GnRH Antagonist Protocol Enhances Coagulation During Controlled Ovarian Stimulation for IVF
Reproductive sciences (Thousand Oaks, Calif.)(2022)
摘要
Changes in coagulation and fibrinolysis have been reported in women undergoing controlled ovarian hyperstimulation (COH) supporting a potential hypercoagulable condition related to this treatment. This study aimed at evaluating the changes in fibrin clot properties and thrombin generation induced by two different COH protocols: long with gonadotropin-releasing hormone agonist (GnRH-a) and GnRH antagonist (GnRH-ant). Primary outcomes included determination of plasma fibrin clot properties, including clot permeability ( K s ) and efficiency of fibrinolysis using clot lysis time (CLT), along with thrombin generation (prothrombin fragments 1 + 2) and endogenous thrombin potential (ETP) and fibrinolysis inhibitor levels. One hundred twenty-nine infertile women were included in the final analysis. The GnRH-ant protocol resulted in increased ETP (+ 9.8%) and reduced K s (− 2.4%). Conversely, COH with the GnRH-a protocol reduced thrombin generation by decreasing both ETP (− 6.6%) and F1 + 2 (− 30.8%) together with favorably altered fibrin clot properties represented by increased K s (+ 21.7%) and reduced CLT (− 13.8%) as well as decreased PAI-1 levels (by 2.5 times). The GnRH-ant compared to the GnRH-a protocol increased PAI-1 levels (+ 77.3%), thrombin generation (9.3% higher ETP), and K s (+ 13.7%). In the GnRH-a group, post-COH K s was 14.3% higher ( K s ≥ 7.92 × 10 −9 cm 2 ) in women with positive vs. negative pregnancy outcomes. Our results show that the GnRH-ant protocol enhanced thrombin generation and slightly decreased fibrin clot density. COH with the GnRH-a reduced thrombin generation and improved fibrin clot features. This trial was registered (NCT04166825). Clinical Trial Registration Number: NCT04166825.
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关键词
Fibrin clot,Fibrinolysis,Infertility,Ovarian stimulation,Thrombin generation
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