Medičnì Perspektivi (Jan 2019)
Prothrombotic states as risk factor of in vitro fertilization failures in women with infertility and psychosomatic disorders.
Abstract
Failures of in vitro fertilization (IVF) may be associated with prothrombotic states, the circulation of antiphospholipid antibodies (APA). 93 women with infertility were screened: 1 group - 32 women without severe psychosomatic disorders; 2 group - 61 women with psychosomatic disorders. The control group consisted of 30 fertile women. The level of AFA to membrane phospholipids (phosphatidylethanolamine, phosphatidylserine, cardiolipinum), antibodies to β2-glycoprotein (β2-GPI), hemostasis (platelet count, ADP-induced platelet aggregation index, fibrinogen concentration, prothrombin index, activated partial thromboplastin time - APTT, test for soluble fibrin-monomeric complexes, D-dimer), homocysteine in the blood serum was defined. The frequency of significant AFA titres in the group of women without psychosomatic disorders was 18.9%, and if they were present - 44.3%, the rate of β2-GPI 9.6% versus 24.5%, respectively. Only in 11.5% of women in 2 groups, elevated levels of APA were associated with β2-GPI and/or one or more clinical criteria for antiphospholipid syndrome (APS). In patients with infertility and psychosomatic disorders, increased platelet aggregation in the context of relative thrombocytopenia, higher fibrinogen levels, soluble fibrin-monomeric complexes, and prolonged APTT with elevated D-dimer levels was revealed. Some patients have hyperhomocysteinemia. Factors that adversely affect the efficiency of IVF in the patients with psychosomatic disorders were noted: elevation of APA; reduction in the number of platelets; growth of the ADP-induced aggregation index; extension of APTT; increase of fibrinogen, D-dimer; homocysteine. The presence of prothrombotic states associated with APS should be taken into account when preparing for IVF and perform their appropriate correction.
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