Hemostasiological Aspects of Failed in Vitro Fertilization Attempts in Women with Metabolic Syndrome
The purpose of research. To study the state of platelet, plasma, anticoagulant and fibrinolytic links of the haemostasis system in women with metabolic syndrome (MS) and failures in assisted reproductive technology (ART) programs.Materials and methods. Comparative analysis of plasma-platelet, anticoagulant and fibrinolytic links of hemostasis system in 65 women (group I) with metabolic syndrome and multiple (3 or more) ART programs failures. Group II consisted of 60 women with infertility of tubular peritoneal origin without MS who require ART programs.Results. The study of indicators of the hemostasis system revealed multicomponent shifts in procoagulant, vascular platelet and fibrinolytic links. Patients with metabolic syndrome showed signs of activation of the procoagulant link of the hemostasis system in the form of increased levels of prothrombin fragments, thrombin-antithrombin complex and D- dimer in combination with hyperfibrinogenemia, against the background of decreased plasminogen activity and increased PAI-1 concentration.In all patients with metabolic syndrome platelet aggregation activity significantly increased in comparison with platelet aggregation in women of group II. Increased spontaneous and induced platelet aggregation on the background hyperhomocysteinemia and increased Willebrand factor activity in metabolic syndrome leads to increased thrombogenic plasma potential. The closest correlation between platelet aggregation and carbohydrate and lipid metabolism was revealed.Conclusions. It is indicated to carry out studies of procoagulent link, plasminogen activty, PAI-1 concentration, platelet aggregation activity, Willebrand factor activity, homocystein content, prothrombin fragments and thrombin-antithrombin complex with blood in order to asses the hemostasis and prescribe adequate therapy for prevention of pre-embryonic and perinatal losses, as well as thrombotic complications in women with metabolic syndrome planning ART programs.