Thromb Haemost 2023; 123(03): 283-294
DOI: 10.1055/s-0042-1760255
Coagulation and Fibrinolysis

Venous Thromboembolism Associated with Assisted Reproductive Technology: A Systematic Review and Meta-analysis

Marianne Goualou
1   Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
,
Steve Noumegni
1   Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
,
Claire de Moreuil
1   Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
,
Mathilde Le Guillou
3   Gynecology Department, CHU Brest, Brest, France
,
Gabrielle De Coninck
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
,
Clément Hoffmann
1   Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
4   F-CRIN INNOVTE, Saint-Etienne, France
,
Sara Robin
1   Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
4   F-CRIN INNOVTE, Saint-Etienne, France
,
Karine Morcel
3   Gynecology Department, CHU Brest, Brest, France
,
Emmanuelle Le Moigne
1   Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
4   F-CRIN INNOVTE, Saint-Etienne, France
,
Christophe Tremouilhac
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
3   Gynecology Department, CHU Brest, Brest, France
,
Philippe Merviel
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
3   Gynecology Department, CHU Brest, Brest, France
,
Raphael Le Mao
1   Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
,
Christophe Leroyer
1   Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
4   F-CRIN INNOVTE, Saint-Etienne, France
,
Sarah Bouée
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
3   Gynecology Department, CHU Brest, Brest, France
,
Francis Couturaud
1   Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
4   F-CRIN INNOVTE, Saint-Etienne, France
5   Centre d'investigation clinique INSERM 1412, University Brest, Brest, France
,
Cécile Tromeur
1   Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France
2   INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
4   F-CRIN INNOVTE, Saint-Etienne, France
› Author Affiliations


Abstract

Background Hormonal exposure leads to an increased risk of venous thromboembolism (VTE) but the risk of VTE associated with assisted reproductive technology (ART) is not clearly determined.

Methods We searched in PubMed, EMBASE, Web of Science, and the Cochrane Library databases and identified all relevant articles published up to February 1, 2021. The primary objective was to determine the frequency of VTE associated with ART. Secondary objectives were to determine (1) the risk of VTE associated with ART as compared to pregnancy without ART; (2) the risk of VTE associated with ovarian hyperstimulation syndrome (OHSS); and (3) to determine potential risk factors of VTE related to ART.

Results Fourteen studies were included. The overall frequency of VTE associated with ART was 0.23% (95% confidence interval [CI]: 0.07–0.46). Women undergoing ART had a two- to threefold increased risk of VTE as compared to spontaneous pregnancy (relative risk [RR]: 2.66; 95% CI: 1.60–4.43). The overall frequency of VTE specifically related to OHSS was <0.001%. The risk of VTE after ART complicated by OHSS, as compared to ART without OHSS, was higher but not statistically significant (RR: 14.83; 95% CI: 0.86–255.62). Risk factors of VTE associated with ART were in vitro fertilization procedure (RR, odds ratio [OR], and hazard ratio varying from 1.77, 95% CI: 1.41–2.23 to 4.99, 95% CI: 1.24–20.05), hyperhomocysteinemia (OR: 15.2; 95% CI: 2.0–115.0), polycystic ovarian syndrome (PCOS) (RR: 4.8; 95% CI: 1.7–13.4), successful ART leading to pregnancy (OR: 13.94; 95% CI: 1.41–137.45).

Conclusion Further large prospective studies on risk factors of VTE in women undergoing ART are needed in order to optimize thromboprophylaxis in this context.

Supplementary Material



Publication History

Received: 01 July 2022

Accepted: 18 October 2022

Article published online:
31 December 2022

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