title: Impact of blood hypercoagulability on in vitro fertilization outcomes: a prospective longitudinal observational study.
abstract: BACKGROUND
  Blood coagulation plays a crucial role in the blastocyst implantation process and its alteration may be related to in vitro fertilization (IVF) failure. We conducted a prospective observational longitudinal study in women eligible for IVF to explore the association between alterations of coagulation with the IVF outcome and to identify the biomarkers of hypercoagulability which are related with this outcome.
  
  
  METHODS
  Thirty-eight women eligible for IVF (IVF-group) and 30 healthy, age-matched women (control group) were included. In the IVF-group, blood was collected at baseline, 5-8 days after administration of gonadotropin-releasing hormone agonist (GnRH), before and two weeks after administration of human follicular stimulating hormone (FSH). Pregnancy was monitored by measurement ofβHCG performed 15 days after embryo transfer. Thrombin generation (TG), minimal tissue factor-triggered whole blood thromboelastometry (ROTEM®), procoagulant phospholipid clotting time (Procoag-PPL®), thrombomodulin (TMa), tissue factor activity (TFa), factor VIII (FVIII), factor von Willebrand (FvW), D-Dimers and fibrinogen were assessed at each time point.
  
  
  RESULTS
  Positive IVF occurred in 15 women (40%). At baseline, the IVF-group showed significantly increased TG, TFa and TMa and significantly shorter Procoag-PPL versus the control group. After initiation of hormone treatment TG was significantly higher in the IVF-positive as compared to the IVF-negative group. At all studied points, the Procoag-PPL was significantly shorter and the levels of TFa were significantly higher in the IVF-negative group compared to the IVF-positive one. The D-Dimers were higher in the IVF negative as compared to IVF positive group. Multivariate analysis retained the Procoag-PPL and TG as predictors for the IVF outcome.
  
  
  CONCLUSIONS
  Diagnosis of women with hypercoagulability and their stratification to risk of IVF failure using a model based on the Procoag-PPL and TG is a feasible strategy for the optimization of IVF efficiency that needs to be validated in prospective trials.
authors.affiliation: Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938 and Université Pierre et Marie Curie (UPMC), Sorbonne Universities, Paris, France.|Service d'Hématologie Biologique, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris, 4, rue de la Chine, Paris, Cedex 20 France.
authors.forename: Grigoris T
authors.initials: GT
authors.lastname: Gerotziafas
authors.affiliation: Clinical Research Department, Diagnostica Stago, Gennevilliers, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Van Dreden
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Mathieu d'Argent
authors.affiliation: Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938 and Université Pierre et Marie Curie (UPMC), Sorbonne Universities, Paris, France.
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Lefkou
authors.affiliation: Clinical Research Department, Diagnostica Stago, Gennevilliers, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Grusse
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Comtet
authors.affiliation: Clinical Research Department, Diagnostica Stago, Gennevilliers, France.
authors.forename: Rabiatou
authors.initials: R
authors.lastname: Sangare
authors.affiliation: Service d'Hématologie Biologique, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris, 4, rue de la Chine, Paris, Cedex 20 France.
authors.forename: Hela
authors.initials: H
authors.lastname: Ketatni
authors.affiliation: Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938 and Université Pierre et Marie Curie (UPMC), Sorbonne Universities, Paris, France.
authors.forename: Annette K
authors.initials: AK
authors.lastname: Larsen
authors.affiliation: Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938 and Université Pierre et Marie Curie (UPMC), Sorbonne Universities, Paris, France.|Service d'Hématologie Biologique, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris, 4, rue de la Chine, Paris, Cedex 20 France.
authors.forename: Ismail
authors.initials: I
authors.lastname: Elalamy
keywords: Blood coagulation tests; Hypercoagulability; In vitro fertilization; Thrombin generation; Tissue factor