Life after the transfer in the IVF program. D-dimer during pregnancy: to avoid unnecessary worries

12.08.2019

In vitro fertilization is a complex process, with mandatory monitoring of the woman's condition before entering the protocol and during it. During IVF, patients have to undergo numerous tests, monitor hormones and other indicators that will help reproductive specialists choose the right treatment tactics. One such assay is the dimer after embryo transfer. But in order to correctly interpret the results obtained, it is necessary to know what is the rate of the indicator, under what conditions it must be monitored and adjusted and what it affects.

Characteristics of the indicator

The d dimer itself is a degradation product of the fibrinogen protein. The latter is involved in the process of direct blood clotting, stopping bleeding. This is how our body works - there is a threat to lose vital blood, you need to start reacting, a complex reaction mechanism is triggered, which contributes to the "baking" of blood.

Determining the level of an indicator in the blood can indicate a serious problem with the blood. An increased d-dimer often indicates a tendency to form blood clots, blood thickening, and the presence of pathology in the blood coagulation system. These factors are indisputably important for any pregnancy, both natural and IVF.

To identify the concentration, an extended coagulogram is usually performed (other names are hemotest, hemostasiogram). In the basic packages of different laboratories, the indicator d dimer is not always included

Controlling the d dimer will at least make sense if, during pregnancy planning, before embryo transfer, a pathology or mutation in the blood was detected.

Thick blood will deliver little nutrients to the baby in the uterus, there will be a threat of fetal hypoxia, and too thin blood can provoke severe bleeding during childbirth or early pregnancy. But some doctors are inclined to argue that the d-dimer analysis itself after embryo transfer is not informative enough. To clarify the situation, it is sometimes necessary to donate blood for a number of additional studies.

Therefore, it would be more rational to define q dimer before eco. In most cases, if doctors prescribe this analysis, then after embryotransfer, after implantation has occurred. Usually women donate a dimer after embryo transfer on day 5. There is an opinion that the very process of embryo attachment can provoke a jump in the indicator.

Change in indicator

An increased dimer during eco is a phenomenon that almost every woman in the protocol encounters. After replanting the embryos, patients are often prescribed special anticoagulants that thin the blood in certain doses.

There are factors that can indicate the answer to the question of why the dimer rises after embryo transfer:

embryo implantation process;
the effect of hormone therapy;
a natural physiological process - with the onset of pregnancy, the blood thickens a little;
the presence of previously not diagnosed pathologies in a woman's body.

It is very important to understand that in this situation the rate of dimer after embryo transfer will differ from the usual ones, and any self-medication - an increase in the dose of the drug, its replacement with another analogue or spontaneous prescription can nullify the efforts of reproductive specialists.

The blood will thin so much that bleeding is inevitable. No wonder, by nature, a certain thickening of the blood is conceived during pregnancy, and if the pregnancy is multiple, then the dimer with twins or triplets will be larger.

Why does d dimer grow after transfer? As mentioned above, the value of the indicator can increase immediately at the time of implantation or in the presence of health problems in a woman not related to pregnancy. The high D dimer after IVF is also directly related to hormonal therapy, estradiol in particular. Large doses of the hormone used often lead to unpredictable growth spikes in the d-dimer. The ability of estradiol to affect blood clotting has been proven.

Allowable norms

The analysis of this indicator has been applied relatively recently. A little more than 20 years ago, it was discovered and successfully recommended in medicine, as a reliable assistant in the diagnosis of a number of diseases. A number of the latest studies conducted in the past few years argue that there is no connection with the level of dimer and implantation, the risk of a missed pregnancy and other similar problems. For this reason, many doctors do not prescribe monitoring of this indicator.

But, nevertheless, most specialists adhere to the tactics of monitoring and responding in a timely manner to any deviations from the norm in blood clotting indicators during IVF, and dimer in particular. The scheme is as follows - if fibrinogen is normal, and d dimer is increased, you can still wait a day or two, retake the analysis, if, on the contrary, fibrinogen is increased, and d dimer is normal, you should take action immediately.

The most commonly used drugs in this case are fraxiparin, clexane. The main thing is not to overdo it, since too low a dimer after embryo transfer is fraught with bleeding and miscarriage, and during pregnancy, profuse bleeding during childbirth.

What dimer should be after embryo transfer? The average value of the indicator should not exceed 280 ng / ml from the first to 13 weeks, 700 ng / ml for 21 weeks, 850 ng / ml before 29 weeks and 1550 ng / ml after 35 weeks. It is important to distinguish between units so that there is no confusion. But measures taken on time are capable of maintaining pregnancy even at such a level as d dimer 2000.

Delivery of analysis

If a woman has not been assigned a blood test for the concentration of d dimer, but she wants to track its dynamics on her own, it is worth taking note of the following information.

In order for the result of the analysis to be as reliable as possible, there are certain recommendations that will tell you how to take the d dimer correctly:

it is better to take blood samples in the morning and on an empty stomach;
for 12 hours, you should limit water consumption to the usual level;
coffee, sweet tea will have a negative impact;
during the week prior to the date of the intended analysis, you should adhere to the principles of a healthy diet.

Also, if a woman is taking any medications, this should be reported to the doctor when donating blood for research.

Where to take a dimer? Reproductive clinics do not always carry out such tests. Often the doctor himself, leading the patient or already a hematologist, can recommend a laboratory that has sufficient technical equipment and experience in conducting a hemostasiogram. You can also be guided by the reviews of other women who have already donated blood for research.

Answering the question, how much does the dimer analysis cost, we can say that the price of the study is, for the most part, quite acceptable. Depending on the institution, the cost ranges from 900 to 1600 rubles. It should be noted that the cost of collecting material may be added to the indicated amount. The urgency of the analysis also plays a role. In the standard, it is performed in a day, in some cases an express test is possible.

The coagulogram after the embryo transfer should be deciphered by a doctor, preferably a hematologist, not only by a reproductive specialist conducting the protocol. Ideally, with sufficient experience in observing pregnant women after IVF. Since the standard values will differ significantly from the indicators of ordinary people. The influence of the hormones taken on the woman, the presence or absence of blood clotting pathologies in the patient's family must be taken into account.

