Sharma Nidhi, Srinivasan Jayashree K, Priya Margeret Harriet, Sibiya Venkatachalam
Department of Obstetrics and Gynaecology, Saveetha Medical College, Saveetha University, Chennai, Tamil Nadu, India.
J Hum Reprod Sci. 2017 Apr-Jun;10(2):135-137. doi: 10.4103/jhrs.JHRS_30_17.
This is a rare case of gene polymorphism causing thrombophilia and recurrent implantation failure following intrauterine insemination. gene encodes plasminogen activator inhibitor type 1 and inhibits fibrinolysis, or clot dissolution. The 4G variant results in increased expression of SERPINE1 and consequently higher inhibition of fibrinolysis, thus leading to thrombophilia. The patient had unexplained primary infertility for 9 years. Ovulation induction was done with gonadotropin releasing hormone (GnRH) agonist long protocol. Recombinant follicle stimulating hormone (FSH) with step down protocol was used. Ovulation trigger was given with recombinant human chorionic gonadotrophin (HCG). Ovum pick up was done after 40 h of trigger. A total of 13 eggs were collected. Patient was put on Cabergoline to prevent ovarian hyperstimulation syndrome (OHSS). Four frozen embryos were transferred on day 14 after Laser-assisted hatching. EmbryoGlue was used to prevent implantation failure. Luteal phase support was given. She was put on enoxaparin and pregnancy has now been confirmed. The patient was on strict monitoring as this gene is also associated with preeclampsia during pregnancy.
这是一例罕见的因基因多态性导致血栓形成倾向以及宫内人工授精后反复植入失败的病例。该基因编码纤溶酶原激活物抑制剂1型,并抑制纤维蛋白溶解或血栓溶解。4G变异导致SERPINE1表达增加,进而对纤维蛋白溶解产生更高的抑制作用,从而导致血栓形成倾向。该患者有9年原因不明的原发性不孕症。采用促性腺激素释放激素(GnRH)激动剂长方案进行促排卵。使用递减方案的重组促卵泡生成素(FSH)。用重组人绒毛膜促性腺激素(HCG)触发排卵。触发排卵40小时后进行取卵。共采集到13枚卵子。患者使用卡麦角林以预防卵巢过度刺激综合征(OHSS)。在激光辅助孵化后的第14天移植了4枚冷冻胚胎。使用胚胎胶以防止植入失败。给予黄体期支持治疗。患者使用依诺肝素,现已确认怀孕。由于该基因也与妊娠期子痫前期有关,因此对该患者进行了严格监测。