Comparison of clinical characteristics between early and late patterns in hospitalized patients with ovarian hyperstimulation syndrome

Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul 110-744, South Korea.
Fertility and sterility (Impact Factor: 4.59). 02/2009; 93(7):2274-80. DOI: 10.1016/j.fertnstert.2009.01.057
Source: PubMed


To clarify the differences in clinical characteristics between early and late ovarian hyperstimulation syndrome (OHSS).
Retrospective study.
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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    • "In addition, it was recently proposed that early OHSS can be equally severe as late OHSS, requiring a mean of 6.8 to 20 days of hospitalization depending on whether the women subsequently became pregnant or not [44], despite previous reports showing that late pregnancy-induced OHSS is associated with more severe symptoms [1,2]. "
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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.
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