Venous and arterial thromboses in ART programs: epidemiology and preventive strategies

Here, we review the current data on the relationship between in vitro fertilization (IVF) procedures and thrombotic complications by focusing on epidemiological, pathophysiological and clinical aspects. Although being a rare IVF complication (incidence is about 0.2 %), thrombosis poses a serious threat especially in patients with ovarian hyperstimulation syndrome (OHSS). The risk of thrombotic complications in OHSS is elevated markedly thereby underscoring the need for careful monitoring and prevention. Despite that arterial thrombosis is less common than venous thrombosis, it is more often associated with OHSS and arise early after ovarian stimulation. IVF is also characterized by atypical thrombosis localization targeting upper limbs, neck and cerebral veins. The risk of thrombogenesis peaks in the first trimester of IVF-related pregnancy and can persist for several weeks after OHSS resolution. Key risk factors for thrombotic complications include OHSS that elevates thrombosis risk by 100-fold; thrombophilia (both hereditary and acquired), especially in women with multiple risk factors; obesity associated with increased estrogens and procoagulant factors level; maternal age > 35 years; polycystic ovary syndrome, which increases VTE risk by five-fold. Special attention is paid to strategies for reducing the risk of thrombotic complications. Compared to fresh embryo transfer, use of revitalized embryos can prominently lower thrombosis risk due to the lack of markedly increased estrogen levels and elimination of OHSS risk.

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