Correlation between coagulation abnormalities and in vitro fertilization outcomes in infertile patients with endometriosis: a retrospective cohort study
- 1hijiazhuang Maternal and Child Health Care Hospital, Shijiazhuang, Hebei, China
Abstract
ObjectiveTo investigate coagulation function in infertile patients with endometriosis (EMs) undergoing IVF-ET and analyze its correlation with reproductive outcomes, providing evidence for perioperative optimization.MethodsThis retrospective cohort study included 216 infertile patients (108 with EMs, 108 age-matched tubal-factor controls) undergoing IVF-ET from 2022 to 2024. Only the first IVF cycle and first embryo transfer per patient were included in the primary analysis to ensure independence of observations. Coagulation parameters (PT, APTT, TT, FIB, D-dimer, AT-III) were measured before controlled ovarian hyperstimulation. Coagulation abnormality was defined as the presence of at least one of the following: FIB > 4.0 g/L, D-dimer > 0.5 mg/L, or AT-III < 75%. PT, APTT, and TT were analyzed as continuous variables because no validated consensus threshold exists for defining shortened PT/APTT/TT as a hypercoagulable state. Baseline characteristics, COH parameters, IVF outcomes, and confounders were compared. EMs patients were stratified by this coagulation abnormality definition. Hierarchical logistic regression was used to identify factors associated with live birth failure.ResultsEMs patients showed significantly shortened PT/APTT/TT, elevated FIB and D-dimer, and decreased AT-III when these parameters were analyzed as continuous variables (all P < 0.05); however, PT/APTT/TT were not used to classify patients as having coagulation abnormality. Based on the composite definition including FIB, D-dimer, and AT-III, the incidence of coagulation abnormalities was 48.15% (52/108) in the EMs group versus 7.41% (8/108) in the control group (P < 0.001). Among EMs patients, those with coagulation abnormalities had lower high-quality embryo rate, implantation rate, and live birth rate, and higher early abortion rate (all P < 0.05). Live birth rates decreased progressively across 0, 1, 2, and 3 abnormal parameters among FIB, D-dimer, and AT-III (44.6%, 29.6%, 16.7%, and 0.0%, respectively; P-trend = 0.002). In fully adjusted models, elevated D-dimer (OR = 2.864, 95% CI: 1.427–5.748, P = 0.003) and decreased AT-III (OR = 0.512, 95% CI: 0.276–0.949, P = 0.034) were independently associated with live birth failure, while high-quality embryo rate was protective (OR = 0.326, 95% CI: 0.154–0.689, P = 0.003). After additional adjustment for high-quality embryo rate, the association between elevated D-dimer and live birth failure was attenuated but remained statistically significant. This attenuation was interpreted as a change in the adjusted association rather than as evidence of causality. Fibrinogen was not significant (P = 0.227). In multivariable models, elevated D-dimer and decreased AT-III were independently associated with live birth failure after adjustment for embryo quality. Subgroup analysis suggested stronger associations in stage III–IV EMs, but this finding was exploratory.ConclusionCoagulation abnormalities, defined by FIB, D-dimer, and AT-III, were more frequent in infertile EMs patients and were associated with adverse IVF outcomes. Elevated D-dimer and decreased AT-III were independently associated with live birth failure. These findings are exploratory; routine D-dimer and AT-III testing cannot currently be recommended until prospective validation is available.
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BibTeX
@article{du2026correlation,
title = {{Correlation between coagulation abnormalities and in vitro fertilization outcomes in infertile patients with endometriosis: a retrospective cohort study}},
author = {Xiufang Du and Wenjing Hu and Changna Fu},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1888342},
url = {https://doi.org/10.3389/fmed.2026.1888342},
note = {CC BY},
}
RIS
TY - JOUR
TI - Correlation between coagulation abnormalities and in vitro fertilization outcomes in infertile patients with endometriosis: a retrospective cohort study
AU - Xiufang Du
AU - Wenjing Hu
AU - Changna Fu
PY - 2026
DA - 2026/10/23
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1888342
UR - https://doi.org/10.3389/fmed.2026.1888342
AB - ObjectiveTo investigate coagulation function in infertile patients with endometriosis (EMs) undergoing IVF-ET and analyze its correlation with reproductive outcomes, providing evidence for perioperative optimization.MethodsThis retrospective cohort study included 216 infertile patients (108 with EMs, 108 age-matched tubal-factor controls) undergoing IVF-ET from 2022 to 2024. Only the first IVF cycle and first embryo transfer per patient were included in the primary analysis to ensure independence of observations. Coagulation parameters (PT, APTT, TT, FIB, D-dimer, AT-III) were measured before controlled ovarian hyperstimulation. Coagulation abnormality was defined as the presence of at least one of the following: FIB > 4.0 g/L, D-dimer > 0.5 mg/L, or AT-III < 75%. PT, APTT, and TT were analyzed as continuous variables because no validated consensus threshold exists for defining shortened PT/APTT/TT as a hypercoagulable state. Baseline characteristics, COH parameters, IVF outcomes, and confounders were compared. EMs patients were stratified by this coagulation abnormality definition. Hierarchical logistic regression was used to identify factors associated with live birth failure.ResultsEMs patients showed significantly shortened PT/APTT/TT, elevated FIB and D-dimer, and decreased AT-III when these parameters were analyzed as continuous variables (all P < 0.05); however, PT/APTT/TT were not used to classify patients as having coagulation abnormality. Based on the composite definition including FIB, D-dimer, and AT-III, the incidence of coagulation abnormalities was 48.15% (52/108) in the EMs group versus 7.41% (8/108) in the control group (P < 0.001). Among EMs patients, those with coagulation abnormalities had lower high-quality embryo rate, implantation rate, and live birth rate, and higher early abortion rate (all P < 0.05). Live birth rates decreased progressively across 0, 1, 2, and 3 abnormal parameters among FIB, D-dimer, and AT-III (44.6%, 29.6%, 16.7%, and 0.0%, respectively; P-trend = 0.002). In fully adjusted models, elevated D-dimer (OR = 2.864, 95% CI: 1.427–5.748, P = 0.003) and decreased AT-III (OR = 0.512, 95% CI: 0.276–0.949, P = 0.034) were independently associated with live birth failure, while high-quality embryo rate was protective (OR = 0.326, 95% CI: 0.154–0.689, P = 0.003). After additional adjustment for high-quality embryo rate, the association between elevated D-dimer and live birth failure was attenuated but remained statistically significant. This attenuation was interpreted as a change in the adjusted association rather than as evidence of causality. Fibrinogen was not significant (P = 0.227). In multivariable models, elevated D-dimer and decreased AT-III were independently associated with live birth failure after adjustment for embryo quality. Subgroup analysis suggested stronger associations in stage III–IV EMs, but this finding was exploratory.ConclusionCoagulation abnormalities, defined by FIB, D-dimer, and AT-III, were more frequent in infertile EMs patients and were associated with adverse IVF outcomes. Elevated D-dimer and decreased AT-III were independently associated with live birth failure. These findings are exploratory; routine D-dimer and AT-III testing cannot currently be recommended until prospective validation is available.
SN - 2296-858X
ER -