Effect of heparin on the outcome of IVF treatment: a systematic review and meta-analysis.
The effect of heparin on IVF outcome has been widely debated in the literature. A systematic review and meta-analysis of the published literature was conducted to evaluate the effect of heparin treatment on IVF outcome. Searches were conducted on MEDLINE, EMBASE, Cochrane Library and Web of Science and identified 10 relevant studies (five observational and five randomized) comprising 1217 and 732 IVF cycles, respectively. The randomized studies included small numbers of women and exhibited high methodological heterogeneity. Meta-analysis of the randomized studies showed no difference in the clinical pregnancy rate (RR 1.23, 95% CI 0.97-1.57), live birth rate (RR 1.27, 95% CI 0.89-1.81) implantation rate (RR 1.39, 95% CI 0.96-2.01) and miscarriage rate (RR 0.77, 95% CI 0.24-2.42) in women receiving heparin compared with placebo during IVF treatment. However, meta-analysis of the observational studies showed a significant increase in the clinical pregnancy rate (RR 1.83, 95% CI 1.04-3.23, P=0.04) and live birth rate (RR 2.64, 95% CI 1.84-3.80, P<0.0001). The role of heparin as an adjuvant therapy during IVF treatment requires further evaluation in adequately powered high-quality randomized studies. The effect of heparin on IVF outcome is widely debated. Despite the results of published studies being conflicting, it has been suggested that the use of heparin results in increased pregnancy rates following IVF treatment. We conducted a systematic and comprehensive of the published literature to evaluate the effect of heparin treatment on IVF outcome. Searches were conducted on MEDLINE, EMBASE, Cochrane Library and Web of Science. We identified 10 studies from the literature and extracted the relevant data from the studies. Analyses of the data from randomized trials showed no improvement in the clinical pregnancy rate or the live birth rate in the group that received heparin. However, the studies included had small numbers of women and high methodological heterogeneity. The role of heparin in this context requires further evaluation in adequately powered randomized studies.
Assisted Conception Unit, Guys Hospital, London, United Kingdom. v9dya@hotmail.com
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S
Seshadri
S K
SK
Sunkara
Y
Y
Khalaf
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T
El-Toukhy
H
H
Hamoda
D000925:Anticoagulants / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D010064:Embryo Implantation / Q000187:drug effects; D019317:Evidence-Based Medicine; D005260:Female; D005307:Fertilization in Vitro; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007247:Infertility, Female / Q000188:drug therapy* / Q000276:immunology / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate
D000925:Anticoagulants; D007155:Immunologic Factors; D006493:Heparin