Association between higher levels of serum estradiol and elevated levels of fibrin (fibrinogen) degradation products in late pregnancy following assisted reproductive technology treatment

Cheng Li; Yun-Fei Su; Li Jin; Yan-Yan Guo; Guo-Lian Ding; Lin Tang; Mei Cai; He-Feng Huang; Xin-Mei Liu

doi:10.1016/j.thromres.2019.12.024

Association between higher levels of serum estradiol and elevated levels of fibrin (fibrinogen) degradation products in late pregnancy following assisted reproductive technology treatment

Thromb Res. 2020 Mar:187:63-71. doi: 10.1016/j.thromres.2019.12.024. Epub 2020 Jan 10.

Authors

Cheng Li¹, Yun-Fei Su¹, Li Jin², Yan-Yan Guo¹, Guo-Lian Ding¹, Lin Tang², Mei Cai², He-Feng Huang³, Xin-Mei Liu⁴

Affiliations

¹ International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
² International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
³ International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China. Electronic address: huanghefg@sjtu.edu.cn.
⁴ International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China. Electronic address: 183747@shsmu.edu.cn.

PMID: 31958688
DOI: 10.1016/j.thromres.2019.12.024

Abstract

Introduction: Assisted reproductive technology (ART) treatment is a risk factor for pregnancy-related venous thromboembolism (VTE). This study aims to explore the risk factors for elevated fibrin (fibrinogen) degradation products (FDPs), an indicator of hypercoagulability, in late pregnancy among women who underwent ART treatment.

Materials and methods: This retrospective case-control study recruited 227 women who spontaneously conceived and 214 women who underwent ART treatment and gave birth. A subgroup analysis of the 214 pregnant women after ART treatment was performed. 156 women with elevated FDP levels and 58 women with normal FDP levels were designated as the case and control groups, respectively.

Results: We found that ART treatment was a risk factor for higher FDP. After adjustments were made for confounders in the group of 214 women after ART treatment, fresh embryo transfer (adjusted odds ratio (aOR) = 3.33, 95% confidence interval (CI), 1.57-7.03) and >10 oocytes retrieved (aOR = 2.09, 95% CI, 1.10-3.99) were associated with elevated FDP in late pregnancy. Serum estradiol (E2) levels on human chorionic gonadotropin (hCG) trigger day were higher in the high-FDP group. A positive correlation between E2 on hCG trigger day and FDP was found for both fresh embryo transfer (r = 0.67, p < 0.001) and frozen embryo transfer (FET) (r = 0.53, p < 0.001).

Conclusions: A higher E2 level on hCG trigger day is closely associated with dysfunction of coagulation and fibrinolysis in late pregnancy. When performing the thromboprophylaxis assessment during pregnancy, clinicians should pay more attention to patients who had previous ART treatment and had a high E2 level on hCG trigger day.

Keywords: Assisted reproductive technology; Controlled ovarian stimulation; Estradiol; Fibrin (fibrinogen) degradation products; Oocyte retrieval.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anticoagulants
Case-Control Studies
Estradiol
Female
Fertilization in Vitro
Fibrin Fibrinogen Degradation Products*
Humans
Ovulation Induction
Pregnancy
Reproductive Techniques, Assisted
Retrospective Studies
Venous Thromboembolism*

Substances

Anticoagulants
Fibrin Fibrinogen Degradation Products
Estradiol