Low molecular weight heparin versus low dose aspirin in improvement of pregnancy rate in patients with unexplained infertility with high uterine artery doppler indices

الملخص EN

Objective : The aim of this study was to find out the effect of using low molecular weight heparin and low dose aspirin on pregnancy rate among patients with unexplained infertility that had high uterine artery Doppler indices.

Setting : Obstetrics and Gynecology Department of Al-Azhar university hospital at Assiut.

Duration : From April 2011 to October 2012.

Methods : This study has been recruited on 200 women with unexplained infertility with high uterine artery Doppler indices (RI > 0.58, PI > 1.2 and S / D ratio > 2.6) from those attendant outpatients clinic of obstetrics and gynecology department of Al-Azhar University Hospital at Assiut.

Those patients were classified into two groups : Group I (Clexane group) : Included 100 patients received low molecular weight heparin (Clexane 20 mg per day) starting from fifth day of menstrual cycle to first day of next cycle.

Group II (Aspirin group) : Included 100 patients received Aspirin 75 mg daily starting from fifth day of menstrual cycle to first day of next cycle.

Transvaginal uterine artery color Doppler was done for all patients and only patients had high uterine artery Doppler indices included in this study.

Transvaginal folliculometry started on 10th day of cycle for all patients to assess follicular growth and endometrial thickness.

Uterine artery Doppler indices were assisted in mid luteal phase for all patients and serum progesterone on day 22 of menstrual cycle was estimated.

Serum pregnancy tests and transvaginal U / S were done for all cases with missed period to confirm pregnancy.

Results : The M ± SD of patients age, BMI and duration of infertility were 28.5 ± 4.6, 24.1 ± 3.4 and 3.4 ± 1.7 respectively in group I) and (28.2 ± 4.1, 24.5 ± 4.1 and 3.1 ± 1.7 respectively in group II) with p value > 0.05.

No statistically significant differences were found between both studied groups in either age, BMI and duration of infertility.

There were statistically significant differences between both groups after treatment with (Clexane 20 mg in group I and Aspirin 75 mg in group II) as regard to endometrial thickness, ovulation rate, serum progesterone in day 22 of cycle, uterine artery Doppler indices and pregnancy rate with p value < 0.05.

Conclusion and Recommendations : Low molecular weight heparin (Clexane 20 mg / day) had better results than low dose Aspirin (Aspirin 75mg / day) as regard to ovulation rate, endometrial thickness, serum progesterone on day 22 of cycle and pregnancy rate.

So we recommend using low molecular weight heparin in each case with unexplained infertility with stimulated and non stimulated cycles.