Does elective cryopreservation of all embryos from women at risk of ovarian hyperstimulation syndrome reduce the incidence of the condition?

Abstract

Objectives To analyse the incidence and factors associated with the ovarian hyper‐stimulation syndrome (OHS) in our IVF/GIFT programme before and after the introduction of a strategy to cryopreserve all embryos from women judged to be at risk. Design Two hundred forty‐one consecutive IVF/GIFT cycles from January to December 1989. Setting Specialist fertility unit, Manchester, UK. Interventions Pituitary suppression was effected by a daily subcutaneous injection of buserelin (500 μg) beginning 7 days before the expected menses. The ovarian stimulation was with variable amounts of human menopausal gonadotrophin. Ovulation was induced with 10 000 i.u. human chorionic gonadotrophin (hCG). From January to May (period A), gametes/embryos were replaced and 2000 i.u. hCG given, irrespective of the serum oestradiol (E2) concentration. From June to December (period B), all the embryos from women with an E2>3500 pg/ml on the day of ovulatory trigger were electively cryopreserved. Main outcome measures Serum E2, features of moderate or severe OHS, clinical pregnancies. Results The OHS occurred in 10/105 (9.5%) and 12/136 (8.8%) cycles in periods A and B, respectively. Fewer women (6% versus 60%, P<0.05) who had their embryos cryopreserved developed severe OHS compared with women with an E2 >3500 pg/ml who became pregnant after gamete/embryo transfer in period A. The main factors associated with the development of OHS were serum E2 concentrations >3500 pg/ml, whether gamete/embryos were replaced and the additional hCG given, the occurrence of a pregnancy and the presence of polycystic ovary disease. Conclusion The elective cryopreservation of all embryos from women with high E2 levels reduced the severity, but not the incidence of symptomatic OHS.

Dual renin-angiotensin blockage and total embryo cryopreservation is not a risk-free strategy in patients at high risk for ovarian hyperstimulation syndrome

“…Wada et al reported that TEC in women with E 2 values >3500 pg/mL on the day of hCG administration did not decrease the overall incidence of the OHSS but decreased the incidence of severe OHSS compared with women who underwent fresh ET (23). Sixty percent of women with high E 2 levels in the cryopreservation group developed the syndrome, with 8% being severe.…”

“…The mean number of collected oocytes was 25.5 AE 7.3 (range, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Fertilization was affected by ICSI.…”

Ovarian Hyperstimulation Syndrome (OHSS)

“…The outcomes in this experimental group were compared with a group of historical controls with a similar estradiol concentration, but who had their embryos transferred to the uterus. In this study, 60 % of the historical controls with an estradiol > 3,500 pg/mL who had embryos transferred and became pregnant had OHSS, compared to 6 % of the women who had all their embryos cryopreserved [ 42 ]. Following a "freeze all" cycle, the patient is prepared for a cryopreserved embryo transfer in a subsequent cycle.…”

Coasting May Reduce the Severity of the Ovarian Hyperstimulation Syndrome in Patients with Polycystic Ovary Syndrome

“…This option is emotionally and financially taxing. The other option is embryo cryopreservation for embryo transfer (ET) in a nonstimulated cycle [7]. This technique is inconvenient and generally yields inferior pregnancy rates compared with fresh ET.…”