Status of the coagulation and fibrinolytic systems in ovarian hyperstimulation syndrome

Objective: To elucidate characteristic changes of plasma hemostatic markers in ovarian hyperstimulation syndrome (OHSS) cycles. Design: Prospective study. Setting: The IVF-ET program of the Department of Obstetrics and Gynecology, The University of Akita, School of Medicine. Patients: Forty cycles of 40 IVF patients, including 12 cycles in which a severe form of OHSS occurred. Interventions: Blood samples were taken during IVF treatment to determine the levels of blood markers that reflect activation of the coagulation and fibrinolytic systems. Main Outcome Measures: Thrombin-antithrombin III complexes, plasmin-alpha(2) antiplasmin complexes, and other hemostatic markers related to the coagulation and fibrinolytic system activation. Results: In the OHSS cycles, the levels of thrombin-antithrombin III and plasmin-alpha(2) antiplasmin complexes in the plasma began to rise within a few days after hCG administration and demonstrated significantly higher levels during the midluteal phase. In OHSS cycles with pregnancy, elevation of these markers continued for greater than or equal to 3 weeks after the onset of disease. There were some characteristic changes in OHSS cycles in other hemostatic markers, such as a decrease in the levels of antithrombin III and prekallikrein and shortened activated partial thromboplastin time. Conclusion: These data demonstrate the status of the coagulation and fibrinolytic systems in OHSS cycles and provide insight into the mechanism of activation in the hemostatic system.