They say that the most powerful adrenaline rush is not a roller coaster, but waiting for the result of a pregnancy test. This is especially true for a patient after IVF. The embryo is transferred. Much has already been passed, a lot of effort, time, money has been spent. There are two weeks of endless waiting ahead….
What happens during this period? The body has already gone through a lot. Prescribed drugs (primarily progesterone and its derivatives) are designed to create optimal conditions for pregnancy. There are no other, more effective medicines for this stage yet. It remains to be patient and wait.

At this time, mild cramping pains, scanty spotting or even light bleeding, slight bloating, general fatigue and chest soreness may bother you. Symptoms shouldn't get worse. Their presence (as well as their absence) does not mean that the pregnancy has not occurred.

Please note that if, after completing the IVF program, there is excessive, increasing bloating and soreness in the abdomen, shortness of breath, chest pain, or impaired urination, you should urgently contact your clinical team, as these are the first signs of hyperstimulation syndrome and intensive therapy is likely to be required.

But even if all is well, painful doubts, forebodings do not leave:

Please tell me, the absence of discharge or some other symptoms, does it indicate that the implantation did not take place again? Today I have a 3DPP for two five days, according to the timing it should already happen. The first 2 days my lower abdomen ached, today I feel like an astronaut. I am very worried that there are NO sensations AT ALL …….

Help with advice: transfer of 3 good quality blastocysts. here is my HCG 5DPP - 2.8 (I have already decided that the flight and all appointments performed mechanically), 12DPP - 118.8 (I was very surprised), 14DPP 253.1. I do not fit into the table of hCG norms. what can be done to stretch the baby? This is already the 8th transfer.

Tell me, please, if on 7 DPP a three-day hCG is negative, is it possible to hope for a pregnancy?

Questions like this are common. In this connection, I would like to talk a little more about the early diagnosis of pregnancy, about how hCG grows, and whether it is worth making any predictions based only on its values. Are laboratory studies of hormone levels and indicators of the blood coagulation system justified at this stage?

I'll start with the main thing: HCG (human chorionic gonadotropin)- a special hormone of pregnancy. It is an important indicator of the development of pregnancy and its deviations. Chorionic gonadotropin is produced by the cells of the embryonic membrane immediately after it is attached to the wall of the uterus (implantation). Based on the figure obtained, the doctor determines the presence of fetal tissue in the body, and therefore the onset of pregnancy in a woman.

The level of hCG blood can be determined as early as 6-8 days after implantation, which suggests pregnancy (the concentration of hCG in the urine depends on the sensitivity of the test and usually reaches the diagnostic level 1 to 2 days later than in the blood serum). It is worth noting that the timing of the appearance of the first positive hCG values and the rate of its increase are similar, but in 15% of cases they do not fit into generally accepted norms and require more careful observation to make a correct diagnosis.

In 85% of cases the normal course of pregnancy, between 2 - 5 weeks, accompanied by a doubling of hCG every 72 hours... The peak concentration of hCG falls on 10-11 weeks of pregnancy, then its concentration begins to slowly fall. This is the result of the work of the "embryo-placenta" complex, it is the placenta that begins to independently maintain the necessary hormonal background. The body does not need a high content of hCG by this time.

Increased levels of human chorionic gonadotropin during pregnancy can occur with:
normal uterine pregnancy (individual characteristics in 10-15%)

multiple pregnancy
toxicosis
maternal diabetes mellitus
some genetic pathologies of the fetus
trophoblastic disease
incorrectly set period of pregnancy
taking synthetic progestogens (drugs from the progesterone group)

Its increased values can also be seen within 7-10 days after an interrupted pregnancy (medical or spontaneous abortion). But the concentration of the hCG indicator in dynamics in these cases does not increase, but more often falls.

Low levels of human chorionic gonadotropin may mean that the gestational age has not been correctly set or be a sign of a serious disorder, such as:

ectopic pregnancy
undeveloped pregnancy
delayed fetal development
threat of spontaneous abortion
some other more rare conditions.

It is important to understand that a decrease in the value of hCG in repeated studies says only one thing: the development of the ovum has already stopped, it is impossible to reanimate it. An exception is a laboratory error (not often, but it does happen).

Optimal terms for determining the level of hCG 12-14 days after the transfer(lower probability of error). If a two-week wait is insurmountable for you, you can donate blood earlier, starting from 7-8 days, but after receiving any (positive or negative) value of conclusions, do not draw until you repeat the analysis 2-3 times in dynamics.

The values of hCG, depending on the duration of pregnancy, are in many laboratory tables, I will not repeat them here. But it is important to consider the following:

From 0 to 10.0 mIU / ml 13-14 days after transfer - no pregnancy.
From 10.0 to 25.0 mIU / ml doubtful value, which requires repetition, the presence of implantation is debatable.
From 25.0 mMEml and above, a positive value, an indicator of implantation.
When examining on the 16th day after puncture, the level of hCG in the blood is higher than 100 mMU / ml (for embryos of 3 days) or 130 mMU / ml (for embryos of 5 days) indicates high chances of successful pregnancy, while while at lower values, the likelihood of uterine progressive pregnancy is not high.
Any positive hCG digit dictates the need keep previously assigned support, first of all, progesterone preparations (krynon, progesterone, urozhestan, dyufaston and others). In controversial cases (the figure is below average, there is spotting from the genital tract, etc.), it is necessary to plan repeated hCG determinations every 4-5 days. With an increase in the value of hCG, one can unequivocally talk about a progressive pregnancy, but an ectopic pregnancy cannot be ruled out.
With a progressive decrease in hCG levels, maintaining supportive therapy is not worth it. This will only increase the time of uncertainty and vain hopes. The most common causes of missed pregnancies are genetic disorders of the fetus. As a rule, it is not possible to maintain a pregnancy with severe genetic abnormalities. And is it worth it? Discussion of supportive therapy should be discussed with your gynecologist.
More specific information about the onset of pregnancy can only be given by Ultrasound of the pelvic organs, which can be planned no earlier than 20-22 days after the transfer.
The dynamics of the increase in hCG can be assessed only when lack of hCG-containing drugs in support(rotten, chorionic gonadotropin, choragon and others). A trace concentration of externally administered hCG lasts from 5 to 15 days. depending on the dose received and the individual characteristics of the organism. A sufficient number of studies have been published indicating that the prescription of these drugs does not affect the prognosis, but significantly complicates the assessment of the results obtained.
The level of hCG after 5 days of embryo transfer is often slightly higher than after 3 days of transfer, and practically does not depend on whether the transfer was fresh or cryo.

