Humanitas Research Hospital, Cardiovascular Department, Thrombosis and Haemorragic Diseases Center, Rozzano, Milan, Italy.
Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy.
Thromb Res. 2017 Nov;159:116-121. doi: 10.1016/j.thromres.2017.08.006. Epub 2017 Aug 15.
In-vitro and in-vivo models suggest the influence of low-molecular weight heparin on conception in infertile women undergoing in vitro fertilization procedures (IVF). In this randomized controlled trial we assessed whether a low-molecular weight heparin (parnaparin) could affect IVF outcomes.
271cycles were analyzed in 247 women having a first or subsequent IVF cycle at Fertility Center of Humanitas Research Hospital. Patients, without severe thrombophilia and hormonal or active untreated autoimmune disorders, were randomly allocated (1:1) to receive for the whole cycle parnaparin, or routine hormonal therapy only. The primary endpoint was the clinical pregnancy rate and the secondary endpoints included implantation rate and live birth rate.
The clinical pregnancy and the live birth rate were similar in treated and controls (21.5% vs. 26.7%, p=0.389; 18.5% vs. 20.6%, p=0.757). The abortion rate was 10.3% vs 22.9%, p=0.319, respectively. The subgroups analysis, ≤35, 36-38, 39-40years, showed the following: comparable clinical pregnancy rate (22.5% vs 38.8%, p=0.124; 21.8% vs 17.3%, p=0.631; 19.4% vs 23.3%, p=0.762 respectively) and live birth rate (16.3% vs 32.7%, p=0.099; 20.0% vs 13.5%, p=0.443; 19.4% vs 13.3%, p=0.731 respectively) in treated vs controls. Sensitivity analyses on women with ≥3 previous attempts and first enrolment only, and subgroup analyses according to trial conclusion conditioning a small sample size with low statistical power.
Our study excludes positive effect of parnaparin, once a day for the whole cycle, on clinical pregnancy rate in infertile women undergoing in vitro fertilization techniques.
体外和体内模型表明,低分子量肝素对接受体外受精(IVF)程序的不孕妇女的受孕有影响。在这项随机对照试验中,我们评估了低分子量肝素(那屈肝素)是否会影响 IVF 结局。
在 Humanitas 研究医院生育中心进行首次或后续 IVF 周期的 247 名女性中分析了 271 个周期。患者无严重血栓形成倾向且无激素或活动未治疗的自身免疫性疾病,随机分配(1:1)接受整个周期那屈肝素或仅常规激素治疗。主要终点是临床妊娠率,次要终点包括着床率和活产率。
治疗组和对照组的临床妊娠率和活产率相似(21.5% vs. 26.7%,p=0.389;18.5% vs. 20.6%,p=0.757)。流产率分别为 10.3%和 22.9%,p=0.319。亚组分析,≤35 岁、36-38 岁、39-40 岁,结果如下:临床妊娠率相当(22.5% vs 38.8%,p=0.124;21.8% vs 17.3%,p=0.631;19.4% vs 23.3%,p=0.762)和活产率(16.3% vs 32.7%,p=0.099;20.0% vs 13.5%,p=0.443;19.4% vs 13.3%,p=0.731)在治疗组和对照组之间。敏感性分析包括≥3 次既往尝试和仅首次入组的女性,以及根据试验结论进行的亚组分析,由于样本量小,统计效能低。
我们的研究排除了低分子量肝素(那屈肝素)每天一次治疗整个周期对接受体外受精技术的不孕妇女临床妊娠率的积极影响。