Low-dose aspirin therapy to prevent ovarian hyperstimulation syndrome

Várnagy, Ákos; Bódis, József; Mánfai, Zoltán; Wilhelm, Ferenc; Busznyák, Csaba; Koppán, Miklós

doi:10.1016/j.fertnstert.2009.01.085

Cited by 67 publications

(49 citation statements)

References 10 publications

(10 reference statements)

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“…A recent network meta-analysis suggested that aspirin (100mg/day) during ovarian stimulation, and continued until a negative pregnancy test or ultrasonographic evidence of embryonic cardiac activity may be a prophylactic regimen for OHSS (RR 0.07, 95% CI 0.07-0.30), with no detrimental side effects on clinical pregnancy rates [13]. It is noteworthy though that this beneficial effect was primarily driven by a large single centre study, with only two (0.25%) cases of severe or critical OHSS developing in the 780 high-risk patients treated with 100mg aspirin, as compared to 43 patients (8.4%) of the 412 who did not receive aspirin [14]. The only other smaller RCT (n=145) similarly reported a reduction in OHSS with aspirin [15].…”

Section: Concomitant Use Of Aspirinmentioning

confidence: 95%

Prevention and management of ovarian hyperstimulation syndrome

Nelson

2017

Thrombosis Research

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Ovarian hyperstimulation syndrome (OHSS) is a serious iatrogenic complication of ovarian stimulation. It is feasible to identify patients at risk, modify stimulation strategies to ameliorate risk, and initiate out-patient treatments that alter disease pathophysiology to reduce disease severity. Mitigation of OHSS risk and severity, through innovative approaches prior to treatment, during treatment and after treatment should now be the standard care. This review summarizes recent developments and provides recommendations on the prevention and treatment of OHSS.3

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Section: Concomitant Use Of Aspirinmentioning

confidence: 95%

Prevention and management of ovarian hyperstimulation syndrome

Nelson

2017

Thrombosis Research

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“…A RCT found such a benefit in the use of aspirin for the prevention of hypertensive complications of pregnancy [25], however, a recent meta-analysis with individual patient data did not recommend the low-dose aspirin for hypertensive complications and preterm delivery after IVF [26]. One study found low incidence of ovarian hyperstimulation syndrome in patients receiving low-dose aspirin [27].…”

Section: Low-dose Aspirinmentioning

confidence: 99%

Adjuvants Therapies for Women Undergoing IVF: Is There Any Evidence of their Safety and Efficacy? An Updated Mini-Review

Fabozzi¹

2017

OGIJ

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In the last two decades a series of adjuvant therapies have been proposed to improve the success of IVF and most of them are currently prescribed even though the quality of scientific evidence supporting their efficacy in improving live birth rates after IVF is weak. The aim of this paper is to describe some of the therapies mostly used by women undergoing IVF such as dehydroepiandrosterone, testosterone, low-dose aspirin, low-molecular-weight heparin (LMWH), corticosteroids and endometrial scratching, and to assess the current evidence about their safety and efficacy. (Relative Risk (RR) 2.13; 95% CI 1.12-4.08). Similar results were obtained in subgroup analyses including randomized controlled trials and case-control studies (RR 2.57; 95% CI 1.43-4.63) and self-controlled studies (RR 3.95;). However, the effects of DHEA on oocyte retrieval, implantation, and abortion were not significant. The Cochrane review conducted in 2015 showed higher ongoing pregnancy rates or live birth rates following the pre-treatment with DHEA. Nevertheless, no benefit was observed when studies with high risk of bias were excluded [14,15]. Finally, a third meta-analysis analysing the effect of DHEA in women with DOR including a total of nine studies, four RCTs, four retrospective and one prospective concluded that clinical pregnancy rates were increased significantly in DOR patients who were pre-treated with DHEA (OR = 1.47, 95% CI: 1.09-1.99), whereas no differences were observed in the number of oocytes retrieved, the cancellation rate of IVF cycles and them is carriage rate between the cases and controls (WMD= −0.69, 95% CI: −2.18-0.81; OR = 0.74,95% CI: 0.51-1.08; OR = 0.34, 95% CI: 0.10-1.24). However, restricting the analysis to only RCTs, a non-significant difference in the clinical pregnancy rate was observed(OR = 1.08, 95% CI: 0.67-1.73) [15]. Keywords: Conclusive statementAlthough the effect of DHEA on improving ovarian response seems to be promising, there is insufficient evidence to recommend DHEA supplementation at this time. Furthermore, the long-term risk of DHEA administration remain unknown. More RCTs with large sample size are needed to obtain good quality evidence on its safety and efficacy. Testosterone (TT)Testosterone is a downstream molecule in the steroidal pathway from DHEA. It can be administered either trans-dermally or orally. Different RCTs report a beneficial effect of TT pre-treatment [16,17] and the meta-analysis from Bosdou et al. [18] analyzing both trials conducted by Massin et al. [16] and Kim et al. [17] reported that pretreatment with transdermal testosterone was associated with an increase in clinical pregnancy (risk difference (RD): +15%, 95% confidence interval (CI): +3 to +26%) and live birth rates (RD: +11%, 95% CI: +0.3 to +22%) in poor responders undergoing ovarian stimulation for IVF. A second meta-analysis conducted by also reported that testosterone-treated women achieved a significantly higher live birth rate (risk ratio, RR, 1.91, 95% CI 1.01 to 3.63), clinical pregnancy ra...

