NEW YORK (Reuters Health) – Routine screening for coagulation abnormalities before oocyte retrieval for in vitro fertilization (IVF) is costly and not clinically effective, researchers from Israel found in a retrospective study.

In their experience, they say, more than 500 coagulation tests would be needed to prevent one case of bleeding associated with an abnormal coagulation test result.

At Hadassah-Hebrew University Medical Center, Jerusalem, it has become routine to do coagulation screening in all women before each oocyte retrieval procedure, Dr. Ariel Revel and colleagues note in their report published online November 10 in the journal Fertility and Sterility.

To test the utility of this policy, they took a look-back of all ultrasound-guided transvaginal oocyte retrievals performed between 1998 and 2002.

A total of 2,160 procedures were performed in 1,132 women, with most of the women having up to three retrieval procedures. Coagulation test results were missing in 23 procedures (1.1%); of the remaining 2,137 procedures, only 78 (3.6%) were abnormal.

Prolonged partial thromboplastin time (PTT), ranging from 42 to 52.4 seconds, was the most common abnormality, observed in 62 of 2,137 procedures, or 2.9%. Abnormal prothrombin time (PT; INR range 1.5 to 2.21) was seen in 15 procedures (0.7%).

Procedure-related bleeding, defined as acute bleeding requiring hospital admission and/or blood transfusion during the week after the procedure, was “undeniably rare,” the clinicians note, occurring in just 7 of 2,160 procedures, or 0.32%. Moreover, there was no association between procedure-related bleeding and abnormal coagulation (p = 0.23).

“Only one patient had hemorrhage in the presence of abnormal coagulation,” Dr. Revel and colleagues report, and they calculate that 534 coagulation tests would be needed to prevent and/or identify one bleeding event, at a cost of $45,390 (534 tests times an estimated $85 per test).

Dr. Revel and colleagues also report that systematically assessing a woman’s bleeding history didn’t help predict procedure-related bleeding, but this could be due to the small number of women with persistent abnormal coagulation and to the retrospective data collection.

“Until prospective data are available, we believe that a personal and family bleeding history should be taken before every procedure,” they conclude.

Reference:

Is routine screening needed for coagulation abnormalities before oocyte retrieval?


Fertil Steril 2010.