Another "fashionable theme" - control of blood hormone levels in the period after the transfer in order to correct support drugs.

I want to get advice, I have 18dpp, hgch 970, support: dyufaston 2tab 3 times a day, divigel 2g. Folio, passed estradiol-725, progesterone -15.6 ... Tell me if there is sufficient support? And are hormones normal?

***

Help me understand, 3 DPP of blastocysts, today I passed progesterone 105.0 nmol / l (1 trim: 29.6 - 106), estradiol 68 pmol / l. Inzhest support 2.5.% 2 p. per day, kryynon at night, proginova 0.5 tablets per day. Is estradiol low? Perhaps more support for progynous needs to be increased?

The initial idea looked logical: you determine the level of hormones (progesterone and estrogens) in the blood and, knowing their norms, you adjust the medication prescriptions, like on a scale, adding a deficiency. These guidelines have existed in many manuals for a while. But in practice, everything turned out to be much more complicated.

First, the laboratory values of the hormone level during repeated studies in the blood vessel and in the uterine vessels (obtained during surgery) turned out to be different. The concentration of hormones in the tissue of the uterus was much higher.

Secondly, the production of hormones is pulsating in nature. One secretory impulse takes 60 to 90 minutes. Do not take the analysis multiple times during the day to calculate average concentrations?

Thirdly, the level of hormones is additionally supported by the vaginal forms of gestagens, which have a slightly different chemical formula than the progesterone we know. That is, they are in the blood, but they are not determined in the analysis (another formula).
Therefore, laboratory testing of progesterone levels is of limited clinical value because does not reflect his true concentration in uterine vessels and n e is a reason to change support... It is impossible, looking at the calm water surface near the coast, to estimate the speed of the river flow in the fairway.

In the later stages of pregnancy, when the "fetus-placenta" complex is included in the work, the concentration of progesterone can be one of the indirect signs of the progression of uterine pregnancy. But by this time, more reliable information can be obtained already during an ultrasound scan.

Determination of estrogens for the purpose of assessing the chances of pregnancy is even less promising. A high concentration of estrogen in the blood indicates only the severity of the hyperstimulation syndrome. Correlation between estrogen value and pregnancy rate has not been shown. In addition, the introduction of estrogens from the outside in the period after the transfer is far from always justified.

I'll write a little more about the myth of “ thick blood«:

I had a transfer of 2 five-day blastocysts. On the third day after the transfer, I passed the D dimer, the result was 2121.6 ng / ml !!! And on the fourth I passed the RFMK, the result was 12 mg / dl (the norm is 0.00-4.00). Kolya Fraxiparin 0.3 2 times a day and I take thromboass 100 mg. Please tell me, is it possible to indirectly assume that the implantation has taken place by such indicators? And why are such high rates dangerous?

Please tell me how often you need to monitor the D dimer after the transfer? And in general, is it advisable to do this? For some reason, doctors have an ambiguous opinion about high rates ... Some say that this is normal ... Others - that the therapy needs to be changed urgently, that it is very dangerous ...

The opinions of doctors in assessing this factor are really not unambiguous. In different clinics, one can hear directly opposite recommendations on the significance of altered hemostasis indices in the ART protocol. This brings confusion, misunderstanding, who is right, is it important to "monitor hemostasis" after the transfer? Does the appointment of low molecular weight fraxiparines affect the final result?

There are always controversial topics in science. This is one of them. I am close to the position about the absence of influence of fluctuations of some values of the coagulation system on the onset of pregnancy. An increase in a number of indicators of the hemostasis system is a kind of "patches" for the repair of blood vessels, protection from obstetric bleeding.

Studies show that the incidence of thrombophilia among women requiring IVF is the same as among completely healthy women - about 7%. During IVF in women with thrombophilia, the birth rate was the same (60.8% after 6 cycles) as in women without thrombophilia (56.8% after 6 cycles) - this means that the analysis for thrombophilia before IVF is not informative, detection and treatment of thrombophilia with IVF does not affect the prognosis. In addition, many external factors can contribute to "hemostasis disorders": stimulation of ovulation, follicle puncture, the onset of multiple pregnancies, and much more. Today, there are no absolute norms for coagulogram indicators for different conditions (except for assessing baseline indicators outside of stimulation and pregnancy). In this connection, I am sure that "monitoring of hemostasis" and the appointment of expensive fraxiparines, most likely, are only of commercial interest.

Blood clotting constantly increases during pregnancy, this process helps to avoid a lot of blood loss during childbirth. But an excessive increase or decrease can lead to serious complications, up to a miscarriage, therefore, throughout the entire period, doctors monitor coagulation, directing expectant mothers to a coagulogram (blood test). In its expanded version, one of the most important indicators for interpretation is D-dimer, the rate of which changes depending on the period.

Thrombus formation is a complex, multi-stage process. It is impossible to judge it by one indicator, therefore the D-dimer is interpreted taking into account other values of the coagulogram, as well as the duration of pregnancy and the state of health of the woman.

The D-dimer index is the amount of a protein fragment in the blood formed after the breakdown of fibrin. With its increased content, coagulability is increased, there is a risk of blood clots. When low, there is a risk of bleeding.

D-dimer formation is the result of a chain of responses to tissue and vascular damage:

after a violation of the integrity of tissues, fibrinogen (a blood protein dissolved in plasma) turns into fibrin;
fibrin (an insoluble protein) forms white polymer filaments that cover the lesion;
platelets and erythrocytes accumulate in this network, due to which a clot is formed that prevents bleeding;
cells of the damaged tissue are actively dividing, healing occurs;
after that, the thrombus is no longer needed, it breaks down with the formation of a D-dimer and other elements.

The norm of D-dimer in blood is variable. It depends on the age of the patient, his state of health, and during pregnancy - on the gestational age.

D-dimer test procedure

Blood for the study of clotting, including the determination of the concentration of D-dimer, is taken from a vein. It is better to come to the procedure in the morning, since the last meal should be at least 8 hours before the test. For this period of time, you need to give up not only food, but also from any drinks, with the exception of water.

The use of certain drugs may affect the results of the study. Therefore, you need to warn the laboratory assistant about all medications taken within the last 24 hours, or mark this information in a special form.

In what cases is a study prescribed?

All women need to take a basic coagulogram three times during pregnancy.

