Recurrent Implantation Failure
Implantation failure in ART is common and this is what we are facing and we lack the evidence-based therapeutic solutions for treating it. We believe in following evidence-based medicine otherwise but this is a situation that is equally frustrating to both patients and to doctors as well. Evidence is often lacking because when these studies are done in repeated IVF failure cases a lot of patients are just not willing to offer the placebo arm. They also want to do something different. This is just one of the reasons why the evidence is lacking apart from the fact that a lot of these adjuvants are fairly new but when the clinic starts offering all these adjuvant treatments.
Low molecule weight heparin along with IVF because of increased thrombotic risk when IVF stimulation is given. Due to pro-thrombotic changes of the coagulation parameters specifically related to this kind of treatment to IVF procedures. The presence of potential thrombophilic alterations can increase the risk to these women. Furthermore, the presence of thrombophilia has been suggested as a potential cause of recurrent IVF failures. Therefore, anti-thrombotic treatments have been historically planned to prevent thrombotic disorders during pharmacological ovarian stimulation. It increases live birth rates. So the whole idea behind using anticoagulants is not just to prevent venous thromboembolism but also it is assumed to prevent thrombosis in the trophoblastic invasion. Heparin has a positive effect on conception and early pregnancy events. This is what has been postulated. It has also been shown in a few studies not just because of its ability to alter the hemostatic response to ovarian stimulation and decrease the risk of thrombosis.
The existing studies are very heterogeneous including different regimens. Even different routes of administration, intrauterine and subcutaneous and so their interpretation should be carried out with caution. Growth hormone is a requisite of normal puberty, it has a role in the ovarian function it has been proposed to have a modulatory effect on the effect of FSH on granulosa cells by up-regulating the local synthesis of IGF-1. It is thought to enhance the effect of gonadotropin action at the level of both the granulosa and the theca cells.
So low molecular weight heparin actually has a much larger safety profile as compared to unfractionated heparin and it actually does not need monitoring but still, to be on the safe side you can get your patient's coagulation profile done before and during the low molecular weight heparin therapy that is going on.
You can find out more details by enrolling in Recurrent Implantation Failure lecture by Dr. Sulbha Arora MD, DNB, Fellowship in Assisted Reproducive Techniques (Israel) & Dr. Shrutika Thakkar (Director, MedAnsh Multispeciality hospital & Medansh IVF), here, https://docmode.org/recurrent-implantation-failure-dr-sulbha-arora-dr-shrutika-thakkar/
