Ovarian hyperstimulation syndrome. A new look at an old problem

Petrenko, Aleksei; Castelo-Branco, Camil; Marshalov, D.V.; Салов, И. А.; Shifman, E.М.

doi:10.1080/09513590.2019.1592153

Cited by 14 publications

(9 citation statements)

References 17 publications

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“…OHSS refers to iatrogenic complications caused by ovarian stimulation, which occurs in the luteal phase or early pregnancy. Although the prevalence of severe OHSS was reported to be between 0.5 and 5%, it has potentially fatal consequences, such as renal failure, hypovolemic shock, thromboembolic events, acute respiratory distress syndrome, and even death [ 21 , 22 ]. Furthermore, females with high ovarian response, relating to the abnormal sensitivity of the ovary to gonadotropin, are prone to run the risk of OHSS [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Pregnancy and Incidence of Ovarian Hyperstimulation Syndrome in High Ovarian Responders Receiving Different Doses of hCG Supplementation in a GnRH-Agonist Trigger Protocol

Shen

Yang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Objective. Ovarian hyperstimulation syndrome (OHSS) is a side effect of the exogenous human chorionic gonadotropin (hCG) hormones used to trigger oocyte maturation. High ovarian responders represent a population with a higher risk of OHSS and are characterized by an exaggerated response to gonadotropin administration. In this study, we compared clinical pregnancy and incidence of OHSS in high ovarian responders receiving different doses of hCG supplementation in a GnRH-agonist trigger protocol. Methods. A total of 205 high ovarian responders who were to undergo in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles were recruited and randomly assigned to receive different doses of hCG supplementation in a GnRH-agonist trigger protocol: GnRH-a (n = 42), GnRH-a + 1000 IU hCG (n = 49), GnRH-a + 2000 IU hCG (n = 54), and GnRH-a + 3000 IU hCG (n = 60) groups. Results. The GnRH-a + 1000 IU hCG, GnRH-a + 2000 IU hCG, and GnRH-a + 3000 IU hCG groups had more oocytes retrieved, embryos, high-quality embryos, and a higher rate of high-quality embryos than the GnRH-a group ( p < 0.05 ). The GnRH-a + 1000 IU hCG group demonstrated more oocytes retrieved, embryos, high-quality embryos, and a higher rate of high-quality embryos than the GnRH-a + 2000 IU hCG and GnRH-a + 3000 IU hCG groups ( p < 0.05 ). No moderate and severe OHSS cases occurred in the GnRH-a and GnRH-a + 1000 IU hCG groups. The incidence rate of moderate and severe OHSS was remarkably lower in the GnRH-a group and GnRH-a + 1000 IU hCG groups than in the GnRH-a + 2000 IU hCG and GnRH-a + 3000 IU hCG groups ( p < 0.05 ). The GnRH-a + 1000 IU hCG, GnRH-a + 2000 IU hCG, and GnRH-a + 3000 IU hCG groups had a higher clinical pregnancy rate than the GnRH-a group, showing no significant difference ( p > 0.05 ). The GnRH-a + 1000 IU hCG, GnRH-a + 2000 IU hCG, and GnRH-a + 3000 IU hCG groups had a lower abortion rate than the GnRH-a group ( p < 0.05 ). Conclusion. Based on the data obtained from this prospective study, we recommend 1000 IU hCG supplementation in a GnRH-agonist trigger protocol for high ovarian responders during IVF/ICSI cycles considering a higher rate of high-quality embryos, a lower incidence rate of moderate and severe OHSS, and a lower abortion rate.

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Section: Discussionmentioning

confidence: 99%

Clinical Pregnancy and Incidence of Ovarian Hyperstimulation Syndrome in High Ovarian Responders Receiving Different Doses of hCG Supplementation in a GnRH-Agonist Trigger Protocol

Shen

Yang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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“…Exogenous and/or endogenous hCGdependent increase in VEGF is known as the main regulator of many pathophysiological processes in OHSS [Hortu et al, 2021]. As a result, targeting the VEGF system to prevent OHSS became the basis for many researches [Kasum et al, 2017;Petrenko et al, 2019]. VEGF subsequently phosphorylates many regulator proteins in various pathways leading to many cellular responses, one of which is known to be PKA.…”

Section: Discussionmentioning

confidence: 99%

A Histopathological Evaluation of Ovarian Hyperstimulation Syndrome on Reproductive and Vital Organs and the Role of the VEGF-PKA Pathway in a Mouse Model

