Comparison of clinical characteristics between early and late patterns in hospitalized patients with ovarian hyperstimulation syndrome
ABSTRACT To clarify the differences in clinical characteristics between early and late ovarian hyperstimulation syndrome (OHSS).
Tertiary university hospital.
Ninety-four patients/cycles hospitalized for moderate-to-severe OHSS after controlled ovarian hyperstimulation (COH) for IVF/intracytoplasmic sperm injection (ICSI); early type (n = 69) and late type (n = 25).
The COH and pregnancy outcomes, preclinical and clinical miscarriage rate, and hospital courses.
Serum E(2) levels (4,955.5 +/- 3,268.5 pg/mL vs. 2,340.8 +/- 960.6 pg/mL) and the number of follicles > or =11 mm on day of hCG administration (15.9 +/- 6.0 vs. 13.0 +/- 4.0), and the number of oocytes retrieved (21.9 +/- 9.7 vs. 13.2 +/- 5.9) were significantly higher in the early OHSS group compared with the late OHSS group. Clinical pregnancy rate (PR) was significantly higher in the late OHSS group (23.6% [13/55] vs. 92.0% [23/25]). There were no significant differences in multiple PR and disease severity between the two groups.
Early OHSS is associated with excessive ovarian response to gonadotropin stimulation, whereas late OHSS is closely associated with conception cycle. Our findings do not support that late OHSS is more severe and closely associated with multiple pregnancies compared with early OHSS.
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ABSTRACT: Objectives To identify, appraise and summarize the current evidence regarding the physiopathology, staging, prediction and prevention of ovarian hyperstimulation syndrome (OHSS)Methods Two comprehensive systematic reviews: one examined methods to predict either high ovarian response or OHSS; and the other examined interventions to reduce the occurrence of OHSS. Additionally, we described the related physiopathology and staging criteria.ResultsWe included seven studies examining methods to predict OHSS and eight more examining methods to predict ovarian high response to COS. Current evidence shows that the best methods to predict high response is the antral follicle count (AFC) and anti-müllerian hormone (AMH); and that the ovarian high response (examined by the number of large follicles, estradiol concentration, or the number of retrieved oocytes) is the best method to predict the occurrence of OHSS. We included 97 RCTs examining the effect of several interventions for reducing the occurrence of OHSS. There was high quality evidence that replacing hCG (by GnRH agonists or recombinant LH) and moderate quality evidence that antagonist protocol, dopamine agonists, and mild stimulation reduce the occurrence of OHSS. The evidence for the effect of the other interventions was of Low/Very-Low quality. We additionally identified and described 12 different staging criteria.Conclusions There are useful predictive tools and several preventive interventions aimed to reduce OHSS. Acknowledging and understanding them is of crucial importance for planning the treatment and, ultimately, eliminating OHSS while maintaining high pregnancy rates.Ultrasound in Obstetrics and Gynecology 10/2014; 45(4). DOI:10.1002/uog.14684 · 3.14 Impact Factor
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ABSTRACT: Abstract The object of this retrospective cohort study was to determine if hCG levels correlate with ovarian hyperstimulation syndrome (OHSS) risk after adjustment for other risk factors during in vitro fertilization (IVF). We measured serum hCG approximately 12 h after hCG trigger in women undergoing 406 cycles of controlled ovarian hyperstimulation for IVF between June 2006 and December 2009. Serum hCG levels were measured 12 h after trigger. Bivariate logistic regression was used to assess the association between patient and cycle characteristics and OHSS. In our series, mild to moderate OHSS occurred in 9% (38/406), and severe OHSS diagnosed in 1.5% (6/406) of IVF cycles. OHSS risk was increased in younger women (<30 years old: adjusted odds ratio: aOR 2.46, 95% confidence interval: CI 1.14-5.34), increased number of oocytes (11-20: aOR 6.79, 95% CI 1.97-23.40; >20: aOR 17.55, 95% CI 4.84-63.70), and increase E2 levels (≥3,000 pg/mL: aOR 2.59, 95% CI 1.33-5.05), but was unrelated to hCG level (100-200 IU/L: aOR 1.53, 95% CI 0.60-3.91; ≥200 IU/L: aOR 1.42 95% CI 0.48-4.20). These results indicate that OHSS risk during IVF is unrelated to serum hCG level measured approximately 12 h after trigger.Gynecological Endocrinology 01/2014; DOI:10.3109/09513590.2013.875998 · 1.14 Impact Factor
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ABSTRACT: To investigate the kinetics of serum vascular endothelial growth factor (VEGF) following gonadotrophin-releasing hormone (GnRH) antagonist administration in the luteal phase in women with established severe early ovarian hyperstimulation syndrome (OHSS). Pilot observational cohort study. Private in vitro fertilisation (IVF) Unit. Twelve IVF women diagnosed with established severe early OHSS 5 days post oocyte retrieval (POR). Women undergoing IVF diagnosed with severe early OHSS 5 days POR were given 0.25 mg GnRH antagonist for 4 days, from day 5 until and including day 8 POR, combined with elective blastocyst cryopreservation. Serum VEGF was measured from the day of oocyte retrieval until day 11 POR. Ovarian volume, ascites, serum estradiol and progesterone, haematocrit and white blood cells were monitored during the same period. Kinetics of VEGF following luteal GnRH antagonist administration in women with established severe early OHSS. The concentration of VEGF was highest (390.9 ± 137.4 pg/ml) 5 days POR, coinciding with the day of diagnosis of severe OHSS. There was a significant decline of VEGF on day 7 (302.8 ± 104.9 pg/ml; P = 0.026), day 9 (303.3 ± 148.3 pg/ml; P = 0.007), and day 11 (252.6 ± 182.7 pg/ml; P = 0.010) compared with day 5 POR. This decline was associated with an improvement of ultrasound and laboratory parameters, indicating regression of severe OHSS. All women were managed at an outpatient level. GnRH antagonist administration in the luteal phase is associated with a significant decline of VEGF and with regression of established severe early OHSS.BJOG An International Journal of Obstetrics & Gynaecology 02/2014; 121(7). DOI:10.1111/1471-0528.12572 · 3.86 Impact Factor