Division of Medicine, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
Thromb Res. 2012 Oct;130(4):649-53. doi: 10.1016/j.thromres.2011.11.024. Epub 2011 Dec 7.
Controlled ovarian hyperstimulation during in vitro fertilization (IVF) causes profound increments in serum estradiol which may influence haemostasis and the ovarian hyperstimulation syndrome. In the present study we investigated the effect of the standard IVF-stimulation protocol on coagulation and fibrinolysis as assessed by different global haemostatic assays.
Blood samples were drawn from 31 women during the down-regulation phase when estradiol secretion is inhibited, and before egg retrieval, i.e. when estradiol levels are at supraphysiological levels, in the following called high level stimulation phase. Haemostasis was assessed during both treatment phases with 1) the calibrated automated thrombogram which measures thrombin generation, 2) overall haemostasis potential which measures fibrin formation and degradation and 3) fibrin gel permeability measurements which measures the quality of the fibrin network.
Estradiol increased from <150pg/mL to 5889pg/mL (range 1620-19500pg/mL). We found both increased thrombin generation as measured by the calibrated automated thrombogram (p<0.001) and an increase in overall haemostasis potential (p<0.001) from time of down-regulation to high level stimulation.
The assays used indicated procoagulable changes in haemostasis during in vitro fertilization. Further studies should evaluate their potential in the prediction of thrombosis and hyperstimulation.
体外受精（IVF）过程中的控制性卵巢刺激会导致血清雌二醇水平显著升高，这可能会影响止血和卵巢过度刺激综合征。在本研究中，我们通过不同的整体止血检测评估了标准 IVF 刺激方案对凝血和纤溶的影响。
在下调阶段（即雌二醇分泌被抑制时）和取卵前（即雌二醇水平处于超生理水平时），从 31 名女性中抽取血液样本。在这两个治疗阶段，使用 1）校准的自动化血栓图来测量凝血酶生成，2）整体止血潜能来测量纤维蛋白形成和降解，以及 3）纤维蛋白凝胶通透性测量来测量纤维蛋白网络的质量来评估止血。
雌二醇从<150pg/mL 增加到 5889pg/mL（范围 1620-19500pg/mL）。我们发现，从下调到高水平刺激的时间，校准的自动化血栓图测量的凝血酶生成增加（p<0.001）和整体止血潜能增加（p<0.001）。
使用的检测方法表明体外受精过程中止血存在促凝变化。进一步的研究应该评估它们在血栓形成和过度刺激预测中的潜力。
