Coagulation parameters predictive of repeated implantation failure in Chinese women

Abstract

Repeated implantation failure (RIF) greatly influences pregnancy rate after assisted reproductive technologies (ART) with elusive causes. Our study aimed to explore coagulation parameters in association with RIF and establish a model to predict the risk of RIF in Chinese women. Coagulation parameters, including prothrombin time (PT), thrombin time (TT), activated partial prothrombin time (APTT), D-dimer (DD), fibrin degradation products (FDP), fibrinogen (FG), and platelet aggregation induced by arachidonic acid (AA) and adenosine diphosphate (ADP) were measured in RIF patients and controls. A logistic regression model was built by using the purposeful selection to select important factors for the prediction of RIF. Between 92 RIF patients and 47 controls, we found a statistically significant difference in all of the coagulation parameters except APTT, FDP and platelet aggregation induced by ADP. The purposeful selection method selected PT (odds ratio [OR] = 0.28, 95% CI: 0.12-0.66, P = .003), APPT (odds ratio [OR] = 0.76, 95% CI: 0.63-0.91, P = .004), TT (odds ratio [OR] = 0.75, 95% CI: 0.53-1.08, P = .124), and platelet aggregation induced by AA (odds ratio [OR] = 1.27, 95% CI: 1.11-1.44, P = .0003) as important predictors of RIF risk. ROC curve analysis indicated that the area under ROC curve (AUC) of the model was 0.85 with an optimal cut-off point of the predicted probability being P = .65, leading to a sensitivity of 0.83 and a specificity 0.75. We found that coagulation parameters including PT, APTT, TT and platelet aggregation induced by AA are predictive of RIF in Chinese women. Our results highlight the potential of anti-coagulation therapies to lower the risk of RIF.

Predictive value of D‐dimer in patients with unexplained recurrent implantation failure during freeze‐thaw embryo transfer cycles

“…Previous studies provide increasing evidence that RIF is associated with thrombosis, which can lead to subsequent implantation failure. 22 In recent years, researchers have not only focused on the cause of RIF but also sought to understand the potential therapeutic role of antithrombotic treatments in improving IVF-ET outcomes. A number of antithrombotic therapeutic interventions, such as LMWH, have been used to improve the success of IVF-ET.…”

“…This suggests that the occurrence of RIF may be related to a prethrombotic state. 22 Therefore, women with higher D-dimer levels may have difficulty with embryo implantation or poor placental circulation after implantation, leading to lower clinical outcomes. In this observational study, we explored the level of D-dimer before patients received FET cycles and compared the clinical data of patients with live birth and patients without live birth.…”

“…compared D‐dimer levels between patients with RIF and healthy controls and found that the level of D‐dimer in the RIF group was significantly higher than in the control group (0.22 ± 0.11 mg/L vs. 0.15 ± 0.07 mg/L, P = .0001). This suggests that the occurrence of RIF may be related to a prethrombotic state 22 . Therefore, women with higher D‐dimer levels may have difficulty with embryo implantation or poor placental circulation after implantation, leading to lower clinical outcomes.…”

The threshold effect of factors associated with repeated implantation failure in human‑assisted reproductive technology

“…With a view to altering practice, an important conceptual issue relates to the mutability of risk factors for RIF, as potentially modi able factors can form the basis for clinical or preventive interventions. [7] The individual parameters and laboratory data of females were included to explore the associated factors of RIF. According to previous studies, and considering the emotional, psychological and economical burden RIF imposes on infertile couples offered ART, awareness of the risk factors associated with RIF is of signi cant help.…”

“…Through individual parameters and laboratory test results, we can predict the probability of repeated implantation failure to carry out preventive and targeted interventions to prevent RIF and inform patients in advance of the risk of RIF to avoid patients having too low of an awareness of unpredictable pregnancy risks, resulting in anxiety and con icts between clinicians and patients. [7] Our study retrospectively analyzed the clinical data of 882 patients who received ART treatment in Qinghai Province people , Hospital and Lanzhou University Second Hospital from January 2016 to December 2020. The individual parameters and laboratory data of female were included to explore the associated factors of through the independent associated factors, we can draw a smooth curve t based on these factors and analyze the threshold effect so that we can more accurately reveal the correlation between repeated implantation failure and independent associated factors.…”