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

PLoS One. 2019 May 23;14(5):e0216724. doi: 10.1371/journal.pone.0216724. eCollection 2019.

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.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Coagulation Disorders / blood
  • Blood Coagulation Disorders / complications
  • Blood Coagulation Tests
  • Blood Coagulation*
  • Cohort Studies
  • Embryo Transfer
  • Female
  • Fertilization in Vitro*
  • Humans
  • Infertility, Female / blood*
  • Infertility, Female / complications
  • Infertility, Female / therapy*
  • Pregnancy
  • Pregnancy Rate
  • Prospective Studies
  • Risk Factors

Grants and funding

This work was supported by grant from Russian Science Foundation (17-74-10-224) to ANB; Thrombodynamics analyzing (Figures 4 and 5 E, F, G) was supported by grant from Russian Science Foundation (17-74-10193) to AMS (http://rscf.ru/). The study was supported by the Ministry of Science and Higher Education of the Russian Federation (project АААА-А18118012390250-0). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Altra Vita IVF clinic provided support in the form of salaries for authors TAT, AGY, IVZ, SAY, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.