Embryo implantation after assisted reproductive procedures and maternal thrombophilia

BACKGROUND AND OBJECTIVES

Women undergoing assisted reproductive procedures, such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), fail to achieve pregnancy in approximately 70% of cases. Postulating that among the possible causes of failure of embryo implantation might be an impairment of the uteroplacental circulation due to hypercoagulability in the mother, we investigated the association between thrombophilia and failure to achieve pregnancy after IVF or ICSI.

DESIGN AND METHODS

A case-control study was carried out in 234 women undergoing IVF or ICSI and in 234 women who, in the same period, conceived naturally. Thrombophilia due to mutations in genes encoding coagulation factor V (G1691A), prothrombin (G20210A), methylene-tetrahydrofolate reductase (C677T) and the presence of antiphospholipid antibodies was searched for.

RESULTS

The prevalence of factor V, prothrombin and methylene-tetrahydrofolate reductase mutations was similar in the 162 women who failed to achieve pregnancy after IVF or ICSI and in control women (5% and 2% for factor V G1691A, odd ratio 2.4, 95% CI 0.8-7.4; 3% and 6% for prothrombin G20210A, odds ratio 0.5, 95% CI 0.2-1.5; 19% and 20% for homozygous methylene-tetrahydrofolate reductase C677T, odds ratio 1.0, 95% CI 0.6-1.6). Nor was any association found when women who failed to achieve pregnancy were divided according to the total number of assisted reproductive procedures, age, type of procedure and cause of infertility. Antiphospholipid antibodies were not detected in any of the women.

INTERPRETATION AND CONCLUSIONS

This study provides no evidence for an association between maternal thrombophilia and failure to achieve pregnancy after assisted reproductive procedures. Routine anticoagulant treatment in women undergoing assisted reproductive procedures is not warranted.

Percutaneous umbilical blood sampling: indication changes and procedure loss rate in a nine years' experience

A 9 years' experience with percutaneous umbilical blood sampling (PUBS) has been appraised. A total number of 1,272 procedures have been performed in our institution between 1986 and 1994; 861 before the 24th week of gestation and 411 after 24 weeks. The indications for PUBS changed throughout these years because of the rapid evolution of molecular biology and because of the fact that certain conditions can now be diagnosed at earlier stages of gestation by chorionic villi sampling and amniocentesis. Sampling at a later gestational age reflected changes in indications. PUBS loss rate has been calculated for 482 fetuses less than 24 weeks, retrospectively found to be negative for the suspected condition and has been related to gestational age, duration of the procedure and number of needle insertions. Total procedure-related loss rate was 2.3%: 1.6% intrauterine fetal deaths within 48 h of the procedure and 0.7% spontaneous abortions in the 2 weeks following the procedure. Gestational age at the time of the procedure and duration of the procedure were significantly related to fetal losses within 48 h.

Insemination of HIV-negative women with processed semen of HIV-positive partners

Many HIV-discordant couples want to have children so much that they are willing to abandon condom-protected sexual intercourse irrespective of the risks. Previous testing in our laboratory showed that gradient centrifugation followed by a swim-up procedure effectively removed HIV-1-infected cells from the semen of HIV-seropositive men. 85 HIV-discordant couples were screened for fertility; 29 women were found suitable for a timed insemination course with the processed semen of their HIV-seropositive partner. None of the inseminated women seroconverted, and 17 pregnancies were achieved in 15 women. All 10 babies born to these mothers remain HIV seronegative. The findings may help in the counselling of such couples and also give them hope of having healthy babies.