Thrombosis risk and in vitro fertilization
https://doi.org/10.17749/2313-7347/ob.gyn.rep.2022.286
Abstract
Assisted reproductive technologies (ART) have been progressively recognized as a widely applied means to fight against infertility. Women after ART were shown to have higher risk of developing venous thromboembolism (VTE) that might be related to using some drugs, particularly gonadotropins. VTE risk emerges at relatively early time points after ovulation induction being sustained virtually until pregnancy is complete. According to the multi-center RIETE Registry (Spanish, Registro Informatizado de la Enfermedad TromboEmbolica), a risk of developing isolated pulmonary embolism (PE) is elevated in women after ART compared to those receiving hormonal contraceptives as well as women having spontaneous pregnancy. Low-molecular-weight heparins (LMWH) are justified to be used as a preventive means. However, commonly recommended preventive LMWH dose in such patient cohort may not always be sufficient. On the other hand, escalating dose for some LMWH results in increased rate of developing hemorrhages. Hence, it is important to take into consideration what exact type of LMWH as well as its dose and duration of therapy should be prescribed to women after ART that requires to be further investigated.
About the Author
E. Grandone
Sechenov University;
Research Center «Casa Sollievo della Sofferenza»
Italy
Italy
MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology, 2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991;
Head of the Department of Thrombosis and Hemostasis, 1 Viale Cappuccini, San Giovanni Rotondo 71013
References
1. Mara M., Koryntova D., Rezabek K.et al. Thromboembolic complications in patients undergoing in vitro fertilization: retrospective clinical study. Ceska Gynekol. 2004;69(4):312–6. [Article in Czech].
2. Grandone E., Colaizzo D., Vergura P. et al. Age and homocysteine plasma levels are risk factors for thrombotic complications after ovarian stimulation. Hum Reprod. 2004;19(8):1796–9. https://doi.org/10.1093/humrep/deh346.
3. Chan W.S., Ginsberg J.S. A review of upper extremity deep vein thrombosis in pregnancy: unmasking the ‘ART’ behind the clot. J Thromb Haemost. 2006;4(8):1673–7. https://doi.org/10.1111/j.1538-7836.2006.02026.x.
4. Chan W.S. The ‘ART’of thrombosis: a review of arterial and venous thrombosis in assisted reproductive technology. Curr Opin Obstet Gynecol. 2009;21(3):207–18. https://doi.org/10.1097/GCO.0b013e328329c2b8.
5. Chan W.S., Dixon M.E. The “ART” of thromboembolism: a review of assisted reproductive technology and thromboembolic complications. Thromb Res. 2008;121(6):713–26. https://doi.org/10.1016/j.thromres.2007.05.023.
6. Piazza G. Oh heavy burden: recognizing the risk of venous thromboembolism in women undergoing assisted reproduction. Thromb Haemost. 2018;118(12):2011–3. https://doi.org/10.1055/s-0038-1676073.
7. Henriksson P., Westerlund E., Wallen H. et al. Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilisation: cross sectional study. BMJ. 2013;346:e8632. https://doi.org/10.1136/bmj.e8632.
8. Sennström M., Rova K., Hellgren M. et al. Thromboembolism and in vitro fertilization–a systematic review. Acta Obstet Gynecol Scand. 2017;96(9):1045–52. https://doi.org/10.1111/aogs.13147.
9. Marongiu F., Mameli A., Grandone E., Barcellona D. et al. Pulmonary thrombosis: a clinical pathological entity distinct from pulmonary embolism? Semin Thromb Hemost. 2019;45(8):778–83. https://doi.org/10.1055/s-0039-1696942.
10. Grandone E., Di Micco P.P., Villani M. et al. Venous thromboembolism in women undergoing assisted reproductive technologies: data from the RIETE registry. Thromb Hemost. 2018;118(11):1962–8. https://doi.org/10.1055/s-0038-1673402.
11. Cantwell R., Clutton-Brock T., Cooper G. et al. Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006–-2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118 Suppl 1:1–203. https://doi.org/10.1111/j.1471-0528.2010.02847.x.
12. Braat D.D.M., Schutte J.M., Bernardus R.E. et al. Maternal death related to IVF in the Netherlands 1984–2008. Hum Reprod. 2010;25(7):1782–6. https://doi.org/10.1093/humrep/deq080.
13. Selter J., Huang Y., Becht L.C.G. et al. Use of fertility preservation services in female reproductive-aged cancer patients. Am J Obstet Gynecol. 2019;221(4):328.e1–328.e16. https://doi.org/10.1016/j.ajog.2019.05.009.
14. Rova K., Passmark H., Lindqvist P.G. et al. Venous thromboembolism in relation to in vitro fertilization: an approach to determining the incidence and increase in risk in successful cycles. Fertil Steril. 2012;97(1):95–100. https://doi.org/10.1016/j.fertnstert.2011.10.038.
15. Zore T., Joshi N.V., Lizneva D., Azziz R. Polycystic ovarian syndrome: long-term health consequences. Semin Reprod Med. 2017;35(3):271–81. https://doi.org/10.1055/s-0037-1603096.
16. Bates S.M., Greer I.A., Middeldorp S. et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e691S–e736S. https://doi.org/10.1378/chest.11-2300.
17. Bates S.M., Rajasekhar A., Middeldorp S. et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2018;2(22):3317–59. https://doi.org/10.1182/ bloodadvances.2018024802.
18. The Management of Ovarian Hyperstimulation Syndrome. Green-top Guideline No. 5. RCOG, 2016. 22 p. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_5_ohss.pdf.
19. Lindqvist P.G., Dahlbäck B. Bleeding complications associated with low molecular weight heparin prophylaxis during pregnancy. Thromb Haemost. 2000;84(7):140–1.
20. Galambosi P.J., Kaaja R.J., Stefanovi V., Ulander V.-M. et al. Safety of low-molecular-weight heparin during pregnancy: a retrospective controlled cohort study. Eur J Obstet Gynecol Reprod Biol. 2012;163(2):154–9. https://doi.org/10.1016/j.ejogrb.2012.05.010.
Review
For citations:
Grandone E. Thrombosis risk and in vitro fertilization. Obstetrics, Gynecology and Reproduction. 2022;16(1):90-95. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2022.286
Views:
2384
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 
