Romagnuolo Ilaria, Sticchi Elena, Fedi Sandra, Cellai Anna P, Lami Donatella, Alessandrello Liotta Agatina, Rogolino Angela, Cioni Gabriele, Noci Ivo, Abbate Rosanna, Fatini Cinzia
aDepartment of Clinical and Experimental Medicine, Thrombosis Center, University of Florence, Azienda Ospedaliero-Universitaria Careggi bFiorgen Foundation cDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Blood Coagul Fibrinolysis. 2014 Apr;25(3):254-8. doi: 10.1097/MBC.0000000000000044.
Increased serum estradiol levels occurred during ovarian stimulation for assisted reproduction. Tissue factor pathway inhibitor (TFPI) plays a relevant role in regulating haemostatic equilibrium, and its decrease has been documented in conditions in which blood coagulation occurs. We investigated TFPI concentrations and coagulative pathway in healthy infertile women undergoing ovarian stimulation. We investigated 27 healthy infertile women, median age 37 (25-41) years, undergoing ovarian stimulation, observed during the mid-luteal phase of cycle (T0) and on day 5 (T1), and between day 7 and 9 (T2) of ovarian stimulation. Coagulative pathway was assessed by a global test [endogenous thrombin potential, (ETP)] and TFPI concentrations. TFPI values progressively and significantly decreased throughout the ovarian stimulation procedure (P = 0.03), contemporarily estradiol levels progressively and significantly increased from baseline to T2 (P < 0.0001). A significant negative correlation between changes in estradiol and TFPI levels was observed (P = 0.03). As concerns ETP parameters a significant increase of ETP (mA) and Cmax (mA/min) throughout the ovarian stimulation cycle was found (P = 0.003 and P = 0.002, respectively). TFPI values progressively and significantly decreased throughout the ovarian stimulation, and negatively correlated with estradiol, thus suggesting that TFPI may represent one of the main 'actors' involved in the hypercoagulable status, occurring during assisted reproduction. The relationship between TFPI and estradiol levels might contribute to the knowledge of mechanisms able to modify a quite milieu into a prothrombotic status. Nevertheless, the small number of individuals investigated might influence the relevance of our results.
在辅助生殖的卵巢刺激过程中，血清雌二醇水平会升高。组织因子途径抑制剂（TFPI）在调节止血平衡中发挥着相关作用，并且在发生血液凝固的情况下其水平会降低。我们研究了接受卵巢刺激的健康不孕女性的TFPI浓度和凝血途径。我们调查了27名年龄中位数为37（25 - 41）岁、正在接受卵巢刺激的健康不孕女性，在月经周期的黄体中期（T0）、第5天（T1）以及卵巢刺激的第7至9天（T2）进行观察。通过一项整体测试[内源性凝血酶潜力，（ETP）]和TFPI浓度来评估凝血途径。在整个卵巢刺激过程中，TFPI值逐渐且显著降低（P = 0.03），同时雌二醇水平从基线到T2逐渐且显著升高（P < 0.0001）。观察到雌二醇变化与TFPI水平之间存在显著的负相关（P = 0.03）。关于ETP参数，发现在整个卵巢刺激周期中ETP（mA）和Cmax（mA/min）显著增加（分别为P = 0.003和P = 0.002）。在整个卵巢刺激过程中，TFPI值逐渐且显著降低，并且与雌二醇呈负相关，这表明TFPI可能是辅助生殖过程中发生的高凝状态所涉及的主要“因素”之一。TFPI与雌二醇水平之间的关系可能有助于了解能够将相当的内环境转变为血栓前状态的机制。然而，所研究的个体数量较少可能会影响我们结果的相关性。
