Management strategies for thrombophilic patients undergoing assisted reproductive technologies

Objective: To summarize the current data on optimal thromboprophylaxis in thrombophilic women undergoing in vitro fertilization (IVF) and embryo transfer, primarily with a focus on strategies for preventing venous thromboembolism (VTE); to discuss the possibility of preventing pregnancy complications in pregnant women with thrombophilia.

Materials and methods: The databases and services, namely PubMed, Wiley, Scopus and Google scholar, have been searched for articles on thrombophilia and assisted reproductive technology-related pregnancy over the past 10 years. No restrictions were imposed on the design of the study. The search was carried out using MESH keywords.

Results: Hereditary thrombophilia is a genetic condition that increases the risk of thromboembolic diseases, especially during pregnancy. However, it is not recommended to have routine screening for hereditary thrombophilia in asymptomatic patients. Pregnant women with a previous history of VTE or with first-line relatives with this disease should be screened for thrombophilia genes. Low molecular weight heparins and acetylsalicylic acid are effective methods of thromboprophylaxis; anticoagulant therapy should start in the first trimester and continue in the postpartum period. The patients with antiphospholipid syndrome may have a high antibody titer, these patients should refrain from IVF until the antibody titer decreases. Immunosuppressive therapy is an effective method of reducing antibodies.

Conclusion: The history of repeated IVF failures and habitual miscarriage is not an indication for examination for thrombophilia genes; however, these women should be examined for the presence of antiphospholipid syndrome.