An enhanced clot growth rate before in vitro fertilization decreases the probability of pregnancy

Abstract

Background The shift towards hypercoagulation during in vitro fertilization (IVF) can lead to the impairment of embryo implantation and placental blood circulation, which is believed to be a factor in an unsuccessful IVF cycle. Objectives To assess coagulation in women with infertility before the start of an IVF cycle and during treatment to reveal the association between coagulation imbalance and IVF outcome. Patients/Methods We conducted a prospective cohort observational study including 125 participants who underwent fresh IVF cycles. Blood samples were collected at five time points: before IVF, one week after the start of controlled ovarian stimulation (COS), on the day of follicular puncture, on the day of embryo transfer (ET) and one week after ET. Coagulation tests (clotting times: activated partial thromboplastin time (APTT) and prothrombin; fibrinogen and D-dimer concentrations; thrombodynamics) were performed. Results Women with an elevated clot growth velocity (>32.3 μm/min, detected by thrombodynamics) before IVF demonstrated a higher risk of negative IVF outcomes (adjusted RR = 1.38; 95% CI 1.28–1.49; P<0.001). During the procedure, we observed increases in prothrombin, fibrinogen and D-dimer concentrations, a slight shortening of APTT and a hypercoagulation shift in the thrombodynamics parameters. The hemostasis assay values during COS and after ET had no associations with IVF outcomes. Conclusions Hypercoagulation in the thrombodynamics before the start of IVF treatment was associated with negative IVF outcomes. After the start of COS, all tests demonstrated a hypercoagulation trend, but the hypercoagulation did not influence IVF outcome. This research is potentially beneficial for the application of thrombodynamics assay for monitoring hemostasis in infertile women prior to an IVF procedure with the goal of selecting a group requiring hemostasis correction to increase the chances of pregnancy.

Hypercoagulation detected by routine and global laboratory hemostasis assays in patients with infective endocarditis

“…Thrombodynamics assay was performed with a thrombodynamics analyzer and kit (HemaCore LLC, Moscow, Russia) in platelet-free plasma (PFP), obtained by serial centrifugation at 1600g for 15 min and at 10,000g for 5 min. This method is based on registering spatial fibrin clot growth after activation of clotting in a thin layer of plasma after contact with an immobilized tissue factor-bearing surface [ 16 , 18 , 21 , 24 , 28 – 32 ]. The process of clot growth was registered by serial photography during the test.…”

Use of Thrombodynamics for revealing the participation of platelet, erythrocyte, endothelial, and monocyte microparticles in coagulation activation and propagation

“…Thrombodynamics test turned to be sensitive to presence of active factors VIIa, IXa, XIa [35,36], microparticles [21,36], unfractionated heparin and enoxaparin [37] in plasma, impaired coagulation in hemophilia [38], hypercoagulation in patients with sepsis [39], malignant tumors [40], multiple myeloma [41]. The assay was shown to be useful for monitoring heparin efficiency [37,42], predicting negative in vitro fertilization caused by hypercoagulation [43]. A total of 107 μl of MP-poor plasma was supplemented with 13 μl of MPs in different concentrations or buffer A.…”

Cardiovascular problems associated with IVF therapy

“…Patient‐specific risk factors for VTE in a spontaneous pregnancy are the well‐recognized obesity, smoking, thrombophilia, lack of mobility and inflammatory disorders. The boost of oestrogen during the ovarian stimulation phase is as shown in Table 1 coupled with an increase of procoagulant factors, a decrease of anticoagulant factors such as antithrombin III, Protein S and Protein C and acquired activated protein C resistance [63‐68]. In addition to this, fibrinolysis is decreased.…”