Battinelli EM. Thrombosis 2013

Reproductive Thrombophilia medicine Rose Marie Meier Genk - Belgium

Thrombophilia Predisposition for thrombotic events

Deep vein thrombosis Pulmonary embolism

Thrombo-embolic disease Mayor cause of maternal mortality Absolute incidence 1 / 1000 IVF increase 3 fold the risk (2.66 / 1000) Severe OHSS 4,1 %

Asociation with poor reproductive outcome Implantation failure and recurrent pregnancy loss Women with >2 IVF-ET increase find of thrombophilia factor Qublan H. Hum Fertil (Camb) 2008 Scott N. Throm Res 2013

Venous thromboembolic events (VTE) & IVF

Rova K. Fertil Steril 2012

a Classification

Hereditary

Acquired

Antiphospholipid syndrome

PL

PL PL

aPL antibodies interfere with phospholipids utilized to induce coagulation increasing adhesion and aggregation of platelets Anticoagulant

Davenport W. Obstet Gynecol Clin N Am 2014

Pregnancy

PL

PL PL

Hypercoagulability state Anticoagulant

Ovarian stimulation

PL

PL PL

Hypercoagulability state

HcG effect Anticoagulant

Clinical validity What is the association between thrombophilia and VTE and poor reproductive outcomes ??

Factor V Leiden ✓

Most common inherited thrombophilia

✓

Genetic mutation -> G-to-A substitution (G1691A)

✓

Heterozygote 3 - 8 %

✓

Homozygote 1:5000

Risk VTE

Homozygous OR 43.4 Heterozygous OR 8.3

Risk 1 in 500 pregnancies

IVF? Risk poor rep outcome Battinelli EM. Thrombosis 2013

RPL19w

Rey E. The Lancet 2003

RPL

Bradley LA. Genet Med 2012

Phrotrombin ✓

Second most common inherited thrombophilia

✓

Genetic mutation -> G-to-A substitution (G20210A)

✓

Heterozygote 2 - 3%

✓

Homozygote 1:10.000

Risk VTE

Homozygote OR 24.4 Heterozygote OR 6.8

Risk poor rep outcome

Risk 1 in 200 pregnancies

IVF? RPL OR 2.05

Texto

Rosendaal FR. Thromb Haemost. 1998

Davenport W. Obstet Gynecol Clin N Am 2014

RPL

RPL