At Sims IVF, Dublin, we do a ROTEM evaluation on all new patients. This is a thromboelastogram. While not a thrombophilia screen per se it does point to individuals succeptible to clotting or indeed bleeding (much rarer). I'm not aware of an association with OHSS?
we perform thrombophillia screening for selected ivf patients, but not related with ohss but recurrent miscarriages.
There is no reason to perform any test for Thrombophilia for patients at risk for OHSS. Today the OHSS can be prevented either by triggering with GnRH analogue instead of pregnyl or by doubling the dose of GnRH antagonist the day before Pregnyl administration. In case that none of the above protocols were applied and you realize the risk for OHSS the day of pick up then you may start the GnRH antagonist administration for the 3 days following the pick up and transfer the 5th day after pick up at the blastocyst stage without any risk for OHSS. If you are not able to prevent the OHSS then the transfer should be cancelled and the embryos should be vitrified at the blastocyst stage.Today the risk for thromboembolism in OHSS is very low because we learned how to manage the syndrome and the severe form of the syndrome that thromboembolism could happen is not existing today.
Yannis Prapas
Prof. OB/GYN
Professor Prapas described methods of OHSS prophylaxis, this is very important. But human organism never works fully standardly. We have had some cases of unexpected OHSS in our history. Thrombophilic mutations may besides the worsening of the OHSS influence also the implantation and miscarriages and they are important also as possible causes of the pregnancy complications. In my opinion, it is useful to have information about the clotting status of the patient preparing for IVF and pregnancy.
Pavel Travnik
Patients with severe OHSS should have thrombophylaxis throughout the acute episode and the first trimester regardless of whether they have thrombophilia or not. Patients without OHSS or who do not get pregnant probably don't need thrombophylaxis during treatment unless they have a personal history of DVT or a strong family history of DVT. So there is no indication to do a thrombophylia study as a screening test for patients without a clinical indication.
Screening is not cost-effective and sounds unnecessary. High Estradiol levels may be a risk factor for thrombosis. In my practice, I advice starting coraspin 1 day after opu, and enoxaparin on transfer day.
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