An extended blood coagulation study, which includes a D-dimer, is prescribed in the following cases:

according to the results of the previous study, blood clotting disorders were determined;
the woman has diseases accompanied by disorders of the coagulation system (liver disease, circulatory system, varicose veins, frequent nosebleeds or a tendency to bruise);
the pregnant woman has a gynecological or obstetric pathology or another risk factor is present (abruption, placenta previa, bearing twins or triplets, gestosis, cystic drift, acute fatty hepatosis);
the onset of pregnancy is the result of artificial insemination;
the woman has diseases of the heart, blood vessels, kidneys, autoimmune and hormonal disorders;
the pregnant woman has bad habits, intoxication (smoking, alcoholism, drug addiction).

The norm of the D-dimer index in pregnant women from the above groups may slightly differ from the generally accepted values. For the correct interpretation of the analysis result in each specific case, a doctor's consultation is necessary.

What indicators are the norm?

The norm during pregnancy for the D-dimer indicator is constantly changing: the longer the period, the higher the coagulability. In addition, the volume of circulating blood increases by 1-1.5 liters in order to supply oxygen not only to the mother's body, but also to the child. These two natural mechanisms help prevent significant blood loss during childbirth.

During pregnancy, by the end of the 9th month, the norm of the D-dimer indicator is 3-4 times higher than at the beginning of the term. Changes occur gradually, for each period there are certain rules for interpreting the analysis results.

First trimester

Norms of D-dimer during pregnancy in the first trimester are from 500 to 700 ng / ml. But these figures are relative, it is impossible to judge the state of a woman's health by them alone. When interpreting and evaluating the results, the doctor takes into account all the data of the hemostasiogram (coagulogram), as well as the characteristics of the health and well-being of the expectant mother.

Both an increase and a decrease in coagulation indicators are possible. How significant a deviation from the norm is and when it can affect the course of pregnancy can only be determined by a specialist.

Second trimester

The norm of D-dimer in women in the second trimester is up to 900 ng / ml. This is twice as high as before pregnancy. However, in practice, there are cases when the values exceed this limit, and the condition of the expectant mother and fetus remains normal.

If the D-dimer analysis showed that the blood clotting rate is exceeded for this period, the doctor may prescribe anticoagulants. As a rule, in such a situation, a woman is sent to a hospital under the supervision of a doctor.

Third trimester

D-dimer up to 1500 ng / ml is the norm during pregnancy in the third trimester, when the body of the expectant mother is intensively preparing for the birth of a baby. Sometimes the level of clotting remains practically unchanged during the first two trimesters and this is considered a normal variant. But in the last three months, the D-dimer should increase. If this does not happen, the doctor conducts additional diagnostics and prescribes treatment.

So, the norms of the D-dimer during pregnancy by trimester are relative values. The interpretation of the results of a blood clotting test is performed only on the basis of a comprehensive assessment.

D-dimer for IVF

Pregnancy resulting from IVF is one of the indications for an extended coagulogram, including a D-dimer. With artificial insemination, follicular growth is first stimulated, then the luteal phase of the cycle is maintained.

For this, a woman is prescribed hormonal drugs that increase blood clotting. The D-dimer during IVF is increased, but its norm has not been quantitatively determined, the doctor is guided by the dynamics of all coagulogram indicators while taking hormonal drugs and after they are canceled.

After the embryo has been transferred into the uterine cavity and fixed in it, drugs that reduce blood clotting can be prescribed. This prevents the development of disseminated intravascular coagulation, thrombophilia, and thrombosis.

Decoding the results

The analysis results indicate the concentration of D-dimer. Different laboratories may use dimer equivalent units (DDU) or fibrinogen equivalent units (FEU). Next to the numerical value, ng / ml is noted - nanogram / milliliter, mg / l - milligram / liter or μg / l - microgram / liter. The units of measurement are related to each other according to the formula: 1 mg / l DDU = 2 mg / l FEU.

Each laboratory has its own result sheet. Often they contain the line “reference values” - this is the norm of D-dimer in μg / L or mg / L.

But it must be remembered that deciphering the results does not provide complete information about the state of the blood coagulation system. In order to understand whether there is a threat to a woman and an unborn child, you need to seek advice from a specialized specialist.

What influences the research result?

The norm of D-dimer for non-pregnant women is 250 ng / ml. During pregnancy, the indicators are constantly growing, and by the end of the term they can be 1500 ng / ml and even more.

Diseases of the kidneys and liver, infections, diabetes mellitus, as well as complications of pregnancy: gestosis, acute fatty hepatosis, placental abruption can influence the study result towards an increase in D-dimer.

A decrease in blood clotting is rare; doctors talk about it when the D-dimer indicator is lower than the norm for non-pregnant women. This condition can be caused by taking certain medications, a deficiency of vitamins or proteins, congenital impairment of enzymatic links between coagulation factors, insufficient production of fibrinogen.

D-dimer is one of the indicators of blood clotting. During pregnancy, identification of its concentration is necessary only for those women who fall into the risk group (the presence of diseases, pregnancy complications, IVF, etc.).

The numerical values of the norm give an incomplete idea of the state of the coagulation system. The doctor evaluates the results on the basis of a comprehensive study (coagulogram), taking into account the duration of pregnancy and the state of health of the woman.

Useful video: the role of thrombophilia in miscarriage

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The formation of blood clots is an important process for the human body, as it helps to protect tissues in places where they are damaged and to limit the access of pathogenic bacteria and foreign bodies. The protein fibrin, which is the main building material for a blood clot, takes an active part in this process. When the body has restored the damaged tissue to a sufficient extent, it begins to destroy the already unnecessary thrombus - it starts fibrinolysis. During the breakdown of fibrin, one of the reaction products is its fragment - D-dimer. In clinical practice, the D-dimer is widely used to assess the activity of thrombus formation, as well as to control the action of thinning and thickening drugs (anticoagulants and coagulants, respectively).

D-dimer during pregnancy

Of particular importance is the analysis for D-dimer during pregnancy. It is included in the list of mandatory blood tests for pregnant women, as well as non-pregnant women when planning conception to assess the risk of unwanted blood clots.

In clinical practice, when analyzing for D-dimer, the following dimensions are used: mg / l, μg / ml, ng / ml, μg FEU / ml (micrograms of fibrinogen equivalent units per milliliter). does not exceed values up to 0.55 μg FEU / ml or from 0 to 500 ng / ml.

