Incidence of severe ovarian hyperstimulation syndrome after GnRH agonist/HMG superovulation for in-vitro fertilization

Abstract

In 1673 treatment cycles stimulated with buserelin and HMG, for IVF, GIFT or ZIFT, the severe ovarian hyperstimulation syndrome (OHSS) occurred in 10 cycles (0.6%). Eight patients were hyperandrogenic and showed an increased ovarian response to HMG. After replacement of a maximum of three embryos or zygotes, seven women became pregnant. Three women had a multiple gestation. All patients recovered uneventfully with conservative treatment. Support with progesterone or continuation of the agonist during the luteal phase did not prevent OHSS, confirming that the ovulatory HCG dose is the most important factor in inducing this severe complication. Luteal supplementation with HCG and/or HCG production during implantation could exacerbate OHSS.

Aggressive Outpatient Treatment of Ovarian Hyperstimulation Syndrome with Ascites Using Transvaginal Culdocentesis and Intravenous Albumin Minimizes Hospitalization

“…All patients were rehydrated with intravenous crystalloid solutions and albumin beginning before the procedure and continuing afterwards until equal amounts of fluid were replaced as were removed during the culdocentesis. Intravenous albumin (25-50 g) was diluted in crystalloids (50-1000 cm 3 ) to approximate a 5% albumin solution.…”

“…The incidence of severe OHSS is estimated to be between 0.5 and 1.8% (1)(2)(3). Severe OHSS is characterized 1 Presented at the 56th Annual Meeting of the American Society for Reproductive Medicine, San Diego, California, October 21-25, 2000.…”

“…2 Genetics and IVF Institute, 3020 Javier Road, Fairfax, Virginia 22031. 3 To whom correspondence should be addressed.…”

“…Severe disease can be associated with ovarian enlargement, massive ascites, hydrothorax, hemoconcentration, electrolyte imbalance, hypovolemia, oliguria, and thromboembolic phenomenon (2,3,6). Severe clinical manifestations may include acute renal insufficiency, adult respiratory distress syndrome, liver dysfunction, and even death (7).…”

The treatment of patients with polycystic ovaries undergoing IVF

“…There seems to be little doubt that PCO is a major risk factor for OHSS (9,12). MacDougall and colleagues conducted a study in which 76 women with PCO were compared with a similar number of control subjects, matched for age, cause of infertility, and stimulation regimen (9).…”