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“…After the demonstration of the partial inhibition of ovarian VEGF receptor 2 (VEGFR-2) phosphorylation levels by the dopamine agonist cabergoline in an animal model [35] and its consequent reversion of VEGFR-2 vascular permeability Cabergoline inhibits partially the VEGF receptor 2 phosphorylation levels and associated vascular permeability without affecting luteal angiogenesis [35] Reduction on the 'early'(within the first 9 days after hCG) onset of OHSS [36] Even using cabergoline, the OHSS incidence may be as high as 10.8% [36] Non-steroidal antiinflammatory A large RCT demonstrated that low dose aspirin was associated with reduction in the OHSS incidence (0.25% vs. 8.4%) in a high-risk group with similar pregnancy rates [37] Meloxican was capable of reducing the OHSS associated ovarian weight and expression of VEGF in an animal model [38] GnRH antagonist protocol This regimen is associated with a significant reduction in OHSS (Odds Ratio=0.60) as well as with fewer interventions to prevent OHSS (OR=0.43) However a slight reduction in pregnancy rates was also observed (OR=0.83) [39] Replacement of hCG A single dose of recombinant LH was safer than hCG and was effective in inducing follicular maturation The dosage of 15,000-30,000 IU is still too expensive [42] Using a GnRH agonist to induce final oocyte maturation, no cases of moderate/severe OHSS were observed in 1,152 cycles of oocyte donation against 14 cases in 1,137 cases who received hCG [43,44]. This requires the use of GnRH antagonist protocol.…”

Section: Dopamine Agonist Administrationmentioning

confidence: 99%

“…Non-steroidal anti-inflammatory administration Low-dose aspirin therapy (100 mg daily, beginning on the first day of ovarian stimulation) was shown to be effective in preventing OHSS among high risk women in a recent, large RCT [37]. This study evaluated 2,425 cycles in which gonadotropin-releasing hormone agonist was used.…”

Section: Dopamine Agonist Administrationmentioning

confidence: 99%

Ovarian hyperstimulation syndrome: pathophysiology and prevention

Nastri

Ferriani

Rocha

et al. 2010

J Assist Reprod Genet

190

157

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Purpose To review and discuss the pathophysiology and prevention strategies for ovarian hyperstimulation syndrome (OHSS), which is a condition that may occur in up to 20% of the high risk women submitted to assisted reproductive technology cycles. Methods The English language literature on these topics were reviewed through PubMed and discussed with emphasis on recent data. Results The role of estradiol, luteinizing hormone, human chorionic gonadotropin (hCG), inflammatory mediators, the renin-angiotensin system and vascular endothelial growth factor is discussed in the pathophysiology of OHSS. In addition we consider the prevention strategies, including coasting, administration of albumin, renin-angiotensin system blockage, dopamine agonist administration, nonsteroidal anti-inflammatory administration, GnRH antagonist protocols, reducing hCG dosage, replacement of hCG and in vitro maturation of oocytes (IVM). Conclusions Among the many prevention strategies that have been discussed, the current evidence points to the replacement of hCG by GnRH agonists in antagonist cycles and the performance of IVM procedures as the safest approaches.

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Low-dose aspirin therapy to prevent ovarian hyperstimulation syndrome

Cited by 67 publications

References 10 publications

Prevention and management of ovarian hyperstimulation syndrome

Prevention and management of ovarian hyperstimulation syndrome

Adjuvants Therapies for Women Undergoing IVF: Is There Any Evidence of their Safety and Efficacy? An Updated Mini-Review

Ovarian hyperstimulation syndrome: pathophysiology and prevention

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