title: Prevalence of thrombophilia in women with severe ovarian hyperstimulation syndrome and cost-effectiveness of screening.
abstract: OBJECTIVE
  To determine the prevalence of markers of thrombophilia in patients with severe ovarian hyperstimulation syndrome (OHSS) and to evaluate the cost-effectiveness of screening for factor V Leiden and prothrombin G20210A mutations in women entering an IVF program.
  
  
  METHODS
  Case-control study and cost-effectiveness analysis.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Women undergoing controlled ovarian hyperstimulation for IVF complicated by severe OHSS (group 1, n = 20), women undergoing controlled ovarian hyperstimulation for IVF without development of severe OHSS (group 2, n = 40), and healthy control subjects (group 3, n = 100).
  
  
  METHODS
  Investigation of markers of thrombophilia. Estimate of number of IVF patients needed to detect a case of severe OHSS and thrombosis associated with thrombophilia genetic mutation was calculated from the available data.
  
  
  METHODS
  Blood samples were analyzed for inherited (resistance to activated protein C due to the factor V Leiden mutation; prothrombin G20210A mutation; deficiencies in antithrombin, protein C, and protein S) and acquired (presence of circulating lupus anticoagulants and/or anticardiolipin antibodies; deficiencies of antithrombin and protein S; acquired protein C resistance) markers of thrombophilia. The cost of preventing one thrombotic event in a patient developing severe OHSS after IVF and having factor V Leiden or prothrombin G20210A mutations was calculated.
  
  
  RESULTS
  None of the OHSS patients or controls had antithrombin, protein C, or free protein S deficiencies. All of them tested negative for antiphospholipid antibodies. No patient in group 1 had the factor V Leiden or prothrombin G20210A mutations. The prothrombin G20210A mutation was detected in 1 out of 40 patients (2.5%) in group 2. Both factor V Leiden and prothrombin G20210A mutations were detected in two of the control subjects (2%) (group 3). The estimated cost of preventing one thrombotic event arising as a consequence of screening for factor V Leiden and prothrombin G20210A mutation is a minimum of 418,970 dollars and 2,430,000 dollars, respectively.
  
  
  CONCLUSIONS
  The prevalence of thrombophilia is not increased in women with severe OHSS. Screening for V Leiden and prothrombin G20210A mutation in an IVF general population is not cost-effective.
authors.affiliation: Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Faculty of Medicine-University of Barcelona, Barcelona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fábregues
authors.forename: Dolors
authors.initials: D
authors.lastname: Tàssies
authors.forename: Juan C
authors.initials: JC
authors.lastname: Reverter
authors.forename: Francisco
authors.initials: F
authors.lastname: Carmona
authors.forename: Antonio
authors.initials: A
authors.lastname: Ordinas
authors.forename: Juan
authors.initials: J
authors.lastname: Balasch
mesh_terms: D000328:Adult; D000409:Alanine; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005165:Factor V / Q000235:genetics; D005260:Female; D005820:Genetic Testing / Q000191:economics*; D005998:Glycine; D006801:Humans; D008297:Male; D009154:Mutation; D016471:Ovarian Hyperstimulation Syndrome / Q000235:genetics* / Q000503:physiopathology; D017354:Point Mutation; D015995:Prevalence; D011516:Prothrombin / Q000235:genetics; D012720:Severity of Illness Index; D019851:Thrombophilia / Q000453:epidemiology* / Q000235:genetics*
chemical_list: C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin; D000409:Alanine; D005998:Glycine