FROZEN EMBRYO TRANSFER AND ANTICOAGULANT IMPROVE IN VITRO FERTILISATION OUTCOMES IN ENDOMETRIOSIS WITH RECURRENT PREGNANCY LOSS – ORIGINAL RESEARCH

Problem Statement
Recurrent pregnancy loss (RPL) is closely linked with infertility. Endometriosis induces a low-grade chronic inflammatory environment and adversely affects endometrial receptivity, embryo implantation and subsequent growth and development. Anticoagulants, such as low molecular weight heparin (LMWH) and salicylic acid is suggested to alleviate the inflammation and improve in vitro fertilisation (IVF) success rates among patients with endometriosis suffering from RPL. However, results have been inconclusive. We investigated if anticoagulants were beneficial for Indonesian IVF patients with endometriosis.
Methods
We performed an audit at two tertiary fertility centres in West Java, Indonesia. Total sampling was employed from 01/01/2017 to 31/10/2022. We included patients with endometriosis and RPL as defined by ESHRE receiving anticoagulants during their IVF cycles. Anticoagulants were LMWH, salicylic acid or both and their choice depended on the consultant’s assessment. Excluded were those with incomplete data, those undergoing frozen embryo transfer outside the study period, and those halting their programs for various reasons. Biochemical pregnancy rate was the primary outcome with positive pregnancy being beta-hCG level above 5 mIU/mL. Statistical analysis incorporated t-test and Mann-Whitney U test for scale variables and Chi-square for nominal and ordinal variables.
Results
86 patients were included, 22 of which receiving anticoagulant(s) and 64 did not. Age was not significantly different among the two groups (32 vs. 33, p: 0.377) and among those who got pregnant or not (33 vs. 32, p: 0.287). The use of anticoagulant was not associated with a higher likelihood of becoming pregnant (OR 1.706, 95% CI 0.635 - 4.584). In subgroup analysis, with fresh embryo transfer, the use of anticoagulant was also not associated with a significantly higher likelihood of getting pregnant (35.3% vs. 62.1% OR 0.333, 95% 0.096 - 1.159; p 0.126). However, with frozen embryo transfer, the use of anticoagulant was associated with a significantly higher likelihood of getting pregnant (80% vs. 9.4%, OR 38.667 95% CI 3.196 - 467.745, p <0.001)
Conclusion
Frozen embryo transfer significantly improves biochemical pregnancy rate amongst endometriosis patients with recurrent pregnancy loss treated with anticoagulants.