However, the D-dimer during pregnancy is significantly increased depending on the period. In the first trimester, it rises one and a half times. After the thirteenth week (second trimester), the D-dimer is increased 2.5–3 times. In the third trimester, the indicators of the protein fragment of fibrin should be increased up to four times.

Such a high level of D-dimer is the norm during pregnancy, therefore, it is not worth carrying out the transfer of these tests during pregnancy to the level of a healthy person. The increase is explained by the fact that the body intensifies all its functionality and is actively preparing for childbirth and the accompanying large blood loss. The rate of the D-dimer test during pregnancy is presented in table 1.

Table 1. D-dimer during pregnancy, reference values

In addition to pregnancy, excess of the D-dimer norm is initiated by three pathologies:

thromboembolism;
disseminated intravascular coagulation syndrome;
hereditary thrombophilia;

oncological diseases;
over 80 years of age;
inflammatory processes;
infectious diseases;
liver diseases.

If the analysis for D-dimer during pregnancy revealed an increase, then the risk of these diseases remains. It is important to note that the thoughtless use of anticoagulants in this case is very dangerous. These drugs lead to intense blood thinning in excess of the norm, while the activity of fibrin is reduced. During pregnancy, this can lead to early placental abruption and profuse bleeding after childbirth. According to statistics, this pathology is the most common cause of female death during childbirth.

When carrying several fetuses at the same time, the D-dimer during pregnancy can be increased even more. This fact can make it difficult to correctly diagnose. Accordingly, the doctor should prescribe drugs for you only after making sure of the source of the increase in D-dimer. With this approach to therapy, the risk of pathology is reduced.

D-dimer for in vitro fertilization

D-dimer in IVF is an important factor that can affect the success of the procedure. The purpose of in vitro fertilization at the first stage is to perform superovulation. The essence of this process is to artificially stimulate the maturation of follicles in the ovaries. For this, during the procedure, the patient is prescribed a large amount of hormones that stimulate the ovaries.

The high concentration of estrogen is one of the reasons for the significant increase in the level of D-dimer and the concomitant formation of thrombosis.

When carrying out IVF protocols at subsequent stages, it is recommended to control the D-dimer rate, especially immediately after embryo transfer. It is important to control the content of the protein fragment of fibrin after transfer to women who have a genetic or acquired predisposition to thrombosis:

close relatives have had strokes or acute heart attacks;
there were cases of thrombosis in the family before the age of 50;
unsuccessful attempts at fertilization;
a history of pregnancy difficulties.

It is worth noting that a woman must undergo all the necessary tests when planning a pregnancy before transferring the embryo. These studies will help prevent possible risks and carry out preparatory procedures. Immediately after the transfer of the embryo, the patient is prescribed antiplatelet agents or heparins with a low molecular weight for careful control over the rate of clotting.

It is worth noting that taking medications and performing all procedures before the transfer, after the transfer and throughout the pregnancy should be carried out only under the supervision of a hematologist and a gynecologist-reproductologist. In rare cases, taking specific medications of anticoagulants continues after childbirth, if there is evidence for that.

You should be especially careful about your health immediately after the embryo transfer procedure.

In this situation, the level of D-dimer slightly increases, which, on the one hand, may indicate a successful outcome of in vitro fertilization, but on the other hand, if the outcome is unsuccessful, this may indicate other diseases not related to pregnancy, in which case the level of D -dimer must be reduced to normal.

Women are advised to be attentive to their health both when planning pregnancy and throughout the entire period. Monitoring the level of indicators will allow you to monitor the development of pregnancy, as well as significantly reduce the risks in the mother and unborn child. It is up to you to decide how the child will be - healthy or not. If at least one analysis is overestimated or lowered, this is a reason to immediately consult a doctor for professional advice, as this can serve as an alarm bell for the development of a serious pathology. Do not be lazy to regularly visit specialists, consult, get tested and lead a healthy lifestyle.

D-dimer after embryo transfer is the most important element of diagnosis, since during IVF with accompanying hormonal therapy, hemostasis disorders are possible. Also, increased coagulation may be associated with autoimmune processes or infections. In any case, the situation affects the patient's condition.

In vitro fertilization protocols allow achieving effective vascular thrombosis - an important condition for successful implantation at first when interacting with the endometrium. D-dimer after embryo transfer is considered the most specific marker showing activation of the hemostatic system. It can be used to easily identify thrombophilia or thrombosis.

What is D-dimer diagnostics for after embryo transfer?

In almost all cases of the implementation of the IVF program, reproductologists and hematologists prescribe the dynamics of the D-dimer level. Especially if a woman is exposed to genetic and acquired risks. Among the complications requiring mandatory diagnosis, it is worth highlighting the following:

relatives with heart attacks and strokes;
personal and family history of thrombosis;
miscarriage and multiple attempts at artificial conception;
non-developing embryos;
delayed fetal development.

In case of complications, a D-dimer test is performed immediately after embryo transfer. If necessary, antiplatelet agents, low molecular weight heparins with dynamic control of coagulation are prescribed. Normally, the D-dimer rises after embryo transfer, although only slightly. It is blood clotting that can show doctors how high-quality placental nutrition, fetal development and other supporting indicators will be.

D-dimer after embryo transfer: continuous monitoring

Therapy and diagnostic examination are prescribed only under the strict supervision of specialists from the reproduction center and doctors-hematologists. Certain indications provide a basis for continuing treatment throughout pregnancy, as well as in the postpartum period. This is required to prevent thrombotic complications.

New research shows that a thorough examination significantly increases the likelihood of a successful in vitro fertilization program. But you cannot perform the procedures and manipulations on your own - self-medication leads to serious dangers and will not give the desired result.

Many women learn about the existence of D-dimer and analysis for it only after pregnancy. When registering with a antenatal clinic, he is appointed necessarily, therefore every woman preparing to become a mother is obliged to go through it.
When assessing the indicators of D-dimer, it is possible to indicate in time an increased tendency to thrombosis. It's not too late at this time correct blood clotting using therapeutic techniques. Previously, it was believed that a deviation from the norm of the D-dimer indicates the presence of pathologies, however, in modern times, doctors have refuted this assumption.

D-dimer: what is it?

