Heparin
Low-molecular weight heparin is used for a variety of indications, such as pulmonary embolus or deep vein thrombosis, and inherited or acquired thrombophilia (53). There are several papers that examine the use of heparin in patients who have repeated ART cycle failure to improve reproductive outcomes, however there were no papers found that examine the effect of long-term heparin therapy for comorbid medical conditions on ART outcomes.
Conclusion
Whilst prescription drug use amongst men and women of child-bearing age is common, use of individual medications is uncommon and given the ethical issues of performing randomised control trials using medications of unknown safety in pregnant women and unborn foetuses, evidence is limited to observational studies and history of previous use. Furthermore, there are some acute and or chronic medical conditions that must be treated in pregnancy to ensure overall health of the mother, father and baby. Adverse outcomes that have been reported are often rare including congenital malformations and stillbirth and therefore is difficult to determine any correlation of risk with one specific medication. As such the impact of medication exposure prior to and during ART treatments is challenging to determine. However, with more couples choosing to delay conception and hence often seek fertility treatment at an older age, couples are more likely to have comorbid medical conditions and hence be taking prescription drugs. Depression in particular is common in men and women of child-bearing age, with suicide rates rising rates amongst young men and is now the leading cause of late direct maternal death (54, 55). Couples with a history of low mood can suffer with an exacerbation of symptoms following an unexpected delay in fertility and subsequent stressful investigations and treatment. Therefore it is vitally important that we have accurate and up to date information to facilitate shared decision making in regards to continuing antidepressant treatment versus alternative non-pharmacological therapies prior to and during ART.
Health promotion through lifestyle factors including smoking cessation to target better asthma control and weight loss to reduce the rates of type II diabetes and gastric-oesophageal reflux disease may also improve patients overall health, reduce the need for prescription drug use and improve reproductive outcomes following ART.
Further research is required on prescription drug use amongst men and women and the impact on reproductive outcomes. Formal clinical guidelines are encouraged to standardise how couples are counselled and enable patients to make informed decisions about their own health and medication use during ART and throughout the pregnancy.
Disclosure of Interests
The authors declare that they have no relevant conflicts of interest, nor any interests to disclose.
Contribution to Authorship
MM and HB developed the idea for the project and designed the study. ER and AS executed the literature review and ER takes full responsibility for the papers used and references. ER drafted the manuscript with inputs and critical discussion from AS. MM and HB reviewed the manuscript once it was completed for any changes or improvements. The final version has been approved by all authors.
Details of Ethical Approval
Since this was a literature review, no specific ethical approval was required.
Funding
No specific funding was sought for this study.
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