Current Medical Strategies in the Prevention of Ovarian Hyperstimulation Syndrome

Abstract

SUMMARY -Th e purpose of this review is to analyze current medical strategies in the prevention of ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation for in vitro fertilization. Owing to contemporary preventive measures of OHSS, the incidence of moderate and severe forms of the syndrome varies between 0.18% and 1.40%. Although none of medical strategies is completely eff ective, there is high-quality evidence that replacing human chorionic gonadotropin (hCG) by gonadotropin-releasing hormone (GnRH) agonists after GnRH antagonists and moderate-quality evidence that GnRH antagonist protocols, dopamine agonists and mild protocols reduce the occurrence of OHSS. Among various GnRH agonists, buserelin 0.5 mg, triptorelin 0.2 mg and leuprolide acetate (0.5-4 mg) have been mostly utilized. Although GnRH trigger is currently regarded as the best tool for OHSS prevention, intensive luteal support with exogenous administration of estradiol and progesterone or low-dose hCG on the day of oocyte retrieval or on the day of GnRH agonist trigger are required to achieve optimal conception rates due to early luteolysis. Among currently available dopamine agonists, cabergoline, quinagolide and bromocriptine are the most common drugs that should be used for prevention of both early and late OHSS. Mild stimulation protocols off er attractive option in OHSS prevention with satisfactory pregnancy rates.

A Histopathological Evaluation of Ovarian Hyperstimulation Syndrome on Reproductive and Vital Organs and the Role of the VEGF-PKA Pathway in a Mouse Model

“…Exogenous and/or endogenous hCGdependent increase in VEGF is known as the main regulator of many pathophysiological processes in OHSS [Hortu et al, 2021]. As a result, targeting the VEGF system to prevent OHSS became the basis for many researches [Kasum et al, 2017;Petrenko et al, 2019]. VEGF subsequently phosphorylates many regulator proteins in various pathways leading to many cellular responses, one of which is known to be PKA.…”

A Retrospective Study of Letrozole Treatment Prior to Human Chorionic Gonadotropin in Women with Polycystic Ovary Syndrome Undergoing In Vitro Fertilization at Risk of Ovarian Hyperstimulation Syndrome

“…Currently, there are several clinical approaches to prevent OHSS in clinical practice during IVF [ 1 , 8 , 9 ], including reducing the dose of hCG on the trigger day, which is shown to be effective without negative clinical outcomes[ 10 ]. Therefore, in this present study, the dose of hCG was reduced to half the dose used in routine use.…”

“…Because of its complex and varied pathogenesis, the level of E2 is unlikely to be the only important clinical factor when assessing the severity of OHSS [ 7 ]. However, the level of E2 is still an important clinical marker to evaluate the risk of OHSS, which means that the significantly increased E2 level on the hCG trigger day is positively correlated with the incidence of OHSS [ 8 ]. Letrozole is an aromatase inhibitor, that prevents aromatase from producing estrogens, and lowers the level of E 2 , as letrozole does not affect the central nervous system, the process of follicular growth and ovulation continues normally.…”

Síndrome de hiperestimulación ovárica severo: Informe de caso y revisión de literatura

“…Se conoce que la aparición del SHEO está ligada al uso de hCG, por ende, si no se administra se podría evitar complicaciones; otras medidas incluyen: identificar factores de riesgo, uso de dosis bajas de gonadotrofinas, maduración con GnRH u hormona luteinizante recombinante (19).…”

“…Son todas aquellas medidas que buscan disminuir la aparición del SHEO, cuando se decide aplicar la hCG, entre ellas están: la disminución de dosis utilizada de hCG de 10,000 UI a 3,000-5,000UI; demorar la administración de hCG si se identifican niveles de estradiol mayores a 3,000 pg/ml o maduración de más de 20 folículos; aplicación de albúmina profiláctica el día de la aspiración con la finalidad de aumentar la presión oncótica intravascular y disminuir la extravasación de plasma; congelación de embriones retrasando el embarazo, evitando el efecto de la hCG endógena (16,19). En la actualidad el uso de agonistas dopaminérgicos, como la cabergolina son recomendados (8).…”