title: Does intrauterine injection of low-molecular-weight heparin improve the clinical pregnancy rate in intracytoplasmic sperm injection?
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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 (p=0.182 andp=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;p=0.146). No statistical significance was found between the two groups in other factors affecting implantation, such as day of transfer (p=0.726), number of embryos transferred (p=0.362), or embryo quality.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.; Egyptian IVF and ET Center, Cairo, Egypt.
authors.forename: Ahmed Mohamed
authors.initials: AM
authors.lastname: Kamel
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.; Egyptian IVF and ET Center, Cairo, Egypt.
authors.forename: Yahia
authors.initials: Y
authors.lastname: El-Faissal
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.; Egyptian IVF and ET Center, Cairo, Egypt.
authors.forename: Mona
authors.initials: M
authors.lastname: Aboulghar
authors.affiliation: Egyptian IVF and ET Center, Cairo, Egypt.
authors.forename: Ragaa
authors.initials: R
authors.lastname: Mansour
authors.affiliation: Egyptian IVF and ET Center, Cairo, Egypt.; Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University, Cairo, Egypt.
authors.forename: Gamal I
authors.initials: GI
authors.lastname: Serour
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.; Egyptian IVF and ET Center, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Aboulghar
keywords: Embryo transfer; Intracytoplasmic sperm injection; Low-molecular-weight heparin