fibrin and Ovarian-Hyperstimulation-Syndrome

Changes in coagulation and fibrinolysis have been reported in women undergoing controlled ovarian hyperstimulation (COH) supporting a potential hypercoagulable condition related to this treatment. This study aimed at evaluating the changes in fibrin clot properties and thrombin generation induced by two different COH protocols: long with gonadotropin-releasing hormone agonist (GnRH-a) and GnRH antagonist (GnRH-ant). Primary outcomes included determination of plasma fibrin clot properties, including clot permeability (K

Topics: Blood Coagulation; Female; Fibrin; Fibrinolysis; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Female; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Plasminogen Activator Inhibitor 1; Pregnancy; Thrombin

Controlled ovarian hyperstimulation during in vitro fertilization (IVF) causes profound increments in serum estradiol which may influence haemostasis and the ovarian hyperstimulation syndrome. In the present study we investigated the effect of the standard IVF-stimulation protocol on coagulation and fibrinolysis as assessed by different global haemostatic assays.. Blood samples were drawn from 31 women during the down-regulation phase when estradiol secretion is inhibited, and before egg retrieval, i.e. when estradiol levels are at supraphysiological levels, in the following called high level stimulation phase. Haemostasis was assessed during both treatment phases with 1) the calibrated automated thrombogram which measures thrombin generation, 2) overall haemostasis potential which measures fibrin formation and degradation and 3) fibrin gel permeability measurements which measures the quality of the fibrin network.. Estradiol increased from <150pg/mL to 5889pg/mL (range 1620-19500pg/mL). We found both increased thrombin generation as measured by the calibrated automated thrombogram (p<0.001) and an increase in overall haemostasis potential (p<0.001) from time of down-regulation to high level stimulation.. The assays used indicated procoagulable changes in haemostasis during in vitro fertilization. Further studies should evaluate their potential in the prediction of thrombosis and hyperstimulation.

Topics: Adult; Blood Coagulation; Blood Coagulation Tests; Estradiol; Female; Fibrin; Humans; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Thrombin; Thrombosis

During ovarian gonadotrophin stimulation for ovulation induction or in vitro fertilization, a clinical severe ovarian hyperstimulation syndrome (OHSS) may occur. Only few studies have investigated the mechanism responsible for the alterations of the haemostatic system in women affected by severe OHSS. The aim of the present study was to investigate the correlation between the magnitude of ovarian stimulation and the increase in fibrin formation and degradation in severe OHSS. Twenty-five patients (age range 23-43 years) who were hospitalized for severe OHSS, 25 women undergoing in vitro fertilization who did not develop OHSS (case-control group) and 25 healthy age-matched women (healthy control group) were investigated. On the day of admission a number of haemostatic markers, including D-dimer, thrombin-antithrombin complexes (TAT), prothrombin fragment 1 + 2 (F1 + 2), plasmin-antiplasmin complexes (PAP), tissue factor (TF), tissue factor pathway inhibitor (TFPI) and von Willebrand factor antigen (vWF), were examined. In patients with severe OHSS, TF, D-dimer, TAT, F1 + 2, PAP and vWF antigen plasma levels were significantly higher than those observed both in the case-control group and in healthy controls, whereas TFPI levels were significantly lower (P < 0.005) with respect to both case-controls and healthy controls. D-Dimer levels were related with serum oestradiol levels and oocyte number recovered (r = 0.45, P < 0.001 and r = 0.47, P < 0.001, respectively). D-Dimer and TAT levels were significantly (P < 0.05 and P < 0.005, respectively) higher in OHSS patients with unsuccessful pregnancy outcome (D-dimer, 226.5, 56-1449 ng/ml; TAT, 19.8, 3.1-82.6 microg/l) with respect to those with successful outcome of pregnancy (D-dimer, 145, 29-330 ng/ml; TAT, 5.0, 1.0-19.6 microg/l). Our data indicate that a marked hypercoagulability with alterations of TF and TFPI levels is detectable in patients with severe OHSS and that it is related to the clinical outcome.

Topics: Adult; Biomarkers; Case-Control Studies; Estradiol; Female; Fibrin; Humans; Lipoproteins; Ovarian Hyperstimulation Syndrome; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Thrombophilia; Thromboplastin