The Pathophysiology of Hypercoagulability and Infertility

Ann Kinga Malinowski
In: Seminars in Reproductive Medicine · 2021 · vol. 39(01/02) , pp. 034–061 · doi:10.1055/s-0041-1729763 · W3163602859
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review explores the link between hypercoagulable states, thrombophilia, and infertility in the context of IVF, including ART outcomes and thromboembolism, and examines therapies to mitigate risks.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This paper reviews the role of the hemostatic system in implantation and examines evidence that ovarian stimulation during IVF may induce a hypercoagulable state, potentially contributing to infertility, ART outcomes, ovarian hyperstimulation syndrome, and failure of implantation. It summarizes findings on thrombophilia and antiphospholipid antibodies in relation to IVF/implantation and reviews studies assessing ART-associated thromboembolism and the use of heparin or aspirin to mitigate thrombotic risk and improve ART-related pregnancy outcomes, along with professional society recommendations. The paper’s caveat is that its conclusions are based on heterogeneous evidence across patient groups and study designs rather than a single unified dataset. Relevance to endometriosis: while endometriosis/adenomyosis are not explicitly discussed in the provided text, the review includes background on endometrial hemostasis in pathological states, and it is therefore included in the corpus for work overlapping implantation and endometrial hemostasis relevant to endometriosis/adenomyosis.

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Abstract

Abstract Alongside an interplay of a multitude of factors, attainment of a favorable pregnancy outcome is predicated on successful implantation, which in itself is a complex process anchored by balanced interchange with the hemostatic system. Among other etiologies, failure of implantation can result in infertility, and lead affected couples to consider assisted reproductive technology (ART) in an effort to fulfill their desire for procreation. Given the critical role of the hemostatic system in the process of implantation, documentation of a hypercoagulable state during controlled ovarian stimulation in the context of in vitro fertilization, as well as the potential association of its derangement in the setting of thrombophilia, with infertility, ART, ovarian hyperstimulation syndrome, and failure of implantation are explored. Additionally, current evidence addressing the relationship between ART and thromboembolism is examined, as is the role of therapy with heparin and aspirin to decrease thrombotic risk and improve ART-related pregnancy outcomes. Evidence-based recommendations from relevant professional societies are summarized.

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infertility

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last seen: 2026-06-10T17:14:06.276822+00:00
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