The effect of in vitro fertilization on coagulation parameters as measured by thromboelastogram.
OBJECTIVE
In vitro fertilization (IVF) induced elevated estrogen levels are associated with a hypercoagulable state. Thromboelastogram (TEG) is a point of care whole blood hemostasis analyzer which measures functionality of clotting parameters. Our study's objective was to examine the influence of the early and late follicular phase of an IVF simulation cycle on coagulation parameters as measured by TEG and to evaluate the influence of age on coagulation parameters.


METHODS
In a single center, prospective, observational trial, 46 women undergoing IVF therapy were studied. All women received a standardized IVF treatment protocol. Venous blood was drawn on the first day of the stimulation cycle and on the day of hCG injection and assessed by TEG. Parameters assessed by were R (represent clotting time), K and Angle (reflect clot strength and development), MA (maximum platelet-fibrin clot strength), CI (represents overall coagulability), and LY30 (represents lysis).


RESULTS
Data from 46 women were analyzed. A statistically significant difference was found in all TEG parameters between early and late follicular phase, indicating a hypercoagulable state. R (p<0.0001), K (p=0.008), angle (p=0.008), MA (p=0.004), CI (p<0.001), LY30 (p=0.59). Age was a significant independent predictor for R at the early follicular phase (p=0.042). Both age and estrogen levels were found to be independent predictors for CI at late follicular phase. Age (p=0.011), estrogen (p=0.019).


CONCLUSIONS
There was a significant difference in all coagulation parameters between early and late follicular phase, indicating a hypercoagulable state.
Department of Anesthesiology, Rabin Medical Center, Beilinson, Petach Tikvah, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: sharonorbach@yahoo.com.
Sharon
S
Orbach-Zinger
Department of Anesthesiology, Rabin Medical Center, Beilinson, Petach Tikvah, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Leonid A
LA
Eidelman
Department of Anesthesiology, Rabin Medical Center, Beilinson, Petach Tikvah, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Alexander
A
Lutsker
IVF and Infertility Unit, Department of Anesthesiology, Rabin Medical Center, Beilinson, Petach Tikvah, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Galia
G
Oron
IVF and Infertility Unit, Department of Anesthesiology, Rabin Medical Center, Beilinson, Petach Tikvah, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Benjamin
B
Fisch
IVF and Infertility Unit, Department of Anesthesiology, Rabin Medical Center, Beilinson, Petach Tikvah, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Avi
A
Ben-Haroush
D000328:Adult; D000367:Age Factors; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology*; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000494:pharmacology; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000494:pharmacology; D006801:Humans; D010976:Platelet Count; D011446:Prospective Studies; D013916:Thrombelastography; D055815:Young Adult
D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone; D005640:Follicle Stimulating Hormone; C062876:cetrorelix
Blood coagulation; Estrogen; In vitro fertilization