Diagnosis, prevention and management of ovarian hyperstimulation syndrome

Brinsden, Peter; Wada, Ibrahim; Tan, Seang‐Lin; Balen, Adam; Jacobs, Howard S.

doi:10.1111/j.1471-0528.1995.tb10840.x

Cited by 216 publications

(76 citation statements)

References 51 publications

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“…One of the most severe and potentially life-threatening complications of ovarian stimulation, however, is ovarian hyperstimulation syndrome (OHSS), which occurs in 1-10% of IVF cycles [1]. The risk factors associated with OHSS are younger age, asthenic habitus, rapidly increasing estradiol (E2) levels, high preovulatory serum E2 levels, large number of follicles during ovarian stimulation, polycystic ovary syndrome (PCOS), and the presence of ultrasounddetected polycystic ovaries [1][2][3]. Moreover, after the introduction of gonadotropin-releasing hormone agonist (GnRHa), a sixfold increase in the incidence of severe OHSS has been observed relative to the clomiphene citrate (CC)/human menopausal gonadotropin (hMG) protocol [3].…”

Section: Introductionmentioning

confidence: 99%

Application of GnRH antagonist in combination with clomiphene citrate and hMG for patients with exaggerated ovarian response in previous IVF/ICSI cycles

Lin¹,

Seow²,

Hsieh

et al. 2007

J Assist Reprod Genet

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Purpose To investigate if the combination of clomiphene citrate, hMG, and cetrorelix (CC/hMG/cetrorelix protocol) can be applied to patients who had excessive response to GnRHa long protocol. Methods Fifty patients who coasted and failed to conceive in their first cycles stimulated with GnRHa long protocol were stimulated with CC/hMG/cetrorelix protocol. The peak serum estradiol levels, the need of coasting and prolonged coasting (≥4 days), and the incidences of OHSS were compared.Results The peak estradiol level was significantly lower with CC/hMG/cetrorelix protocol compared to GnRHa long protocol. With CC/hMG/cetrorelix protocol, only four patients (8%) needed coasting and no one coasted ≥4 days. In contrast, in the first cycles, 11 patients (22%) needed coasting ≥4 days. The incidence of moderate OHSS was significantly lower with CC/hMG/cetrorelix protocol. Conclusions The CC/hMG/cetrorelix protocol is an acceptable alternative protocol for patients who had excessive response to GnRHa long protocol.

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Section: Introductionmentioning

confidence: 99%

Application of GnRH antagonist in combination with clomiphene citrate and hMG for patients with exaggerated ovarian response in previous IVF/ICSI cycles

Lin¹,

Seow²,

Hsieh

et al. 2007

J Assist Reprod Genet

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“…Patients are at a substantially higher risk for developing OHSS and associated complications (1,2). OHSS is a serious and potentially life-threatening complication of IVF (3,4).…”

Section: Introductionmentioning

confidence: 99%

Use of Stimulated Serum Estradiol Measurements for the Prediction of Hyperresponse to Ovarian Stimulation in in Vitro Fertilization (IVF)

