الفهرس 
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Abstract
Summary
Unexplained infertility is defined as failure to conceive after one year in couples with normal semen samples and no abnormality found during an infertility workup (Harrison and Taylor,
The principal treatments for unexplained infertility include: expectant management, clomiphine citrate, intrauterine insemination alone or with controlled ovarian stimulation and IVF (Pandian et al.,
However, according to the National Institute for Health and Care Excellence (NICE) guidelines, IVF is the recommended treatment to women with unexplained infertility who have not conceived after 2 years of regular unprotected sexual intercourse (NICE,
In light of the possible effects of heparins and heparin binding molecules on the blastocyst implantation and placentation, we conducted this study in order to assess the efficacy of LMWH in improving the pregnancy rates in women with unexplained infertility and negative immunological markers undergoing ICSI.
A randomized controlled trial was carried out on 680 women undergoing ICSI with negative immunological markers, 340 of which were randomly allocated to the group that receives LMWH after ovum pick-up and continues to receive it until documentation of fetal life by ultrasound at 7 weeks of gestation and 340 women were allocated to the group that receives placebo.
Summary and Conclusion
The patients were followed up for live birth rate as a primary outcome, clinical pregnancy and biochemical pregnancy rates as secondary outcomes.
Multiples adverse outcomes were also monitored, including the miscarriages, ectopic pregnancy, occurrence of preeclampsia, intrauterine growth restriction, placental abruption, preterm labor, intrauterine fetal demise and perinatal death rates.
According to our study there was no statistical difference between both groups as regards demographical pattern i.e. age and BMI.
There was no statistical difference as regards the cycle characteristics i.e. duration of induction, number of ampoules of gonadotrophin used, progesterone/estradiol ratio on the day of HCG injection, number of MII oocytes retrieved, fertilization rate and number of embryos transferred between both groups.
In the LMWH group, there was a higher biochemical pregnancy rate, clinical pregnancy rate and live birth rate than the placebo group however there was no statistical significance between the two groups. (p= 0.112, 0.201 and 0.371 respectively)
The LMWH group also showed significantly lower rates of preterm labor (p=0.033)
There was no statistical significance in the rates of miscarriage and ectopic pregnancy between the two groups. (p=0.617 and 0.912)
Summary and Conclusion
As regards the occurrence of preeclampsia, IUGR and placental abruption, these adverse outcomes were statistically insignificant among the two groups.
There was no statistical significance between the two groups as regards intrauterine fetal demise and perinatal death rate.
The results of this study do not advocate the routine use of LMWH as an adjunct in patients undergoing ICSI with negative immunological marker