Estimating the risks of ovarian hyperstimulation syndrome (OHSS): Implications for egg donation for research

Newcastle Fertility Centre at Life, International Centre for Life, Newcastle upon Tyne, UK.
Human Fertility (Impact Factor: 0.91). 09/2007; 10(3):183-7. DOI: 10.1080/14647270601021743
Source: PubMed


This study aims to provide an estimate of women's risk of ovarian hyperstimulation syndrome (OHSS) when undergoing superovulation to donate eggs for research. This is an essential prerequisite for appropriate informed consent. In the absence of sufficiently large numbers of egg donors to assess the risk, comparative data was obtained from women undergoing the same superovulation protocol for in vitro fertilization (IVF) treatment. In this prospective study 339 women, who developed >/=20 follicles after superovulation in their first treatment cycle (total number of treatment cycles during the same period - 2417), were intensively monitored on five occasions, between human chorionic gonadotrophin and pregnancy test, according to our routine clinical protocol. Hospital admission was needed for 49 (14.5%) women, 13 (3.8%) needed intravenous fluids and 9 (2.7%) needed paracentesis. The admission rates were similar in pregnant and non-pregnant women (13.5% vs. 15%); the need for intravenous fluids and paracentesis were 3.2% vs. 2.3% and 6.3% vs. 2.3%, respectively. The peak increase in haematocrit occurred on Day 4 after hCG, and the mean day of hospital admission was Day 5. If an egg donor develops <20 follicles, she can be reassured that the risk of OHSS is very small (<0.1%). If >/=20 follicles develop, her risk of hospital admission due to OHSS is <15%. The absence of pregnancy in egg donors does not eliminate the risk of OHSS. Given the timescale of development of the haematological and biochemical abnormalities, egg donors who develop >/=20 follicles should be actively monitored for the first week after egg collection.

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Available from: Kannamannadiar Jayaprakasan, Oct 06, 2015
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    • "Researchers are particularly interested in access to younger women's eggs because they are of better quality. However, while some of the risks associated with extraction are known to be higher in younger women (Jayaprakasan et al. 2007), most research on risks has focused on women undergoing IVF, who are usually in their 30s or over. Furthermore, health risks increase with the number of eggs retrieved: the more eggs, the higher the risks. "
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    • "The guidelines include specific medical exclusion criteria, make recommendations for when it is appropriate to cancel a cycle (i.e., when more than 20 follicles have grown past 12 mm, when hormone levels are too high, or when the ovaries are developing too few follicles ), and have specific follow-up care recommendations. Jayaprakasan and colleagues recommend intensive followup care for donors who produce 20 or more follicles, as they found the risk of hospitalization for OHSS increases to 13–15% in this population (Jayaprakasan et al. 2007). Increased National Institutes of Health (NIH) funding for embryo research and IRB-reviewed protocols that are recruiting women to donate oocytes for research purposes create research opportunities to study the acute and longterm physical and psychological consequences of oocyte donation. "
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