Hendriks

Klinkert

Bancsi

et al. 2004

J Assist Reprod Genet

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Purpose : In ovarian stimulation an exaggerated ovarian response is often seen and is related to medical complications, such as ovarian hyperstimulation syndrome (OHSS), and increased patient discomfort. If it were possible to identify hyperresponders at an early stage of the stimulation phase, adaptation of the stimulation protocol would become feasible to minimize potential complications. Therefore, we studied the usefulness of measuring stimulated serum estradiol (E 2 ) levels in predicting ovarian hyperresponse. Methods : A total of 109 patients undergoing their first IVF treatment cycle using a long protocol with GnRH agonist was prospectively included. The E 2 level was evaluated on day 3 and 5 of the stimulation phase. Two outcome measures were defined. The first was ovarian hyperresponse (collection of ≥15 oocytes at retrieval and/or peak E 2 > 10000 pmol/L, or cancellation due to ≥30 follicles growing and/or peak E 2 > 15000 pmol/L, or OHSS developed). The second outcome measure comprised a subgroup representing the more severe hyperresponders, named extreme-response (cancellation or OHSS developed). Results : The data of 108 patients were analyzed. The predictive accuracy of E 2 measured on stimulation day 3 towards ovarian hyperresponse was clearly lower than that of E 2 measured on stimulation day 5 (area under the receiver operating characteristic curve (ROC AUC ) 0.75 and 0.81, respectively). For extreme-response the predictive accuracy of E 2 measured on stimulation day 3 or 5 was comparable (ROC AUC 0.81 and 0.82, respectively). For both outcome measures the stimulated E 2 tests yielded only acceptable specificity with moderate sensitivity at higher cutoff levels. Prediction of extreme-response seemed slightly more effective due to a lower error rate. Conclusions : There is a significant predictive association between E 2 levels measured on stimulation day 3 and 5 and both ovarian hyperresponse and extreme-response in IVF. However, the clinical value of stimulated E 2 levels for the prediction of hyperresponse is low because of the modest sensitivity and the high false positive rate. For the prediction of extreme-response the clinical value of stimulated E 2 levels is moderate.

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“…The incidence of hospitalization is 1.8% and the mortality rate is low with an estimated incidence at 1:400 000 to 1:500 000 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Using Anti-Müllerian Hormone and Serum Estradiol to Predict Ovarian Hyperstimulation Syndrome in Patients Using Antagonist Protocol During IVF/ICSI Cycles

2017

Evidence Based Women's Health Journal

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Objectives: To investigate the ability of Anti-Müllerian hormone (AMH) and estradiol (E2) to predict OHSS in women using the GnRH antagonist protocol while undergoing invitro-fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI). Study design: Retrospective analysis of women who had performed IVF/ICSI at assisted conception unit of Kasr Alainy university hospital over a period of 3 years. Patients and Methods: Basal serum AMH, estradiol (E2) level on the day of ovulation trigger and OHSS, among various other parameters were recorded and analyzed. Results: Thirty cases of OHSS (8.54%) were identified. There was no statistical difference in incidence of OHSS among age (p=0.976), FSH (p=0.286), LH (p=0.932), TSH (p=0.277), and prolactin (p=0.283), however, AMH (p=0.04), BMI (p=0.012), AFC (p< 0.001), and E2 before trigger (p<0.001) were significant. The overall clinical pregnancy rate was 27.35 % (n=96). The receiver operator analysis curve had a cut-off value of 4.45ng/ml (80%, sensitivity & 56% specificity). The area under the curve (AUC) was 0.661 with 95% confidence interval (CI) (0.548-0.775) (p=0.003). While for E2 the cut-off value was 4459 pg/ml with 76.7% sensitivity and 55.7% specificity), AUC 0.673 95% (CI) (0.554-0.791) (p=0.002). Combining both AMH ≥ 4.45ng/ml and E2 ≥4459 pg/ml had odds ratio 4.302 (95% CI) (1.795-10.304), relative risk (RR) 0.891 with 95%CI (0.832-0.954) (p<0.001). Conclusion: AMH and serum E2 before trigger are not highly accurate tests alone for the prediction of OHSS. When basal serum AMH was ≥4.45ng/ml and E2 ≥ 4459 pg/ml, the patient was at 4 fold increased risk of developing OHSS.

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Diagnosis, prevention and management of ovarian hyperstimulation syndrome

Cited by 216 publications

References 51 publications

Application of GnRH antagonist in combination with clomiphene citrate and hMG for patients with exaggerated ovarian response in previous IVF/ICSI cycles

Application of GnRH antagonist in combination with clomiphene citrate and hMG for patients with exaggerated ovarian response in previous IVF/ICSI cycles

Use of Stimulated Serum Estradiol Measurements for the Prediction of Hyperresponse to Ovarian Stimulation in in Vitro Fertilization (IVF)

Using Anti-Müllerian Hormone and Serum Estradiol to Predict Ovarian Hyperstimulation Syndrome in Patients Using Antagonist Protocol During IVF/ICSI Cycles

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