Association between higher levels of serum estradiol and elevated levels of fibrin (fibrinogen) degradation products in late pregnancy following assisted reproductive technology treatment. Issue 187 (March 2020)

• Record Type: Journal Article
• Authors: Li, Cheng; Su, Yun-Fei; Jin, Li; Guo, Yan-Yan; Ding, Guo-Lian; Tang, Lin; Cai, Mei; Huang, He-Feng; Liu, Xin-Mei
• Is Part Of: Thrombosis research. Issue 187(2020)
• Page Start: 63
• Page End: 71
• Publication Date: 2020-03
• Subjects: APC Activated protein C -- APTT Activated partial thromboplastin time -- ART Assisted reproductive technology -- BMI Body mass index -- COH Controlled ovarian hyperstimulation -- E2 Estradiol -- FDP Fibrin (fibrinogen) degradation product -- FET Frozen embryo transfer -- GnRH Gonadotropin-releasing hormone -- hCG Human chorionic gonadotropin -- HRT Hormone replacement therapy -- ICSI Intracytoplasmic sperm injection -- INR International normalized ratio -- IVF In vitro fertilization -- OS Ovarian stimulation -- PAI Plasminogen activator inhibitor -- PT Prothrombin time -- TESA Testicular sperm aspiration -- t-PA Tissue plasminogen activator -- TT Thrombin time -- VTE Venous thromboembolism; Estradiol -- Fibrin (fibrinogen) degradation products -- Assisted reproductive technology -- Oocyte retrieval -- Controlled ovarian stimulation; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2019.12.024
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Assisted reproductive technology (ART) treatment is a risk factor for pregnancy-related venous thromboembolism (VTE). This study aims to explore the risk factors for elevated fibrin (fibrinogen) degradation products (FDPs), an indicator of hypercoagulability, in late pregnancy among women who underwent ART treatment. Materials and methods: This retrospective case-control study recruited 227 women who spontaneously conceived and 214 women who underwent ART treatment and gave birth. A subgroup analysis of the 214 pregnant women after ART treatment was performed. 156 women with elevated FDP levels and 58 women with normal FDP levels were designated as the case and control groups, respectively. Results: We found that ART treatment was a risk factor for higher FDP. After adjustments were made for confounders in the group of 214 women after ART treatment, fresh embryo transfer (adjusted odds ratio (aOR) = 3.33, 95% confidence interval (CI), 1.57–7.03) and >10 oocytes retrieved (aOR = 2.09, 95% CI, 1.10-3.99) were associated with elevated FDP in late pregnancy. Serum estradiol (E2) levels on human chorionic gonadotropin (hCG) trigger day were higher in the high-FDP group. A positive correlation between E2 on hCG trigger day and FDP was found for both fresh embryo transfer (r = 0.67, p < 0.001) and frozen embryo transfer (FET) (r = 0.53, p < 0.001). Conclusions: A higher E2 level on hCG trigger day is closely associated with dysfunction of coagulation and fibrinolysis in late pregnancy. When performing the thromboprophylaxis assessment during pregnancy, clinicians should pay more attention to patients who had previous ART treatment and had a high E2 level on hCG trigger day. Highlights: ART is a risk factor for hypercoagulability in late pregnancy. In women after ART, over 10 oocytes retrieved and fresh embryo transfer increase the risk of higher FDP in late pregnancy. A positive correlation was found between E2 on hCG trigger day and FDP for both fresh embryo transfer and FET. A higher E2 level induced by COH could enhance the hypercoagulable state during pregnancy.