Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles

Purpose The aim of this study is to compare implantation and live birth rates (LBR) between fresh euploid embryo transfers versus cryo-all cycles with a subsequent embryo transfer into a prepared endometrium. Material and Methods This is a retrospective cohort study. Patients who underwent an IVF cycle with PGS with trophectoderm biopsy from January 2011 to July 2015 were included. Patients were divided into three groups: "Fresh Only," "Frozen Embryo Transfer ('FET) Only," and "Fresh ET then FET." For "Fresh Only" group (n = 345), PGS results were received within 24 h. For "FET Only" group (n = 514), results were expected after 24 h, and embryos were cryopreserved after biopsy; only FET was performed in this group (no fresh transfer). For "FET with a previous fresh ET" (n = 139) group, patients underwent a fresh ET with a subsequent FET, in which the same cohort of embryos was utilized. The main outcome measures were pregnancy rate (PR), clinical PR, implantation rate (IR), LBR, and early pregnancy loss rate. Results IRs were statistically higher in the "FET Only" group when compared to the "Fresh Only" group (59.5 vs. 50.6 %, p < 0.01) and the "FET with a previous fresh ET" (59.5 vs. 50.6 %, p < 0.05). LBR was statistically significant in the "FET Only" group when compared to the "Fresh Only" group (57.6 vs. 46.5 %, p < 0.005) but not when compared to "FET with a previous fresh ET" group (57.6 vs. 47.7 %, p = 0.07). Conclusions This analysis suggests euploid embryos to be more likely to implant and achieve a LBR in a synthetic FET cycle than in a fresh cycle.

Section: Discussionmentioning

confidence: 99%

Reproductive outcome is optimized by genomic embryo screening, vitrification, and subsequent transfer into a prepared synchronous endometrium

Rodriguez-Purata

Lee

Whitehouse

et al. 2016

“…Since cancer patients presenting for fertility preservation typically have a limited window, it is important to balance the risk of OHSS with optimizing the number of retrieved high quality oocytes and embryos. Predicting which patients are at risk for developing OHSS can be challenging, and several parameters have been investigated such as elevated E2 levels and the number of follicles recruited [34]. However, the use of aromatase inhibitors may limit the predictive value of E2 levels given their profound suppression in fertility preservation cycles [16].…”

Section: Discussionmentioning

confidence: 99%

Triggering final oocyte maturation with gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation: an extended experience

Reddy

Turan

Bedoschi

et al. 2014

Purpose To analyze the cycle outcomes and the incidence of ovarian hyperstimulation syndrome (OHSS), when oocyte maturation was triggered by gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation. Methods One hundred twenty-nine women aged≤45 years, diagnosed with stage≤3 breast cancer, with normal ovarian reserve who desired fertility preservation were included in the retrospective cohort study. Ovarian stimulation was achieved utilizing letrozole and gonadotropins. Oocyte maturation was triggered with GnRHa or hCG. Baseline AMH levels, number of oocytes, maturation and fertilization rates, number of embryos, and the incidence of OHSS was recorded. Results The serum AMH levels were similar between GnRHa and hCG groups (2.7±1.9 vs. 2.1±1.8; p=0.327). There was one case of mild or moderate OHSS in the GnRHa group compared to 12 in the hCG group (2.1 % vs. 14.4 %, p=0.032). The maturation and fertilization rates, and the number of cryopreserved embryos were significantly higher in the GnRHa group.Conclusions GnRHa trigger improved cycle outcomes as evidenced by the number of mature oocytes and cryopreserved embryos, while significantly reducing the risk of OHSS in breast cancer patients undergoing fertility preservation.

“…Ovarian hyperstimulation syndrome (OHSS) is an almost exclusive iatrogenic complication related to ovarian stimulation with gonadotropins in otherwise healthy women [1]. While its general incidence is approximately 2 to 3 % per cycle [2,1], OHSS can occur in up to a third of all cases of high-risk patients [3,4], notably those with a previous history of OHSS or polycystic ovary morphology (PCOM)/polycystic ovary syndrome (PCOS).…”

Section: Introductionmentioning

confidence: 99%

“…While its general incidence is approximately 2 to 3 % per cycle [2,1], OHSS can occur in up to a third of all cases of high-risk patients [3,4], notably those with a previous history of OHSS or polycystic ovary morphology (PCOM)/polycystic ovary syndrome (PCOS). In its severe form, this syndrome has the potential to cause serious morbidity or mortality, mainly due to the increased occurrence of ovarian torsion and thromboembolism [5].…”

Section: Introductionmentioning

confidence: 99%

Ovarian hyperstimulation syndrome after gonadotropin-releasing hormone agonist triggering and “freeze-all”: in-depth analysis of genetic predisposition

Santos‐Ribeiro

Polyzos

Stouffs

et al. 2015

Self Cite

Purpose We report on the results of the whole-genome analysis performed in a patient who developed severe ovarian hyperstimulation syndrome (OHSS) following gonadotropinreleasing hormone (GnRH) agonist triggering in a Bfreeze-allp rotocol.Methods A 30-year-old patient with polycystic ovary syndrome who developed severe early-onset OHSS with clinical ascites, and slight renal and hepatic dysfunction was admitted for monitoring and treatment with cabergoline and intravenous albumin. Exome sequencing to assess for any known genetic predisposition for OHSS was performed.Results No known genetic variants associated with OHSS predisposition were found. Conclusions Case reports of severe OHSS following a Bfreeze-all^strategy are starting to arise, showing that OHSS has not been completely eliminated with this approach. Further studies should be conducted to confirm if such cases may be due to genetic predisposition or not.