Thromb Haemost 2018; 118(11): 1962-1968
DOI: 10.1055/s-0038-1673402
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Venous Thromboembolism in Women Undergoing Assisted Reproductive Technologies: Data from the RIETE Registry

Elvira Grandone
1   Thrombosis and Haemostasis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy
,
Pier Paolo Di Micco
2   Department of Internal Medicine, Ospedale Fatebenefratelli, Napoli, Italy
,
Michela Villani
1   Thrombosis and Haemostasis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy
,
Donatella Colaizzo
1   Thrombosis and Haemostasis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy
,
Carmen Fernández-Capitán
3   Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
,
Jorge Del Toro
4   Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
,
Vladimir Rosa
5   Department of Internal Medicine, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
,
Alessandra Bura-Riviere
6   Department of Vascular Medicine, Hôpital de Rangueil, Toulouse, France
,
Isabelle Quere
7   Department of Vascular Medicine, Hôpital Saint Eloi, Montpellier, France
,
Ángeles Blanco-Molina
8   Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
,
Maurizio Margaglione
9   Department of Medical Genetics, University of Foggia, Foggia, Italy
,
Manuel Monreal
10   Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Barcelona, Spain
,
for the RIETE Investigators › Author Affiliations
Further Information

Publication History

04 August 2018

23 August 2018

Publication Date:
08 October 2018 (online)

Abstract

Venous thromboembolism (VTE) during or after assisted reproductive technologies (ART) is predicted to rise due to the increased number of women undergoing this technique. We present data collected in the RIETE registry up to October 2016. Overall, 41 (0.6%) out of 6,718 women of childbearing age with VTE had an ART-related event. Most of them underwent autologous ART cycles; 23 had isolated deep vein thrombosis (DVT) (56.1%), 12 isolated pulmonary embolism (PE) (29.3%) and 6 simultaneous occurrence of both the events (14.6%). VTE occurred in 20 successful and 21 unsuccessful (i.e. not resulting in a clinical pregnancy) ART cycles. No recurrence was observed at 90 days. Logistic regression showed that isolated PE was significantly more frequent than DVT alone or combined with PE in unsuccessful in vitro fertilization (IVF) (odds ratio [OR]: 4.13, 95% confidence interval [CI]: 1.4–12.4), as well as in contraceptive users (OR: 2.96, 95% CI: 1.95–4.5) and in puerperium (OR: 1.96, 95% CI: 1.16–3.3). After grouping isolated PE and DVT + PE, we found that PE was significantly more frequent in women with unsuccessful IVF and higher body mass index (OR: 5.0, 95% CI: 1.2–20.7 and OR: 1.0, 95%CI: 1.0–1.1, respectively). These data document a higher risk of PE in unsuccessful cycles than in successful ones. The risk is higher than that observed during pregnancy, puerperium and contraception.

Supplementary Material

 
  • References

  • 1 Calhaz-Jorge C, de Geyter C, Kupka MS. , et al; European IVF-Monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE). Assisted reproductive technology in Europe, 2012: results generated from European registers by ESHRE. Hum Reprod 2016; 31 (08) 1638-1652
  • 2 Chan WS, Dixon ME. The “ART” of thromboembolism: a review of assisted reproductive technology and thromboembolic complications. Thromb Res 2008; 121 (06) 713-726
  • 3 Grandone E, Colaizzo D, Vergura P. , et al. Age and homocysteine plasma levels are risk factors for thrombotic complications after ovarian stimulation. Hum Reprod 2004; 19 (08) 1796-1799
  • 4 Delvigne A, Rozenberg S. Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review. Hum Reprod Update 2002; 8 (06) 559-577
  • 5 Klemetti R, Sevón T, Gissler M, Hemminki E. Complications of IVF and ovulation induction. Hum Reprod 2005; 20 (12) 3293-3300
  • 6 Chan WS. The ‘ART’ of thrombosis: a review of arterial and venous thrombosis in assisted reproductive technology. Curr Opin Obstet Gynecol 2009; 21 (03) 207-218
  • 7 Rova K, Passmark H, Lindqvist PG. Venous thromboembolism in relation to in vitro fertilization: an approach to determining the incidence and increase in risk in successful cycles. Fertil Steril 2012; 97 (01) 95-100
  • 8 Di Nisio M, Rutjes AW, Ferrante N, Tiboni GM, Cuccurullo F, Porreca E. Thrombophilia and outcomes of assisted reproduction technologies: a systematic review and meta-analysis. Blood 2011; 118 (10) 2670-2678
  • 9 Mancuso A, De Vivo A, Fanara G, Di Leo R, Toscano A. Upper body venous thrombosis associated with ovarian stimulation: case report and review of the literature. Clin Exp Obstet Gynecol 2005; 32 (03) 149-154
  • 10 Al-Shawaf T, Grudzinskas JG. Prevention and treatment of ovarian hyperstimulation syndrome. Best Pract Res Clin Obstet Gynaecol 2003; 17 (02) 249-261
  • 11 Blanco-Molina A, Trujillo-Santos J, Criado J. , et al; RIETE Investigators. Venous thromboembolism during pregnancy or postpartum: findings from the RIETE Registry. Thromb Haemost 2007; 97 (02) 186-190
  • 12 Henriksson P, Westerlund E, Wallén H, Brandt L, Hovatta O, Ekbom A. Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilisation: cross sectional study. BMJ 2013; 346: e8632
  • 13 Villani M, Favuzzi G, Totaro P. , et al. Venous thromboembolism in assisted reproductive technologies: comparison between unsuccessful versus successful cycles in an Italian cohort. J Thromb Thrombolysis 2018; 45 (02) 234-239
  • 14 Czihal M, Hoffmann U. Upper extremity deep venous thrombosis. Vasc Med 2011; 16 (03) 191-202
  • 15 Hansen AT, Kesmodel US, Juul S, Hvas AM. Increased venous thrombosis incidence in pregnancies after in vitro fertilization. Hum Reprod 2014; 29 (03) 611-617
  • 16 van Langevelde K, Flinterman LE, van Hylckama Vlieg A, Rosendaal FR, Cannegieter SC. Broadening the factor V Leiden paradox: pulmonary embolism and deep-vein thrombosis as 2 sides of the spectrum. Blood 2012; 120 (05) 933-946