Is the Screening of Women for Inherited Thrombophilia (IT) Before ART Warranted?

Abstract

ObjectiveThe absolute incidence of spontaneous venous thromboembolism (VTE) is low, and it appears that routine screening of patients is not justified. However, infertile women seeking parenthood via assisted reproductive technology (ART) are typically exposed to treatments requiring administration of oral contraceptives, sex steroids, hormone replacement, and may achieve high hormonal levels following ovarian stimulation, all of which may increase the risk of VTE. In addition, these patients may carry pregnancies complicated by multiple implantations, ovarian hyperstimulation syndrome, and abortions (among other obstetric pathologies) which are known to substantially increase the risks of VTE, with devastating consequences. Therefore, we attempted to study the prevalence of IT in our patient population and wish to compare the found prevalence with worldwide published data to determine whether IT screening is recommended.DesignRetrospective study of medical recordsMaterials and methodsBlood samples were obtained from 354 women, ranging from 20 to 45 (32.9 ± 4.6) yrs. during the interval between 02/03 and 12/04. IT markers examined were the gene mutations for factor V Leiden (FVL) and prothrombin (FII). Determinations of antithrombin-III, protein C, protein S, methylene-tetrahydrofolate reductase (MTHFR), and homocysteine levels were also examined.ResultsTabled 1ConclusionThe findings of this study are in accord with those encountered in the medical literature. While the propensity for IT can be diagnosed by simple laboratory techniques, general screening of women undergoing ART are not warranted due to low-frequency and cost-inefficiency. Patients at risk for VTE should be carefully sought out before screening for IT. ObjectiveThe absolute incidence of spontaneous venous thromboembolism (VTE) is low, and it appears that routine screening of patients is not justified. However, infertile women seeking parenthood via assisted reproductive technology (ART) are typically exposed to treatments requiring administration of oral contraceptives, sex steroids, hormone replacement, and may achieve high hormonal levels following ovarian stimulation, all of which may increase the risk of VTE. In addition, these patients may carry pregnancies complicated by multiple implantations, ovarian hyperstimulation syndrome, and abortions (among other obstetric pathologies) which are known to substantially increase the risks of VTE, with devastating consequences. Therefore, we attempted to study the prevalence of IT in our patient population and wish to compare the found prevalence with worldwide published data to determine whether IT screening is recommended. The absolute incidence of spontaneous venous thromboembolism (VTE) is low, and it appears that routine screening of patients is not justified. However, infertile women seeking parenthood via assisted reproductive technology (ART) are typically exposed to treatments requiring administration of oral contraceptives, sex steroids, hormone replacement, and may achieve high hormonal levels following ovarian stimulation, all of which may increase the risk of VTE. In addition, these patients may carry pregnancies complicated by multiple implantations, ovarian hyperstimulation syndrome, and abortions (among other obstetric pathologies) which are known to substantially increase the risks of VTE, with devastating consequences. Therefore, we attempted to study the prevalence of IT in our patient population and wish to compare the found prevalence with worldwide published data to determine whether IT screening is recommended. DesignRetrospective study of medical records Retrospective study of medical records Materials and methodsBlood samples were obtained from 354 women, ranging from 20 to 45 (32.9 ± 4.6) yrs. during the interval between 02/03 and 12/04. IT markers examined were the gene mutations for factor V Leiden (FVL) and prothrombin (FII). Determinations of antithrombin-III, protein C, protein S, methylene-tetrahydrofolate reductase (MTHFR), and homocysteine levels were also examined. Blood samples were obtained from 354 women, ranging from 20 to 45 (32.9 ± 4.6) yrs. during the interval between 02/03 and 12/04. IT markers examined were the gene mutations for factor V Leiden (FVL) and prothrombin (FII). Determinations of antithrombin-III, protein C, protein S, methylene-tetrahydrofolate reductase (MTHFR), and homocysteine levels were also examined. ResultsTabled 1 ConclusionThe findings of this study are in accord with those encountered in the medical literature. While the propensity for IT can be diagnosed by simple laboratory techniques, general screening of women undergoing ART are not warranted due to low-frequency and cost-inefficiency. Patients at risk for VTE should be carefully sought out before screening for IT. The findings of this study are in accord with those encountered in the medical literature. While the propensity for IT can be diagnosed by simple laboratory techniques, general screening of women undergoing ART are not warranted due to low-frequency and cost-inefficiency. Patients at risk for VTE should be carefully sought out before screening for IT.