الفهرس 
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Abstract
T
he predominant part of IVF cycles results in embryo transfer, but only about one third of all cycles reach clinically achieved pregnancy. This is evidence that most embryos failed in an early stage of pregnancy achievement. Recurrent implantation failure after IVF procedures emphasize the clinical importance of this crucial step in assisted reproductive technology. Repeated unsuccessful IVF attempts force efforts to investigate the firm mechanism of the implantation and to find approach to increase pregnancy outcome success.
Plenty of factors have been recognized to affect either success, or failure rate of IVF embryo transfer.
Hereditary thrombophilia may pay a role in repeated ivf failure through alteration in endometrium blood vessels leading to implantation failure.
The aim of this study is to evaluate the effect of congenital thrombophilia on embryo implantation in an IVF cycle as to make proper management leading to increase IVF success rate.
The study enrolled 30 consecutive patients with recurrent IVF failure. They were recruited from sunrise fertility center during the period between 2017 and 2018 all patients aged from 20-40 years old.
All patients were negative for prothrombin mutation G20210→A. Factor V Leiden G1691→A mutation was detected in 4 patients (13.3%); all of them were heterozygous for the mutant allele. Methylene tetrahydrofolate reductase C677→T mutation was detected in 17 patients (56.7%); only one of them was homozygous for the mutant allele. Also, age was not related to the presence of thrombophilia (p = 0.249). Age of patients with thrombophilia was 32.3±3.6 years compared to 33.8±4.4 years of those without thrombophilia.
Repeated Genetic causes of thrombophilia are associated with the occurrence of or recurrent pregnancy loss. In this respect, the role of FVL has been clearly demonstrated, whereas prothrombin A20210 mutation is more controversial. There is, however, no consensus on the type of inherited thrombophilia associated with recurrent pregnancy loss.
Studies reporting the prevalence of FV Leiden mutation among women with recurrent pregnancy losses (RPL) cite figures ranging from 3 to 42%. Many reports find an association between high prevalence of the FVL mutation and RPL. Brenner et al. (1999) tested women with 3 or more first trimester losses, 2 or more second trimester losses or one or more third trimester loss. The FV Leiden mutation was more frequent in the fetal loss group compared to control. These mutations are reported to have a role in IVF implantation failure or in pregnancy loss after IVF. The role of hereditary thrombophilia in recurrent IVF failure is implicated. Thrombophilia may act by impairing the initial vascularization process occurring at implantation, which is necessary for a successful pregnancy.
However, there are limited data on the association between thrombophilia, hereditary or acquired, with female infertility and IVF failure. Therefore, the aim of this study was to evaluate the effect of congenital thrombophilia on embryo implantation in an IVF cycle as to make proper management leading to increase IVF success rate.
Conclusion
• IVF failure was associated with heterozygous Factor V Leiden G1691→A mutation in 13.3% of the patients.
• IVF failure was associated with Methylene tetrahydrofolate reductase C677→T mutation in 56.7%; one of them was homozygous for the mutant allele.
• Methylene tetrahydrofolate reductase C677→T mutation is the most frequent thrombophilia mutation in cases with recurrent IVF failures.
• Prothrombin G20210→A mutation was absent in women with recurrent IVF failures.
• In view of the historic controls from Egypt and other countries in the word, MTHFR and FVL mutations appear to be positively associated with recurrent IVF failures.