title: Thrombophilia and assisted reproduction technology-any detrimental impact or unnecessary overuse?
abstract: OBJECTIVE
  The aim of this study is to provide an overview of the studies investigating a possible association between thrombophilia and assisted reproductive technology (ART) outcome.
  
  
  METHODS
  This is a literature review.
  
  
  RESULTS
  Congenital thrombophilias (CoT) are reported to be associated with pregnancy loss. However, the association between CoT and early pregnancy loss is weak and does not necessarily support causation. CoT are more likely to be associated with late fetal loss. Even though data pooled from case-control and cohort studies suggest an increased risk of ART failure in women with CoTs, there seems no association when the analysis is confined to better quality cohort studies. The evidence supporting anticoagulation to improve ART outcome in CoT carriers is weak. Likewise, studies on antiphospholipid antibodies (APAs) and ART outcome suffer from multiple methodological limitations and a detrimental impact of APA positivity is controversial. Empirical administration of heparin or low molecular weight heparin to women with recurrent ART failures is supported by weak evidence. Importantly, thrombophilias are likely to increase thrombotic complications after ovarian stimulation for ART.
  
  
  CONCLUSIONS
  Current evidence does not support routinely testing for or treatment of thrombophilia in the setting of ART nor in couples with implantation failure. A careful personal and family history should be obtained and a risk assessment for thrombotic complications should be made in every woman undergoing ovarian stimulation. If positive, testing for thrombophilia is warranted.
authors.affiliation: Department of Obstetrics and Gynecology, Koc University School of Medicine, Davutpasa Caddesi No: 4, Topkapi, Istanbul, 34010, Turkey.
authors.forename: Baris
authors.initials: B
authors.lastname: Ata
authors.affiliation: Department of Obstetrics and Gynecology, Koc University School of Medicine, Davutpasa Caddesi No: 4, Topkapi, Istanbul, 34010, Turkey. burman@ku.edu.tr.
authors.forename: Bulent
authors.initials: B
authors.lastname: Urman
mesh_terms: D000022:Abortion, Spontaneous / Q000503:physiopathology; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted / Q000639:trends*; D019851:Thrombophilia / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: Antiphospholipid syndrome; Assisted reproduction; Heparin; Pregnancy loss; Thrombophilia