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M. Angeles Martínez-Zamora1, Montserrat Creus1, Dolors Tassies2, Juan Carlos Reverter2, Salvadora Civico1, Francisco Carmona1 and Juan Balasch1,*1Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain 2Hemotherapy and Hemostasis Unit, Faculty of Medicine-University of Barcelona, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain *Correspondence address. Tel: +34-932275436; Fax: +34-932279325; E-mail: jbalasch{at}ub.eduReceived September 18, 2010. Revision received October 21, 2010. Accepted November 26, 2010. BACKGROUND Recurrent implantation failure (RIF) following embryo transfer (ET) is a major continuing problem in IVF. Women with haemostatic defects may be at increased risk of miscarriage and preclinical pregnancy loss. The fibrinolytic system is considered, at present, the key to new thrombotic pathogenic mechanisms. Patients with unexplained recurrent miscarriage have an impairment of fibrinolysis, as demonstrated by prolonged clot lysis time (CLT) in association with increased plasma levels of thrombin-activatable fibrinolysis inhibitor (TAFI). In this study, we investigated fibrinolytic potential in patients with RIF. METHODS Three groups of patients were studied: 30 women with RIF (RIF group), 60 patients undergoing a first successful IVF–ET cycle (IVF group) and 60 healthy fertile women (FER group). Plasma CLT was measured using a global fibrinolysis assay. TAFI antigen plasma levels and polymorphisms in the TAFI gene (+505A/G and +1542C/G) were analysed using enzyme-linked immunosorbent assay and allele-specific PCR, respectively. RESULTS CLT was significantly longer (P< 0.0001 and P< 0.0009, respectively) and TAFI antigen levels were significantly higher (both P< 0.0001) in the RIF versus the IVF and FER groups. A direct relationship between CLT and TAFI antigen levels (r = 0.40; P = 0.001) was detected in the whole study population. There were no differences in distribution of TAFI polymorphisms between groups. CONCLUSIONS Patients with RIF have reduced plasma fibrinolytic potential, as shown by a prolonged CLT, and this may be explained, at least in part, by increased TAFI antigen levels. © The Author 2011. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com This ArticleHum. Reprod. (2011) 26 (3): 510-516. doi: 10.1093/humrep/deq369 First published online: January 7, 2011
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