Karabulut

Korkmaz

Altun

et al. 2021

Cells Tissues Organs

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Ovarian hyperstimulation syndrome (OHSS) is one of the most common and iatrogenic complications of in vitro fertilization therapy, which is an exaggerated response to excess hormones resulting in the development of a large number of maturing follicles. Although the complications of and reasons for the condition are well known, the overall histopathological effects on systemic organs and the extent of the damage have not been fully elucidated. Besides, the mechanism that underlies the situation is not very well known. The aim of the present work was to analyse the histopathological effects of OHSS on reproductive (uterus and ovary) and vital organs (liver and kidney) and the possible role of the VEGF-PKA pathway in triggering the condition. Balb/c mice were used to establish an OHSS model. The OHSS group were injected with overdose PMSG while the normal responder group were injected with an optimal dose. Histopathological evaluation was utilised in the liver, kidney, ovary, and uterus stained with hematoxylin and eosin, Masson’s trichrome, and periodic acid-Schiff stain. The expression profiles of VEGF (vascular endothelial growth factor), PKA (protein kinase A), and p-PKA (an activated form of PKA) were detected with immunohistochemistry and Western blotting. OHSS was demonstrated to have a negative histopathological effect on all of the organs analysed. These effects were associated with an overall increase in the expression levels of VEGF, PKA, and p-PKA. OHSS has a serious histopathological negative effect on the systemic and reproductive organs and is proven to affect overall health, and thus should be considered a dangerous complication during ART techniques. The activation of the VEGF-PKA pathway, which is indicated by the expression levels of VEGF, PKA, and p-PKA, is demonstrated to accompany this complication, which should be further elucidated to understand the mechanisms underlying the condition.

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“…While it is argued that successive "freeze-all" stimulation cycles will yield sufficient oocyte quantities for fertilization and testing, it is not just the risk to the embryo that must be accounted for, but the risk to the mother-to-be also. Risk of death from ovarian hyperstimulation syndrome (OHSS) is a rare but not insignificant risk of stimulation protocols for oocyte retrieval, and while frequencies are declining, severe hyperstimulation affected 10% of patients (Mourad, Brown, and Farquhar 2017;Nelson 2017;Petrenko et al 2019).…”

Section: Can We Justify Germline Genome Editing?mentioning

confidence: 99%

Clinical Germline Genome Editing: When Will Good be Good Enough?

O’Neill¹

2020

Perspectives in Biology and Medicine

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Ensuring experimental outcomes are of the highest clinical caliber is crucial prior to the introduction of germline genome editing. However, if we are to police scientific progress using probability or the potential to go wrong, then we must account for the specious standards of human reproduction. With 15% of clinically recognized pregnancies estimated to end in spontaneous miscarriage within the first trimester, and 25% of all pregnancies ending in miscarriage, human reproduction has a high failure rate. These figures, coupled with the percentage of all births with congenital defects and the number of these who will die in the first year of life, paint two scenarios: one, that evolutionary checkpoints are cruel but critical, and two, that for the seemingly inevitable 3%, or 8 million babies born annually with congenital disorders, perhaps more must be done for prevention, when methods exist for prediction. Unifying progress in three coevolving technologies-assisted reproduction, genome editing, and genome sequencing-could produce revolutionary clinical changes in the harsh global statistics of hereditary disease. A historical perspective on the rocky foundations upon which IVF was built suggests that lessons should be learned from the misalignment of research and clinical practice due to funding and research restrictions. At present, it seems likely that history will repeat itself, and that progress in research will be hampered by hypocritical hesitation.

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Ovarian hyperstimulation syndrome. A new look at an old problem

Cited by 14 publications

References 17 publications

Clinical Pregnancy and Incidence of Ovarian Hyperstimulation Syndrome in High Ovarian Responders Receiving Different Doses of hCG Supplementation in a GnRH-Agonist Trigger Protocol

Clinical Pregnancy and Incidence of Ovarian Hyperstimulation Syndrome in High Ovarian Responders Receiving Different Doses of hCG Supplementation in a GnRH-Agonist Trigger Protocol

A Histopathological Evaluation of Ovarian Hyperstimulation Syndrome on Reproductive and Vital Organs and the Role of the VEGF-PKA Pathway in a Mouse Model

Clinical Germline Genome Editing: When Will Good be Good Enough?

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