The cerebrovascular disorder, MoyaMoya disease (MMD), increases the risk of ischemic stroke due to stenosis of the cerebral vasculature. Progressive occlusion leads to the development of weak collateral vessels, which can cause hemorrhagic stroke. Controlled ovarian stimulation for procreation by assisted reproductive technologies induces supraphysiologic serum estrogen levels up to 100 times or greater above baseline values and has been shown to increase the risk of venous thrombosis, making assisted reproduction a unique challenge in patients with MMD. This case report describes a controlled ovarian stimulation and subsequent livebirth in a patient with MMD as well as Factor V Leiden, a thrombophilia that predisposes patients to venous thrombosis.
References
[1]
Zhang, H., Zheng, L. and Feng, L. (2019) Epidemiology, Diagnosis and Treatment of Moyamoya Disease (Review). ExperimentalandTherapeuticMedicine, 17, 1977-1984. https://doi.org/10.3892/etm.2019.7198
[2]
Starke, R.M., Crowley, R.W., Maltenfort, M., Jabbour, P.M., Gonzalez, L.F., Tjoumakaris, S.I., et al. (2012) Moyamoya Disorder in the United States. Neurosurgery, 71, 93-99. https://doi.org/10.1227/neu.0b013e318253ab8e
[3]
Kuroda, S., Ishikawa, T., Houkin, K., Nanba, R., Hokari, M. and Iwasaki, Y. (2005) Incidence and Clinical Features of Disease Progression in Adult Moyamoya Disease. Stroke, 36, 2148-2153. https://doi.org/10.1161/01.str.0000182256.32489.99
[4]
Eichinger, S., Evers, J.L.H., Glasier, A., La Vecchia, C., Martinelli, I., Skouby, S., et al. (2013) Venous Thromboembolism in Women: A Specific Reproductive Health Risk. HumanReproductionUpdate, 19, 471-482. https://doi.org/10.1093/humupd/dmt028
[5]
Chan, W.S. and Dixon, M.E. (2008) The “ART” of Thromboembolism: A Review of Assisted Reproductive Technology and Thromboembolic Complications. ThrombosisResearch, 121, 713-726. https://doi.org/10.1016/j.thromres.2007.05.023
[6]
Westerlund, E., Henriksson, P., Wallén, H., Hovatta, O., Wallberg, K.R. and Antovic, A. (2012) Detection of a Procoagulable State during Controlled Ovarian Hyperstimulation for in Vitro Fertilization with Global Assays of Haemostasis. ThrombosisResearch, 130, 649-653. https://doi.org/10.1016/j.thromres.2011.11.024
[7]
Driscoll, A.K. and Hamilton, B.E. (2025) Effects of Age-Specific Fertility Trends on Overall Fertility Trends: United States, 1990-2023. NationalVitalStatisticsReports, 6, Article 1.
[8]
Lai, P.M.R., Beazer, M., Frerichs, K.U., Patel, N.J., Aziz-Sultan, M.A. and Du, R. (2024) Association between Moyamoya Revascularization Surgery and Neurologic Events during Pregnancy: Systematic Review. Neurosurgery, 96, 948-957. https://doi.org/10.1227/neu.0000000000003184
[9]
Yajima, H., Miyawaki, S., Sayama, S., Kumasawa, K., Ikemura, M., Imai, H., et al. (2023) Hypertensive Disorders of Pregnancy in Moyamoya Disease: A Single Institution Experience. JournalofStrokeandCerebrovascularDiseases, 32, Article 107377. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107377
[10]
Oktay, K., Hourvitz, A., Sahin, G., Oktem, O., Safro, B., Cil, A., et al. (2006) Letrozole Reduces Estrogen and Gonadotropin Exposure in Women with Breast Cancer Undergoing Ovarian Stimulation before Chemotherapy. TheJournalofClinicalEndocrinology&Metabolism, 91, 3885-3890. https://doi.org/10.1210/jc.2006-0962
