[Hypofibrinolysis and other hemostatic defects in women with antecedents of early reproductive failure].

The fibrinolytic system is involved in blood clot lysis and in other biological processes that require extracellular proteolysis such as ovulation, blastocyst implantation and trophoblastic invasion. An impaired fibrinolytic capacity is a common feature in women suffering from unexplained early recurrent pregnancy loss. We carried out a prospective study with 114 patients. Three groups were established: Group 1: women who had two or more unexplained miscarriages of < 12 weeks of gestation (n = 52). Group 2: women who had 2 or more embryo-implantation failure after embryo-transfer with good quality embryos in assisted reproduction (n = 46). Group 3: women who had 2 or more embryo-implantation failure after embryo-transfer and one early loss of a pregnancy achieved in a cycle of assisted reproduction (n = 16). Fibrinolytic pattern pre and post-occlusion test was carried out: ECLT, PAI-1i, PAI-1b, t-PAi, t-PAb. In addition other studies were performed: LAC, ACA IgG and IgM, fibrinogen, factor XII, APCR. A high prevalence of thrombophilic defects and hypofibrinolysis was observed in the three groups. The fibrinolytic pattern was similar in the three groups, although a prolonged pre occlusion ECLT was more frequent in women with primary infertility (Group 2). Isolated hypofibrinolysis was found in 50% of the patients. The remaining patients with hypofibrinolysis presented combined defects with LAC, ACA and abnormal APCR. The fibrinolytic pattern in women with or without antiphospholipid antibodies was similar, although an elevated pre occlusion PAI-1i was more common in women without antiphospholipid antibodies. High prevalence of fibrinolytic abnormalities observed in women with unexplained early recurrent pregnancy loss and in women with repeated failure implantation after embryo-transfer in assisted reproduction, suggests that hypofibrinolysis could be a parameter of early reproductive failure.