Cairo, Egypt.
Clin Exp Reprod Med. 2016 Dec;43(4):247-252. doi: 10.5653/cerm.2016.43.4.247. Epub 2016 Dec 26.
Heparin can modulate proteins, and influence processes involved in implantation and trophoblastic development. This study aimed to assess the improvement of clinical pregnancy and implantation rates after local intrauterine injection of low-molecular-weight heparin (LMWH) in patients undergoing intracytoplasmic sperm injection (ICSI).
A randomised case/control design was followed in women scheduled for ICSI. The study arm was injected with intrauterine LMWH during mock embryo transfer immediately following the ovum pickup procedure, while the control arm was given an intrauterine injection with a similar volume of tissue culture media. Side effects, the clinical pregnancy rate, and the implantation rate were recorded.
The pregnancy rate was acceptable (33.9%) in the LMWH arm with no significant reported side effects, confirming the safety of the intervention. No statistically significant differences were found in the clinical pregnancy and implantation rates between both groups (=0.182 and =0.096, respectively). The odds ratio of being pregnant after intrauterine injection with LMWH compared to the control group was 0.572 (95% confidence interval [CI], 0.27-1.22), while the risk ratio was 0.717 (95% CI, 0.46-1.13; =0.146). No statistical significance was found between the two groups in other factors affecting implantation, such as day of transfer (=0.726), number of embryos transferred (=0.362), or embryo quality.
Intrauterine injection of LMWH is a safe intervention, but the dose used in this study failed to improve the outcome of ICSI. Based on its safety, further research involving modification of the dosage and/or the timing of administration could result in improved ICSI success rates.
肝素可调节蛋白质，并影响着床和滋养层发育过程。本研究旨在评估在接受卵胞浆内单精子注射（ICSI）的患者中，局部宫腔注射低分子量肝素（LMWH）后临床妊娠率和着床率的改善情况。
对计划接受ICSI的女性采用随机病例/对照设计。研究组在取卵手术后立即进行模拟胚胎移植时宫腔注射LMWH，而对照组则宫腔注射相同体积的组织培养液。记录副作用、临床妊娠率和着床率。
LMWH组的妊娠率为33.9%，可接受，且未报告明显副作用，证实了该干预措施的安全性。两组之间的临床妊娠率和着床率无统计学显著差异（分别为P = 0.182和P = 0.096）。与对照组相比，宫腔注射LMWH后的妊娠优势比为0.572（95%置信区间[CI]，0.27 - 1.22），而风险比为0.717（95%CI，0.46 - 1.13；P = 0.146）。在影响着床的其他因素方面，如移植日（P = 0.726）、移植胚胎数（P = 0.362）或胚胎质量，两组之间无统计学显著差异。
宫腔注射LMWH是一种安全的干预措施，但本研究中使用的剂量未能改善ICSI的结局。基于其安全性，进一步研究调整剂量和/或给药时间可能会提高ICSI成功率。
