Outcome of treatment subsequent to the elective cryopreservation of all embryos from women at risk of the ovarian hyperstimulation syndrome

Abstract

From 1st June 1989 to 31st May 1991, 78 women with a serum oestradiol level greater than 3500 pg/ml on the day of the ovulatory trigger, following pituitary suppression with buserelin and ovarian stimulation with human menopausal gonadotrophins (HMG), had all their embryos electively cryopreserved at the pronucleate stage to minimize the risk of developing ovarian hyperstimulation syndrome (OHS). Treatment with buserelin was continued in the luteal phase. A median of 19 oocytes (range 7-43) was obtained and 12 embryos (range 1-37) frozen per cycle. Twenty-one (27%) women developed OHS (six severe). Women developing OHS had higher (P less than 0.05) serum oestradiol concentrations on the 7th day after oocyte retrieval, compared to those who did not. No differences were found for any of the following criteria: aetiology of infertility, age, total dose of HMG, number of oocytes, fertilization rate or freeze-thaw survival of embryos. Subsequently, 125 frozen-thawed embryo replacements have been undertaken, using buserelin and hormone replacement therapy (HRT) (n = 93) or natural cycles (n = 32). The overall freeze-thaw survival and implantation rates per embryo were 71.8 and 11.7%, respectively. The pregnancy rates in natural cycles (19%) and buserelin/HRT cycles (29%) were not significantly different.

Preventing ovarian hyperstimulation syndrome: guidance for the clinician

“…Although early OHSS associated with hCG administration may still occur (76)(77)(78)(79), it is the increase in endogenous hCG associated with pregnancy that is responsible for secondary exacerbation of early OHSS or the development of late OHSS, and these more serious forms of the condition can thus be avoided (77,80,81). Where OHSS does occur after cryopreservation, the severity and duration of the condition appear to be reduced (82).…”

Ovarian hyperstimulation syndrome: Aetiology, prevention and management

“…Systemic and ovarian-related inflammatory mediators such as cytokines (including interleukins 1, 2, 6, and 8 and www.elsevier.com/locate/rigapp Reviews in Gynaecological and Perinatal Practice 6 (2006) [26][27][28][29][30][31][32] tumour necrosis factor alpha (TNFa)), histamine, prostaglandins and vascular endothelial growth factor (VEGF) have been studied to establish their role in OHSS [4,5].…”

Vitrification is a highly efficient method to cryopreserve human embryos in in vitro fertilization patients at high risk of developing ovarian hyperstimulation syndrome

“…Avoiding fresh embryo transfer in patients at high risk of developing OHSS prevents the late onset of the syndrome by simply eliminating the rise of hCG associated with successful embryo implantation. Although several studies have indicated that cryopreservation of all embryos reduced the risk of OHSS while achieving acceptable pregnancy rates (9,19,20), a Cochrane review concluded, on the basis of two studies, that there was insufficient prospective evidence to conclude that cryopreservation prevented OHSS, compared with albumin administration or no cryopreservation (21).…”