Explore the possibility of conceiving with a coagulation disorder and understand the potential challenges you may face when starting a family.

Key Facts

  • Coagulation disorders can be either congenital or acquired.
  • Women with coagulation disorders face an increased risk of pregnancy complications.
  • Coagulation disorders often result in more frequent recurrent pregnancy losses.
  • Hormonal stimulation and pregnancy can slightly elevate the risk of thrombosis during IVF.
  • If required, blood thinners can be administered to mitigate the risk of thrombosis.

Introduction

If you're unable to conceive or have experienced multiple miscarriages, a coagulation disorder may be the reason. Such disorders are often congenital or developed over time.

Typically, when an injury occurs, the body forms a blood clot to halt bleeding. This process involves the coordination of various proteins (clotting factors), platelets, and other elements.

However, in cases of coagulation disorders, this process can be disrupted, leading to either an increased bleeding tendency or a heightened risk of thrombosis (thrombophilia).

  • Coagulation Deficiencies: In these disorders, blood clots too slowly or not at all, resulting in extended bleeding and bruising. Examples include haemophilia A and B, and Von Willebrand syndrome.
  • Thrombophilia: This term encompasses various blood clotting disorders where blood clotting is amplified and thrombi (blood clots) form more frequently. Thrombophilia can be inherited, or triggered by age or lifestyle factors (like smoking or obesity). Examples are the factor V Leiden mutation or a protein S deficiency.

Coagulation disorders can stem from various causes, such as genetic predisposition, autoimmune diseases (like antiphospholipid syndrome), cancer, certain medications, and pregnancy.

Blood cells

Can I become pregnant despite a coagulation disorder?

Yes, women with a coagulation disorder can still become pregnant and carry a child to term. However, thrombophilia can sometimes affect fertility. Impaired blood clotting may interfere with the implantation of the embryo or lead to a miscarriage.

A blood test can identify a coagulation disorder. This allows for the implementation of necessary measures during fertility treatment, minimising potential complications.

A blood coagulation test is especially recommended for pregnant women or women wanting to conceive who:

  • have previously experienced thrombosis
  • have a family history of thrombosis
  • have had repeated miscarriages
  • have had pre-eclampsia

How do coagulation disorders impact fertility and pregnancy?

Studies have established a link between elevated blood clotting tendency (hypercoagulability) and various fertility issues such as unexplained infertility, implantation failure, and recurrent miscarriages.

Blood coagulation disorders can influence both the ability to conceive and the capacity to carry a pregnancy to term:

Placental Function and Coagulation

  • Impaired Blood Supply: The placenta requires a sufficient blood supply to deliver oxygen and nutrients to the fetus. In the presence of coagulation disorders, the placenta's blood supply may be compromised, potentially leading to fetal undernourishment. This can result in growth retardation or, in severe cases, miscarriage.
  • Placental Infarcts: Blood clots can occasionally form in the placenta, creating small "infarcts" or dead placental areas, which can hamper the placenta's function.
  • Hemorrhages: Coagulation disorders can cause increased blood loss when the placenta detaches after birth. This could result in maternal anemia (anemia) and, in rare instances, can be life-threatening.

Increased Risk of Pre-eclampsia

Women with coagulation disorders have an increased risk of pre-eclampsia, which is characterised by increased blood pressure and protein excretion. Pre-eclampsia can lead to severe complications for both the mother and child, including organ damage, premature birth, and in severe cases, death.

Implantation Failure

Coagulation disorders can affect the implantation of the embryo in the endometrial lining of the uterus in several ways:

  • Disruption of Blood Supply to the Uterine Lining: The uterine lining needs an adequate blood supply to provide nutrients and oxygen to the embryo. Coagulation disorders can impair the blood supply to the uterine lining, making the implantation of the embryo more challenging.
  • Formation of Blood Clots: Coagulation disorders can cause blood clots in the uterine lining. These blood clots can prevent the embryo from implanting or cause a miscarriage.
Pregnant woman in yellow dress

What are the risks of a coagulation disorder during pregnancy?

The impact of a coagulation disorder on pregnancy significantly depends on various factors. These include the specific type of blod clotting disorder, the woman's individual risk factors, and the medical care she receives.

The typical scenarios are:

  • Not all women with coagulation disorders will experience complications during pregnancy.
  • Women with certain coagulation disorders, such as Factor V Leiden or prothrombin mutation, may have a higher risk of pregnancy complications.
  • Nevertheless, with suitable prevention and treatment measures, most pregnancies in women with coagulation disorders can be successful.

What should I consider if I'm pregnant and have a coagulation disorder?

  • Before pregnancy: Women with coagulation disorders should consult with their gynecologist regarding potential risks and necessary precautions before becoming pregnant.
  • During pregnancy: Regular antenatal check-ups are crucial to identify and address possible complications early on. In some instances, medication with blood thinners may be needed to lessen complication risks. Compression stockings might also be suggested to lower the risk of thrombosis.
  • After birth: Women with known coagulation disorders like factor V Leiden or prothrombin mutation face up to a 10-fold increased risk of vascular occlusion (pregnant women with factor V Leiden even face a 30-fold increased risk). After consulting with the attending physician, thrombosis prophylaxis may be continued or initiated in the postpartum period.
Feet in white sneakers

Risk of thrombosis with assisted reproduction

The risk of thrombosis, or blood clotting, during IVF is slightly increased compared to a spontaneous pregnancy.

This can be attributed to various factors:

  • Hormonal Stimulation: The hormones used in in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) can affect blood clotting, thus increasing the risk of thrombosis.
  • Pregnancy: Pregnancy itself generally increases the risk of thrombosis as the blood volume and coagulation factors increase. Hormonal changes during pregnancy can further elevate this risk.
  • Other Risk Factors: Women who have had a thrombosis in the past or have other risk factors such as obesity, smoking, lack of exercise or a family predisposition are at an additional risk.

The exact risk is hard to quantify as it relies on various factors. One study found that women who become pregnant after IVF followed by embryo transfer have a more than 8-fold increased risk of venous thromboembolism and pulmonary embolism in the first trimester, compared to women who become pregnant naturally. In contrast, women with cryotransfer in the first trimester did not show an increased incidence of venous thromboembolism.

However, it's crucial to note that the absolute risk remains low. Out of every 1,000 women undergoing IVF treatment, approximately 4 will experience a thrombosis.

Depending on individual risk, preventive treatment with blood-thinning medication (e.g. heparin) may be recommended.

What are the symptoms of a coagulation disorder?

Many women are unaware that they have a coagulation disorder. They often only discover it when they struggle to conceive.

Common symptoms of a heightened bleeding tendency include:

  • Frequent nosebleeds
  • Minor bruising
  • Heavy menstrual flow
  • Extended bleeding after injuries or surgeries
  • Blood in stool or urine

Symptoms of an increased risk of thrombosis include:

  • Deep vein thrombosis (DVT): Pain, swelling, and redness in a leg vein
  • Pulmonary embolism: Sudden shortness of breath, chest pain, coughing, and spitting up blood
  • Stroke
  • Heart attack

Takeaway

Women with a coagulation disorder can still conceive and give birth to a healthy child. However, they have a higher risk of miscarriage, pre-eclampsia, premature birth, and thrombosis. With appropriate prevention and treatment, most pregnancies with coagulation disorders can be successful.

If you suspect you might have a blood clotting disorder, we recommend getting tested prior to starting fertility treatment. This allows us to optimise your treatment plan and reduce any complications due to a coagulation disorder.

If you have an increased risk of bleeding or thrombosis, please discuss this during the free initial consultation.