Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia.
Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia.
PLoS One. 2019 May 23;14(5):e0216724. doi: 10.1371/journal.pone.0216724. eCollection 2019.
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.
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.
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.
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.
体外受精（IVF）过程中的高凝状态可导致胚胎着床和胎盘血液循环受损，这被认为是 IVF 周期失败的一个因素。
评估 IVF 周期前和治疗期间不孕妇女的凝血情况，以揭示凝血失衡与 IVF 结局之间的关系。
患者/方法：我们进行了一项前瞻性队列观察性研究，纳入了 125 名接受新鲜 IVF 周期的患者。在五个时间点采集血样：IVF 前、控制性卵巢刺激（COS）开始后一周、卵泡穿刺日、胚胎移植（ET）日和 ET 后一周。进行凝血试验（凝血时间：活化部分凝血活酶时间（APTT）和凝血酶原；纤维蛋白原和 D-二聚体浓度；血栓动力）。
IVF 前凝血生长速度升高（通过血栓动力检测>32.3μm/min）的女性发生 IVF 结局不良的风险更高（调整后的 RR=1.38；95%CI 1.28-1.49；P<0.001）。在治疗过程中，我们观察到凝血酶原、纤维蛋白原和 D-二聚体浓度增加，APTT 略有缩短，血栓动力参数呈高凝状态改变。COS 期间和 ET 后止血测定值与 IVF 结局无相关性。
IVF 治疗前血栓动力的高凝状态与 IVF 结局不良相关。COS 开始后，所有试验均显示出高凝趋势，但高凝状态并未影响 IVF 结局。这项研究对于应用血栓动力检测来监测不孕妇女 IVF 前的止血情况具有潜在的益处，以期选择需要止血纠正的患者群体，以增加妊娠机会。
