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: 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: BACKGROUND: Management of established severe OHSS requires prolonged hospitalization, occasionally in intensive care units, accompanied by multiple ascites punctures, correction of intravascular fluid volume and electrolyte imbalance. The aim of the present study was to evaluate whether it is feasible to manage women with severe OHSS as outpatients by treating them with GnRH antagonists in the luteal phase. METHODS: This is a single-centre, prospective, observational, cohort study. Forty patients diagnosed with severe OHSS, five days post oocyte retrieval, were managed as outpatients after administration of GnRH antagonist (0.25 mg) daily from days 5 to 8 post oocyte retrieval, combined with cryopreservation of all embryos. The primary outcome measure was the proportion of patients with severe OHSS, in whom outpatient management was not feasible. RESULTS: 11.3% (95% CI 8.3%-15.0%) of patients (40/353) developed severe early OHSS. None of the 40 patients required hospitalization following luteal antagonist administration and embryo cryopreservation. Ovarian volume, ascites, hematocrit, WBC, serum oestradiol and progesterone decreased significantly (P < 0.001) by the end of the monitoring period, indicating rapid resolution of severe OHSS. CONCLUSIONS: The current study suggests, for the first time, that successful outpatient management of severe OHSS with antagonist treatment in the luteal phase is feasible and is associated with rapid regression of the syndrome, challenging the dogma of inpatient management. The proposed management is a flexible approach that minimizes unnecessary embryo transfer cancellations in the majority (88.7%) of high risk for OHSS patients.Reproductive Biology and Endocrinology 08/2012; 10(1):69. DOI:10.1186/1477-7827-10-69 · 2.41 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