In the human body, bleeding is sometimes unexpectedly provoked. This is especially true for pregnant women. Even small injuries of blood vessels and other elements that serve for transportation blood into organs and systems. The homeostasis system is designed to prevent this process. With her correct functioning vessels do not burst under the influence of minor factors, which allows you to maintain human health and avoid blood loss without good reason. With the help of a blood clotting system, a person can not worry even if damage has happened, since blood quickly stops... This system is provided with a wide range of reactions that, using various techniques, make the blood clot.

One of the main methods of homeostasis by the body's forces is the formation of a thrombus at the site of localization of the vessel damage. This process is impossible without the production of a special protein called fibrin. It works by forming filaments that make the blood thicken and thus seal up the hole until it heals.

When the primary wound healing occurs, the formed thrombus loses its meaning, so it is removed naturally, that is, disappears. This process is carried out with the activation of plasminogen, which is also a protein. Its action consists in the splitting of a blood clot into small parts, which allows you to remove a blood clot without delirium for the human body.

A high content of fibrin is observed in the blood clot, therefore, during its destruction, due to chemical reactions, decay products are produced that have an intermediate value. The most significant element is the D-dimer. When this indicator is found in the blood, even in a small amount, this fact means that blood clots have formed with the subsequent decomposition of a dried blood clot. The higher this indicator, the greater the risk of blood clots and associated unpleasant consequences.

D-dimer norm

There is a certain norm of D-dimer in the blood of an ordinary person. Optimally, this value is in the range of 400 -500 ng / ml, which is considered a small value. For a pregnant woman, this value cannot be applied, since significant changes always occur in the body immediately after its onset. Homeostasis of a pregnant woman very quickly rebuilt, as a result of which its increased activation is observed.

The longer the gestation period, the more the blood clotting processes are activated. This helps to keep the blood loss of the pregnant woman to a minimum. With the onset of pregnancy, the level of D-dimer increases, which is not testifies about pathological processes. The degree of overestimation of this indicator may indicate the presence of pathological processes in the body or a complication of the course of pregnancy.

D-dimer rate during pregnancy by week

Blood clots are formed not only during pregnancy, when they are its natural sign when homeostasis is activated, but also with various ailments. An increased level of D-dimer in both pregnant women and ordinary people may indicate the following pathologies:

Vein thrombosis even in the early stages.
Toxicosis in severe or advanced form.
Diabetes mellitus, even at small stages, in the absence of other signs.
DIC is a syndrome in which blood tends to clot directly in the vascular cavity.
Pulmonary embolism.
A pre-stroke condition, as well as a mild or severe stroke.

An increase in the D-dimer invariably indicates that the number and size of blood clots in the body are increasing. During pregnancy, this level may exceed the average, not only due to the fact of carrying a child, but also due to some pathological or unusual conditions.

Blood is taken from a vein. Before this, you should not eat or drink water for 12 hours. Special indicators reveal the presence and amount of fibrinogen protein in the blood. To find out the result, you need to wait no more than 15 minutes. This analysis classified as an express test.

If the results can be classify how satisfactory, then they must be left in storage until the passage of the entire pregnancy. When there are negative or too abrupt changes, it is necessary to consult a doctor, undergo a consultation, and in some cases an examination.

1 trimester: D-dimer norm

During the period of pregnancy, the exact norm of the D-dimer should not be determined, however there are certain restrictions, beyond which it can testify about the presence of pathologies. When contacting a specific laboratory, it is imperative to clarify with them the norms of this indicator, since they can set their own nominal values by which you can navigate during pregnancy.

There are various values that are indicated when registering the results of analysis for D-dimer, namely ng / ml, μg / ml, mg / l. Before conducting a study for the compliance of the results obtained with the norm, it should be ensured that the reconciliation takes place according to equal parameters.

It is impossible to diagnose a specific disease based on the D-dimer indicators, therefore there are no clear boundaries of its norm. For each woman, her own normal value is determined, at which nothing threatens her life and health. Navigate it is possible only by experience, that is, during the passage of the second and subsequent pregnancies. If the indicator significantly exceeds the average rate, it is necessary to undertake a thorough examination of the patient, followed by a diagnosis, which is the justification for the increased level. In most cases, when the D-dimer deviates from the norm, there are significant pathologies that occur in parallel with pregnancy or are its consequence.

To apply the D-dimer for diagnostic events, it is necessary, in case of negative indicators, to immediately carry out hemostasiogram... This is an analysis that shows the level of blood clotting. To draw certain conclusions, in addition to the indicators of these analyzes, it is necessary to take into account the general condition of the woman, the presence of pathologies or diseases, the duration of pregnancy. If necessary, a comprehensive study of pathologies is carried out. This measure is necessary if the D-dimer is growing steadily.

At the beginning of pregnancy, this indicator is usually exceeded when compared with indicators in a normal life. Starting from the initial days of pregnancy, there has been a steady but slow increase in this indicator. For 1 trimester, the normal D-dimer level is assumed to be 500 ng / ml and above. If we compare the results of the analysis for the entire first trimester when finding the average arithmetic, then it will be approximately 750 ng / ml.

Too low D-dimer can be seen extremely rarely. With a decrease in this level, one should not worry, since this indicator does not pose a danger. If this indicator is too underestimated, it is necessary to visit a hematologist and carry out a course diagnostic activities. Decreased performance can be regarded as a signal unsatisfactory the state of blood clotting processes. Also, this feature often indicates the risk of large blood loss during childbirth.

2nd trimester: D-dimer norm

In the 2nd trimester, the D-dimer increases and gradually reaches a value that is approximately 2 times higher than the norm observed before pregnancy. A value of about 900 ng / ml is considered the norm. Values exceeding one thousand units are also considered optimal. Moreover, this analysis cannot be diagnostic method, so it makes no sense to specify the numbers. If in the 2nd trimester the D-dimer is strongly increased, you need to consult a doctor and, if necessary, a number of diagnostic research.

To normalize the level of D-dimer in the 2nd trimester, therapy can be used anticoagulants drugs. Prescribing such drugs is rare. They are usually prescribed for sharp and unmotivated increased D-dimer in the blood compared with recent studies. When, during the 1st and 2nd trimester, the doctor is convinced that the woman has no signs of thrombosis, that is, the level of D-dimer never exceeds the norm, one can judge the health of the body and the absence of serious internal pathologies.

