Document Detail

The "ART" of thromboembolism: a review of assisted reproductive technology and thromboembolic complications.
MedLine Citation:
PMID:  17659766     Owner:  NLM     Status:  MEDLINE    
Since its development over 25 years ago, the use of assisted reproductive technology (ART) is on the increase. Along with its use, are also reports of thromboembolic complications (TEC); these events could resulted in significant maternal morbidity and even mortality. In this article, we reviewed the general principles of ART. We also performed a search of all published cases of TEC associated with ART, and summarized the results of studies investigating underlying hemostatic changes with ART. The goal of this article is to provide non-fertility specialists an understanding of ART, so as to better manage TEC when they occur in predisposed patients. The most common ART procedure performed today, is in-vitro fertilization-embryo transfer (IVF-ET). The process of IVF involves the use of exogeneous hormones to achieve cycle control, stimulate the ovaries, and support implantation. During this process, supraphysiological estradiol levels can result. One major complication of this intervention, ovarian hyperstimulation syndrome (OHSS), can be associated with both arterial and venous thrombotic complications. These events (especially venous thrombosis) have also been reported to occur weeks after OHSS has resolved; and they can present in unusual sites (upper extremities) resulting in treatment challenges. From current available studies, it is clear that with ovarian stimulation, both the coagulation and fibrinolytic systems are activated. This activation appears to be exaggerated and prolonged with the development of OHSS. Whether these changes are sufficient by themselves to explain the occurrence of TEC is yet unknown. Future studies should be focused on defining the frequency and risk factors of these complications; provide a closer examination of the resultant changes in the coagulation cascade during ART, OHSS and early pregnancy; and investigating the appropriate treatment and thromboprophylaxis for patients undergoing a procedure considered "elective".
W S Chan; M E Dixon
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Publication Detail:
Type:  Journal Article; Review     Date:  2007-07-30
Journal Detail:
Title:  Thrombosis research     Volume:  121     ISSN:  0049-3848     ISO Abbreviation:  Thromb. Res.     Publication Date:  2008  
Date Detail:
Created Date:  2008-04-14     Completed Date:  2008-10-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0326377     Medline TA:  Thromb Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  713-26     Citation Subset:  IM    
Department of Medicine and Obstetrics & Gynecology, Women's College Hospital and Sunnybrook Health Sciences Centre, 76, Grenville Street, Toronto, Ontario, Canada M5S 1B2.
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MeSH Terms
Ovarian Hyperstimulation Syndrome / etiology*,  physiopathology
Reproductive Techniques, Assisted / adverse effects*
Risk Factors
Thromboembolism / etiology*,  physiopathology
Comment In:
Thromb Res. 2008;122(2):289-90; author reply 291   [PMID:  18178242 ]

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