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Semin Reprod Med 2021; 39(01/02): 034-061
DOI: 10.1055/s-0041-1729763
Review Article

The Pathophysiology of Hypercoagulability and Infertility

Ann Kinga Malinowski
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, Canada
2   Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
3   Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
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Abstract

Alongside an interplay of a multitude of factors, attainment of a favorable pregnancy outcome is predicated on successful implantation, which in itself is a complex process anchored by balanced interchange with the hemostatic system. Among other etiologies, failure of implantation can result in infertility, and lead affected couples to consider assisted reproductive technology (ART) in an effort to fulfill their desire for procreation. Given the critical role of the hemostatic system in the process of implantation, documentation of a hypercoagulable state during controlled ovarian stimulation in the context of in vitro fertilization, as well as the potential association of its derangement in the setting of thrombophilia, with infertility, ART, ovarian hyperstimulation syndrome, and failure of implantation are explored. Additionally, current evidence addressing the relationship between ART and thromboembolism is examined, as is the role of therapy with heparin and aspirin to decrease thrombotic risk and improve ART-related pregnancy outcomes. Evidence-based recommendations from relevant professional societies are summarized.

Keywords

implantation - infertility - assisted reproductive technology - hypercoagulability


Publication History

Article published online:
17 May 2021

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