3 trimester: D-dimer norm

By the 3rd trimester, the level of D-dimer is constantly increasing. This physiological phenomenon, so all worries about it are in vain. Often in there are also such phenomena when in the 3rd trimester the D-dimer practically does not increase or, on the contrary, begins to grow sharply upward only at this time. This is conditioned characteristics of the maternal organism and the fetus, however, these phenomena are not considered pathological or indicative of a specific disease. Homeostasis can increase only at the end of pregnancy, since all biochemical processes in the human body are strictly individual.

Only too sharp rises or jumps of the D-dimer in a short time interval can cause concern. This phenomenon is often testifies O predispositions to the occurrence of blood clots, which is considered a phenomenon that threatens the life and well-being of a woman. To avoid complications, you need to start using corrective therapy, the order of which is being developed by the attending physician based on a series diagnostic activities.

Video - D-dimer with IVF, impact on implantation

D-dimer with IVF

An overestimated D-dimer can worry people who have diagnosed pathologies related to the process of homeostasis. If the indicators are overestimated, however, there are no problems with blood clotting, you should not worry. Anticoagulant therapy should be taken in dosage and think before taking these drugs. An overdose of them can cause major thrombosis, premature placental abruption, as well as cause other disorders, because the body is sometimes too sensitive.

It is especially important to measure the D-dimer in a timely manner if fertilization has occurred using IVF. When carrying out this procedure, be sure to undertaken normalization of the state of the ovaries with hormonal therapy, therefore, the process of homeostasis is activated more strongly, its increase is more pronounced than during natural pregnancy.

The first analysis is given almost immediately after fertilization, that is, the placement of embryos in the uterus. Blood must be taken on an empty stomach, while before analysis, you must not eat or drink for 12 hours. Blood is taken from a vein, and in the future, regular studies are performed on the level of D-dimer. In the future, one should not shy away from passing the analysis for the D-dimer, so as not to miss sharp changes in its level.

Analysis of increased D-DIMER (D-dimer) values during IVF is the most important for diagnosing conditions associated with the activation of coagulation (blood clotting) such as: DIC syndrome, thrombophillia, thrombosis, etc.

Blood is a unique tissue that, in a liquid state, ensures the vital activity of the body, circulating in a closed vascular bed. If a vessel is damaged, blood loss can occur, so the blood retains its volume through the formation of a temporary "plug" (thrombus) and its subsequent dissolution to restore the integrity of the vessel. This function is provided by the hemostasis system, which is a multicomponent complex due to the interaction of both coagulation and anticoagulant factors.

Thrombus formation when a vessel is damaged is local in nature and does not extend to intact areas. The vascular-platelet link of hemostasis includes 2 interrelated components: the endothelium (the inner lining of the vessel) and platelets (blood cells involved in the formation of a thrombus).

The endothelium in the form of a continuous layer of cells together with the underlying layers makes up the vascular wall, and also maintains an increased vascular tone of the vessel. Through complex biochemical processes, the endothelium and platelets contribute to the formation of fibrin thrombus in the place where the vessel was damaged.

The process of thrombus formation is limited in time, i.e. stops immediately after the closure of the damaged area. Excess enzymes involved in the coagulation process are removed from the blood stream at an increased rate and are destroyed with the participation of the liver.

Thus, the complex processes of ensuring the equilibrium state of the hemostasis system depend on the delicate balance between its components, the violation of which leads either to increased bleeding or to thrombosis.

Hemostasis disorders that can occur in patients during IVF protocols are usually associated with increased hormonal therapy, aimed first at stimulating follicular growth, and then at supporting the luteal phase of the menstrual cycle and, in case of pregnancy, at supporting the corpus luteum.

Various autoimmune processes and viral-bacterial infections, which can occur regardless of the superovulation stimulation scheme, can also lead to hypercoagulation (increased activity of the blood coagulation system). Laboratory parameters such as D-dimer, fibrinogen, thrombin time experience the most pronounced changes (increased D-dimer during IVF, fibrinogen and shortened thrombin time).

During IVF protocols, effective thrombosis of the vessels at the implantation site can be an important condition for the increased success of the very first stages of the interaction of the embryo with the endometrium.

D-dimer is a marker of activation of the hemostasis system and is the most specific test for the diagnosis of thrombophilia (thromboembolic complications) and thrombosis.

According to some literature data, it is recommended to control the level of D-Dimer after embryo transfer, especially in patients with genetic or acquired risks of thrombotic complications:

have close relatives with strokes and acute heart attacks
family history of thrombosis and thromboembolism before the age of 50
an indication of the presence of thrombotic complications in one's own anamnesis
patients with habitual miscarriage
patients with multiple failed IVF attempts
patients with a history of non-developing pregnancies
patients with preterm birth, especially combined with preeclampsia or intrauterine fetal growth retardation against the background of feto-placental insufficiency.

Such women are recommended to be examined for the presence of congenital or acquired thrombophilic conditions. In preparation for IVF protocols and after embryo transfer, it is possible to prescribe antiplatelet agents and / or low molecular weight heparins under the control of coagulation indices.

This therapy is prescribed strictly according to the indications of doctors-hematologists, in cooperation with gynecologists-reproductologists. If there are appropriate indications, treatment continues throughout pregnancy and even the postpartum period in order to avoid thrombotic complications.

Currently, new data on the causes of thrombotic complications, obtained as a result of large studies, open up new possibilities for preventing complications during IVF and pregnancy, however, it is necessary to understand that any therapy, especially when planning or the onset of pregnancy, should be received only by appointment. qualified specialist. Self-medication in this case not only will not bring the desired result, but can also be dangerous!

Treatment specialists, doctors:

Cost of procedures in St. Petersburg

Procedure

Appointment (examination, consultation) of an obstetrician-gynecologist-reproductologist, primary

4 500 P

Reception (examination, consultation) of an obstetrician-gynecologist-reproductologist, repeated

The fact that there is such an analysis as D-dimer, many women find out only during pregnancy. The time of bearing a baby is a very crucial period for the whole organism, the load grows on the internal organs, on all systems, including blood circulation. It is for the diagnosis of blood quality that this test is prescribed. Why the D-dimer is elevated, and what to do in this case, we will tell in our article.

