The effect of short-term elevation of 17B estradiol (E2) levels on the coagulation system as measured by D-Dimer in women undergoing in vitro fertilization

Abstract

Objective: The objective of this study is to evaluate the short-term effect of elevated estrogen levels on the coagulation system, as measured by D-dimer in in vitro fertilization (IVF). Design: Prospective open cohort trial. Setting: University affiliated IVF division. Patients: A total of 62 IVF patients. Interventions: Serum 17B estradiol (E2) and D-dimer levels were measured in patients undergoing long protocol IVF at down regulation (DR) (E2 ≤200 pmol/L) and on the day of oocyte retrieval (OR). Data was analyzed and correlated with clinical and laboratory parameters. Main Outcome Measures: Serum D-dimer levels at DR and oocyte pick-up days and their association with clinical and laboratory parameters. Results: From DR to OR day serum D-dimer levels increased in 31 (66%) and decreased in 16 (34%) women. Mean increased was by 21% ( P < 0.024). Among women with an increase in D-dimer levels, mean increase was 44% above levels on DR day. D-dimer levels increased among all patients with a body mass index (BMI) ≥30 kg/m 2 and among 57.6% of patients with BMI <30 kg/m 2 ( P < 0.009) and increase tended to be higher among obese patients ( P = 0.06). Prothrombin time (PT) on DR day was shorter among patients whose D-dimer levels increased ( P < 0.017). Conclusions: D-dimer serum levels increase during ovarian stimulation; however, levels rarely exceed the normal range. Therefore, short-term exposure to supraphysiological E2 levels in IVF does not seem to affect thromboembolic status as expressed by D-dimer levels. D-dimer increase was associated with a shorter PT on DR day and tended to be comprehensive and higher among overweight women. Therefore, obesity may pose a risk factor for thromboembolism.