Severe ovarian hyperstimulation syndrome in assisted reproductive technology: definition of high risk groups

Abstract

In a retrospective analysis of 637 cycles of ovarian stimulation and transvaginal follicular aspiration for various assisted reproductive technologies, severe ovarian hyperstimulation syndrome (SOH) occurred in six (0.94%) cycles. The patients at a high risk of developing SOH in cycles of assisted reproduction were those who had excessive serum oestradiol levels on the day of human chorionic gonadotrophin (HCG) administration (oestradiol greater than 6000 pg/ml; 38% SOH) and a high number of oocytes obtained (greater than 30 oocytes; 23% SOH). In those patients with both oestradiol greater than 6000 pg/ml on the day of HCG administration and greater than 30 eggs retrieved, the chance of developing SOH was 80%. The higher the serum oestradiol levels and the more eggs retrieved, the higher the pregnancy rates observed. High oestradiol level did not appear to have a detrimental effect on pregnancy rates and outcome. Furthermore, our results are not consistent with suggestions that the addition of gonadotrophin-releasing hormone agonist to ovarian stimulation protocols, follicular aspiration and/or luteal support with progesterone may reduce the incidence of ovarian hyperstimulation syndrome.

Severe ovarian hyperstimulation syndrome after letrozole-gonadotropin stimulation: a case report

“…A number of causal mechanisms have been investigated, involving estradiol (E 2 ), human chorionic gonadotropin (hCG), and vascular endothelial growth factor (VEGF). A strong association between E 2 concentrations and risk for developing OHSS has been observed consistently [3].…”

A double-blind, randomized, placebo-controlled study to assess the efficacy of ketoconazole for reducing the risk of ovarian hyperstimulation syndrome

“…5,6,7 Early identification of the patients at risk and prevention of OHSS is clinically important. Several methods have been recommended for minimizing the probability of the syndrome in high risk pa tients including canceling the cycle before administration of hCG or reduction of the ovulatory hCG dose, 8 withhold ing luteal support with hCG, 9 cryopreservation of all em bryos for further use in a non-stimulated cycle, 10 repeated aspiration of ovarian follicles and early corpus luteum cysts, 11 administration of human albumin at the time of hCG injection, 12 use of GnRh analogue to trigger ovulation, 13 and vaginal aspiration of ascites. 14 Ketoconazole, a broad-spectrum imidazole antimycotic agent, was recently reported to reduce the incidence of OHSS in PCOS women undergoing superovulation program by gonadotropins.…”

Ovarian hyperstimulation syndrome: pathophysiology and prevention

“…Initially the role of estradiol in the pathophysiology of OHSS roused great interest, as a high level of this sex hormone has been strongly associated with this syndrome [9]. This association led researchers to believe that the elevation in estradiol concentration caused this syndrome.…”