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Hum. Reprod. Advance Access published online on December 23, 2004
Human Reproduction, doi:10.1093/humrep/deh640
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Human Reproduction © European Society of Human Reproduction and Embryology 2004; all rights reserved
Received May 25, 2004
Revised September 7, 2004
Accepted November 9, 2004

Article

Factor V Leiden mutation in relation to fecundity and miscarriage in women with venous thrombosis

F.M. van Dunné 1 4, C.J.M. Doggen 2, M. Heemskerk 1, F.R. Rosendaal 3, and F.M. Helmerhorst 1*

1 Department of Obstetrics, Gynaecology and Reproductive Medicine, Leiden University Medical Center, P.O.Box 9600, 2300 RC Leiden, The Netherlands
2 Department of Clinical Epidemiology, Leiden University Medical Center, P.O.Box 9600, 2300 RC Leiden, The Netherlands
3 Department of Clinical Epidemiology, Leiden University Medical Center, P.O.Box 9600, 2300 RC Leiden, The Netherlands; Haemostasis and Thrombosis Research Center, Leiden University Medical Center, P.O.Box 9600, 2300 RC Leiden, The Netherlands

* To whom correspondence should be addressed.
F.M. Helmerhorst, E-mail: F.M.Helmerhorst{at}LUMC.nl


  Abstract

BACKGROUND: Factor V Leiden mutation (Arg506Gln) increases the likelihood of venous thrombosis; it may also have a positive effect through facilitation of embryo implantation. This may manifest itself as a reduced time to pregnancy (increased fecundity) and fewer miscarriages in the first trimester. METHODS: From March 1999 onwards, consecutive patients with a first venous thrombosis (VT) were recruited. The first 115 female VT patients with factor V Leiden and 230 age-matched female VT patients without factor V Leiden were included. All patients, unaware of their genotype, received a structured questionnaire. RESULTS: Of the 297 (86%) women who returned the questionnaire, 220 had been pregnant at least once. Time to first pregnancy was unaffected by carrier status: 58% factor V Leiden carriers reported a pregnancy within 3 months compared to 54% non-carriers. The miscarriage proportion was 14%, similar in both groups. First trimester miscarriage was less frequent among carriers (46%) than among non-carriers (95%) (relative risk 0.5, 95% confidence interval 0.3-0.9). CONCLUSIONS: Factor V Leiden mutation may support embryo implantation, as factor V Leiden carriers had fewer miscarriages in the first trimester with a similar overall miscarriage rate. Miscarriage of embryos with poor viability may be postponed until the second trimester in factor V Leiden carriers. Fecundity was not influenced by factor V Leiden status.

Keywords: Factor V Leiden; fecundity; miscarriage; time to pregnancy.

4Present address: Department of Perinatal Medicine, Royal Women's Hospital Melbourne, 3053 Victoria, Australia


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