Can anticoagulation (anti-coagulant) therapy improve fertility and chances of becoming pregnant?

From the Guidelines

Anticoagulation therapy should not be used as a primary treatment to improve fertility and chances of becoming pregnant, except in specific cases of diagnosed clotting disorders such as antiphospholipid syndrome or inherited thrombophilias. While anticoagulant therapy is indicated during pregnancy for the prevention and treatment of venous thromboembolism (VTE) and systemic embolism in patients with mechanical heart valves, its use in improving fertility is limited to women with antiphospholipid antibodies (APLAs) who are at risk of recurrent pregnancy loss 1. In such cases, anticoagulation therapy, in combination with aspirin, may be recommended to prevent recurrent pregnancy loss. However, the use of anticoagulation for prevention of pregnancy complications in women with hereditary thrombophilia is still a topic of debate, and there is no proven-effective therapy in women with unexplained recurrent pregnancy loss.

Some key points to consider when evaluating the use of anticoagulation therapy in improving fertility include:

• The potential benefits of anticoagulation therapy in preventing recurrent pregnancy loss in women with APLAs or inherited thrombophilias
• The risks associated with anticoagulation therapy, including bleeding complications and fetal and maternal complications
• The importance of comprehensive fertility testing to identify the actual cause of fertility issues, as most cases of infertility are not related to clotting disorders
• The need for medical supervision and personalized treatment recommendations based on individual circumstances.

In terms of specific treatment options, low-molecular-weight heparin (such as enoxaparin 40mg daily by subcutaneous injection) or low-dose aspirin (81mg daily) may be prescribed for women with diagnosed clotting disorders and recurrent pregnancy losses, typically starting before conception and continuing throughout pregnancy 1. However, these medications should never be self-prescribed, and patients should consult with a reproductive endocrinologist to determine the best course of treatment for their individual situation.

From the Research

Anticoagulation Therapy and Fertility

• The relationship between anticoagulation therapy and fertility is complex, and there is limited direct evidence on its impact on fertility and chances of becoming pregnant 2, 3, 4, 5, 6.
• However, anticoagulation therapy is often used in pregnant women with certain medical conditions, such as venous thromboembolism (VTE) or mechanical heart valves, to prevent blood clots and reduce the risk of complications during pregnancy 2, 3, 6.
• Some studies suggest that anticoagulation therapy may be associated with an increased risk of bleeding and other complications during pregnancy, which could potentially affect fertility and pregnancy outcomes 4, 5, 6.
• The use of low-molecular-weight heparin (LMWH) and other anticoagulants during pregnancy is a common practice, and guidelines recommend their use in certain situations, such as in women with a history of VTE or mechanical heart valves 2, 3, 6.

Management of Anticoagulation in Pregnant Women

• The management of anticoagulation in pregnant women with VTE or other conditions requires careful consideration of the risks and benefits of different anticoagulant therapies 2, 3, 6.
• A survey of clinicians found that there is variability in practice regarding the management of anticoagulation in pregnant women with VTE, including the duration and peripartum management of therapeutic anticoagulation 6.
• The choice of anticoagulant therapy during pregnancy depends on various factors, including the individual's medical history, the risk of bleeding and thrombosis, and the stage of pregnancy 2, 3, 4, 6.

Impact on Fertility and Pregnancy Outcomes

• While there is limited direct evidence on the impact of anticoagulation therapy on fertility and pregnancy outcomes, some studies suggest that it may be associated with an increased risk of complications during pregnancy, such as bleeding and placental abruption 4, 5, 6.
• However, anticoagulation therapy may also reduce the risk of thrombosis and other complications during pregnancy, which could potentially improve pregnancy outcomes 2, 3, 6.
• Further research is needed to fully understand the impact of anticoagulation therapy on fertility and pregnancy outcomes, and to inform clinical practice guidelines for the management of anticoagulation in pregnant women 2, 3, 4, 5, 6.