PB0442 - Assessment of the thrombogenic potential of ovarian stimulation and in-vitro fertilization treatment

Sunday, June 23, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

HC

Henrietta Cavanagh

Specialty Registrar in Obstetrics and Gynaecology
Homerton University Hospital, London
London, England, United Kingdom

Co-Author(s)

VV

Veronica Venturelli

Rheumatologist (Medical Doctor)
Rheumatology Unit, Department of Medical Sciences, Universita degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Cona, Italy
Ferrara, Emilia-Romagna, Italy
Rezan Abdul-Kadir

Professor and Consultant Obstetrician and Gynaecologist
The Royal Free NHS Foundation Hospital, London, England
London, England, United Kingdom
AP

Angela Pereira

Consultant Obstetrician and Gynaecologist
Barts Health NHS Trust
London, England, United Kingdom
DM

Dimitrios Mavrelos

Consultant Gynaecologist and Specialist in Reproductive Medicine
University College London Hospital
London, England, United Kingdom
Hannah Cohen, MD

University College London Hospitals, United Kingdom
London, England, United Kingdom
ME

Maria Efthymiou

Senior Research Fellow
Department of Haematology, University College London
London, England, United Kingdom

Background: Failure of in vitro fertilization (IVF) may have a thrombotic basis, with ovarian stimulation possibly augmenting hypercoagulability. Thrombin generation (TG), provides a global measure of thrombogenic potential and could have predictive value in IVF.

Aims: To establish the in vitro thrombogenicity of patients at various points during IVF treatment, in a TG-based assay, and establish relationships with estradiol (E2) and clinical outcomes.

Methods: Sixty-eight women were recruited: Group(G)1: first IVF cycle (n=37), G2: recurrent implantation failures (n=4), G3: healthy controls (n=22). Blood samples were collected at timepoints T1: pre-treatment, T2: maximal stimulation (6-11 days), T3: embryo transfer. TG was established using the PPP-low reagent and activated protein C resistance; APCr (with recombinant (rh)APC or Protac) using the PPP reagent. Endogenous thrombin potential (ETP) and peak were normalised towards pooled normal plasma and APCr was expressed as %inhibition of ETP. E2 and FSH levels were measured. Pregnancy test was performed 15 days after embryo transfer.

Results: At T1: G1 had significantly increased ETP (1035nM.min, 95%CI 865.0-1373), vs controls (753.9nM.min, 542.0-976.4%), p=0.01. ETP of G1 was significantly higher at T3 (1687nM.min, 1364-2447%) compared to T1 (1035nM.min 865.0-1373%), p=0.001, and compared to T2 (1330nM.min, 992.0-1519%), p=0.05. APCr with rhAPC was greater at T3 in both G1 (61.17%, 36-102.6%) and G2 (52.04%, 2.5-103.6%), respectively, compared to T1 and T2. E2 levels were negatively correlated with APCr (rhAPC) at T3 (r= 0.6) but failed to reach significance. ETP was higher in patients with a positive pregnancy test (1175nM.min, 9677-1558%) compared to a negative (704.3nM.min, 414.8-1763%), but did not reach statistical significance.

Conclusion(s): TG parameters vary across the IVF cycle, and coagulability evolves between pre-treatment levels and day of embryo transfer. Our preliminary results suggest that at baseline, women undergoing IVF are more hypercoagulable compared to controls. This finding can be of predictive value in IVF, pending further validation.