2. Thrombophilia and collagen disease in ART
s.Salehpour Associate professor. SBMU
Medical Director
IVF Center.
Taleghani Hospital.
Autumn 2014-Tehran university

3. - Incidence of Thrombophilia: 1.6/100000
Major complication in IVF cycle: thromboembolism
COH→ Protein C resistance→ DVT
HCG injection → ↑ Factor II, V, vII, vIII, Ix
( Last 3 weeks after pregnancy)

4. Indication for thrombophilia screening beforeIVF: - recurrent miscarriage - RIF - hx of VTE - hx of OHSS - Serious infection - Immobilization

5. Management of thrombophilia during IVF:

6. SLE and APS: Fertility is normal in SLE and APS except in:
- Amenorrhea
- Renal insufficiency related subfertility
- ovarian failure due to cyclophosphamide

7. COH→↑ estrogen thombosis exacerbation of disease

8. Safe COH: 1- SLE in Remission (6-12 months after last flare)
2- NO deep organ involvement
3- NO APS or low titer
4- Prophylactic anti coagulant
5- Prophylactic anti inflammatory
6- low dose Aspirin

9. Special considerations in ART for SLE and APS:
- avoid OCP
- Mild Stimulation
- Prevent OHSS
- SET

10. LPS in SLE and APS - Progesterone better than HCG
- Vaginal progesterone better than oral
(Hepatic first pass)

11. Pregnancy and SLE and APS
- Flare of SLE
- deterioration of Renal function
- ↑ thrombosis
- ↑ miscarriage
- ↑ IUFD
- ↑ PIH/preeclampsia
- ↑ IUGR
- ↑ PRETERM LABOR
- ↑ congenital heart block

12. Discourage pregnancy in:
- bad arterial hypertension
- Pulmonary hypertension
- Advanced Renal disease
- Severe heart disease
- previous thrombotic events.