What it is

D-dimer (d-dimer) is a fragment of fibrin protein. When the body has a need for the formation of blood clots (during injury, surgery, during childbirth, etc.), the fibrin protein paired with the enzyme thrombin begins to create a protective mechanism that will prevent profuse bleeding, large blood loss. This is how blood clots are formed, which "seal" the sites of vascular injury.

As soon as the danger passes, the body needs to naturally get rid of blood clots so that they do not clog the blood vessels, and the anti-clotting system of the fibrin filament takes over the elimination of the blood clot, which triggers the process of fibrinolysis. The thrombus dissolves, the vessels become clean and healthy, but after the breakdown of the thrombus, part of the protein remains. This is the D-dimer, a kind of marker of normal activation of the hemocoagulation system.

The amount of this substance is assessed as part of a blood clotting test. For pregnant women, such an examination is prescribed several times during the period of bearing the baby. If the blood of the expectant mother is too thick, then this is fraught with thromboembolism and other serious vascular consequences, if, on the contrary, it is liquid, then the danger lies in the risk of internal bleeding, critical blood loss during childbirth.

Guideline values

There is no fixed rigid framework for the density of this substance in the blood. It is considered normal if the value of this marker in a person does not exceed 500 ng / ml. The lower threshold is not set, that is, it is understood as 0 or 0.5 ng / ml. However, in all pregnant women, the D-dimer is slightly elevated, and it usually increases as the gestation period increases.

In the first trimester, it increases 1.5 times, in the second - two times, in the third - three times compared to the baseline level that a woman had before pregnancy. Knowing this, the recommendations of doctors to take tests not only during pregnancy, but also at the planning stage, become more understandable.

Table of acceptable values for pregnant women

Permissible level after IVF

Different laboratories and medical institutions may use different units of measurement - micrograms, nonagrams, mcg FEU / ml (micrograms of fibrinogen equivalent units per milliliter). It is clear that the numbers will also be different. To avoid confusion, it is worth checking with the doctor in what measurements this marker of hemostasis is calculated and what are its norms for a particular laboratory.

Reasons for the increase

Physiological

The increase in protein formation of D-dimer in the blood of a pregnant woman is easily explained by natural, physiological processes. The body of the expectant mother begins to prepare for childbirth as soon as the pregnancy has begun. Childbirth is a traumatic process associated with blood loss. According to some reports, a woman loses half a liter of blood during childbirth.

The most dangerous moment is the birth of the placenta, its discharge from the wall of the uterus causes bleeding. If the body is not ready for it, if there are too few platelets, then it will not be possible to quickly "close" the blood path with blood clots, and the woman will lose a lot of blood, which can be fatal for her.

To prevent this from happening, the body begins to "thicken" the blood, reduce the clotting time. In laboratory tests, this process is reflected as an increase in the amount of D-dimer, an increase in platelet concentration, and a decrease in the time required for the formation of a blood clot.

Physiological "thickening" of the blood should not cause serious concern; treatment in this case is not required. The fact that overestimated indicators are not a sign of a disease is indicated by the general condition of the woman, the results of other tests.

If the pregnant woman has no visible disturbances, complaints of poor health, pain in the extremities, edema and changes in blood pressure, cyanosis of the skin, vomiting and nausea, then an increased level of D-dimer is not considered dangerous and pathological.

Pathological

If the level of density of the D-dimer in the blood is significantly increased, there has been a sharp jump upward, if the level is too high for a given period (for example, in the early stages), then no one will make a diagnosis on this basis. The woman will only be assigned additional examinations and consultations, which will have to help find the true cause of the deviation in the analyzes.

Most often, significant exceeding the permissible values are observed in diseases such as thromboembolism, disseminated intravascular coagulation syndrome... With thromboembolism, an existing blood clot breaks off and clogs the vessel, preventing blood from circulating normally. The consequences can be very sad: if a vital vessel is clogged, for example, a pulmonary artery, then death occurs in a matter of minutes.

DIC syndrome is a syndrome of disseminated intravascular coagulation. With it, the process of blood clots formation is disrupted, and small vessels in large numbers may be clogged. The lesion is large-scale, the condition deteriorates sharply, the skin turns pale, cyanosis, vomiting, pain in the sternum and abdominal cavity are observed. Blood is found in the urine.

Deep thrombosis (deep vein thrombosis), in addition to an increased level of D-dimer, is accompanied by severe pain in the legs, especially when standing for a long time, as well as discoloration of the skin in a sore spot, swelling, and changes in blood pressure.

Sometimes an increase in this marker speaks not only of problems with the cardiovascular system. Moderate excess of the density of the D-dimer can lead to a false positive result. This happens when:

liver diseases in the expectant mother;
with strong inflammatory processes;
with excessive mobilization of the coagulation system after surgery, injuries;
with oncological and other tumors.

In the 2nd and 3rd trimester, a significant increase in this marker in the blood may be a sign of placental abruption, a sign of bearing two or three fetuses, as well as a symptom of severe toxicosis or diabetes mellitus (even in its initial stages).

Increased rate after IVF

After IVF, increased D-dimer values are common. It is believed that in this way the body reacts to external interference. They try to measure the level of the marker twice - before replanting and after transferring the embryo on the fifth day.

An increased protein fragment may be due to the implantation process itself, because a fertilized egg is introduced into the wall of the uterus and violates its integrity. The hormonal background can also affect the level of D-dimer. Any ultrasound protocol is accompanied by powerful hormonal support progesterone and estradiol.

In pregnant women who decide to become mothers through IVF, after embryo replanting, blood clotting parameters are monitored several times, this analysis will be done 2 or 3 times in 1 trimester, and then the same number of times in the second and third trimester.

Treatment

Before prescribing treatment, if the doctor sees the need for it, the woman is sent for a consultation with a cardiologist, nephrologist and therapist. A detailed analysis is made for all indicators of blood clotting - a coagulogram. If necessary, a woman is advised to consult a hematologist. After that, the question of the presence of a specific pathology is resolved, and ways are sought to provide assistance to the pregnant woman.

To normalize blood clotting, special drugs are prescribed - anticoagulants. Most often these are "Nadroparin calcium" ("Fraxiparin") and "Reopolyglucin". "Nadroparin calcium" in the form of injections is placed in the stomach, in the area of the umbilical ring. You should not be afraid of the procedure; thin and small needles, also called insulin needles, are used for injections. The expectant mother will not feel severe pain during the injection. After the injection, there may be a slight burning sensation and tingling sensation at the injection site.