The ‘ART’ of thrombosis: a review of arterial and venous thrombosis in assisted reproductive technology

Abstract

The use of assisted reproductive technology (ART) has increased tremendously in the past three decades. During the process of ART, supraphysiological estradiol levels with exogenous hormone administration can result. One major complication of this intervention, ovarian hyperstimulation syndrome (OHSS), is associated with both arterial and venous thromboembolic complications. There are an increasing number of both arterial and venous thromboembolic cases reported in the literature. In total, there are 96 cases of thromboses reported in the literature; a third of these cases were reported within the past 2 years. The collective findings from these reported cases were consistent: the timing of arterial and venous events differed, arterial events usually occur concurrently with the onset of OHSS, whereas venous events occur several weeks later after the clinical resolution of OHSS; arterial thromboses are predominantly cerebrovascular accidents, whereas venous events are mostly reported in unusual sites such as the upper extremities. In spite of the frequency of reported cases, there is little in the literature to guide thromboprophylaxis. On the basis of the observations, thromboprophylaxis should be considered for patients who develop moderate-to-severe OHSS for an extended period of 1-2 months beyond the resolution of clinical OHSS, and also be considered for patients with known inherited or acquired thrombophilia, while undergoing ART. Future studies should focus on defining the frequency and risk factors associated with women who develop these complications and more closely examine the resultant effects in the coagulation cascade during hormonal manipulation in women undergoing ART.