Ovarian hyperstimulation syndrome: pathophysiology and prevention

Nastri, C.O.; Ferriani, Rui Alberto; Rocha, Isa A.; Martins, Wellington P.

doi:10.1007/s10815-010-9387-6

Cited by 190 publications

(165 citation statements)

References 49 publications

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“…6 OHSS due to elevated β-hCG rarely is observed in molar pregnancies; because the β-hCG level is higher in cases of complete molar pregnancy OHSS is generally observed in patients with complete molar pregnancy. 7 The present case represents a rare atypical presentation of partial molar pregnancy, as the β-hCG level was >500,000 mIU mL -1 and bilateral ovarian hyperstimulation was observed. The most common karyotype accompanying partial molar pregnancy is triploidy.…”

Section: Discussionmentioning

confidence: 66%

A Case of Partial Hydatidiform Mole Presenting with Ovarian Hyperstimulation and Early Preeclampsia

Melekoğlu¹,

Eraslan²,

Çelik³

2016

Turkiye Klinikleri J Case Rep

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rare maternal complication of partial molar pregnancy is ovarian hyperstimulation syndrome (OHSS). OHSS generally occurs due to ovulation induction and rarely due to increased β-human choriogonadotrophin (β-hCG) without ovulation induction. 1 After the 20th gestational week the frequency of preeclampsia as a maternal complication of partial molar pregnancy is 41.9%, whereas the incidence of OHSS in cases of partial molar pregnancy is not known. 2 To the best of our knowledge based on a search of Türkiye Citation Index, PubMed, Medline, Embase, ScienceDirect, Cochrane and Google Scholar using the search terms molar pregnancy, hydatidiform mole, partial hydatidiform mole, pre-eclampsia, proteinuria, and ovarian hyperstimulation syndrome, A AB BS S T TR RA AC CT T Missed or incomplete abortion occurs in cases of partial molar pregnancy, whereas fetal and maternal complications, including fetal anomaly, fetal anemia, and preeclampsia, generally occur during the 20th week of gestation in cases in which the fetus remains viable. To the best of our knowledge the literature does not include any reports of partial molar pregnancy complicated by both preeclampsia and ovarian hyperstimulation. As such, this case presentation aimed to describe a patient with partial molar pregnancy with early preeclampsia and ovarian hyperstimulation, as complications, and a live fetus that was diagnosed during the 20th gestational week.

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Section: Discussionmentioning

confidence: 66%

A Case of Partial Hydatidiform Mole Presenting with Ovarian Hyperstimulation and Early Preeclampsia

Melekoğlu¹,

Eraslan²,

Çelik³

2016

Turkiye Klinikleri J Case Rep

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“…Ovarian hyperstimulation syndrome (OHSS) is the most potentially dangerous iatrogenic sequel of controlled ovarian hyperstimulation (COH) as well as it is associated with significant morbidity and mortality in context of assisted reproductive technology (ART) cycles [1,2,3,4] . OHSS incidence varies greatly in literatures, owning to existence of several OHSS grading systems with a vague definition of different stages, without specific cut-off values as well as incorporating of subjective and objective parameters [5,6,7] .…”

Section: Introductionmentioning

confidence: 99%

“…These mediators increase vascular capillary permeability either directly or indirectly where the chef player is VEGF with subsequent fluid leakage in third spaces including serous sacs as well as hemoconcentration [3] .…”

Section: Introductionmentioning

confidence: 99%

Calcium infusion plus or minus cabergoline for prevention of ovarian hyperstimulation syndrome: Randomized double-blind placebo-controlled trial

Sharafeldeen

2018

Evidence Based Women's Health Journal

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Aim: To evaluate the interaction of adding oral cabergoline (OC) to calcium infusion as a preventive modality for ovarian hyperstimulation syndrome (OHSS) in risky women undergoing controlled ovarian hyperstimulation (COH) in context of in-vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI). Patients and Methods: This prospective, double-blind, randomized, placebo-controlled trial was conducted at Benha IVF center of Obstetrics and Gynecology Department of Benha University and Nour Al Hayah Fertility Center Between January 2015 and February 2016. 220 risky women for OHSS undergoing ICSI were included, they were randomized to 110 women received once daily OC for eight days, starting at HCG triggering and infusion of calcium gluconate 10 ml 10% in 200 ml 0.9% saline daily for 4 days beginning at ovum pick up (OPU), coined as calcium infusion plus group (CI+) and 110 women received only calcium infusion in the same fashion as in CI+ coined as calcium infusion minus group (CI-). The primary outcome was the overall incidence of OHSS while the secondary issues were OHSS types and grades as well as other ICSI outcomes. Results: The incidence of overall OHSS was significantly lower in calcium infusion plus oral cabergoline (CI+) group compared to calcium infusion alone (CI-) group [8/110(7.2%) in CI+ versus 18/110 (16.3%) in CI-with difference in proportion percentage point (∆PP)=-9.1%, 95% CI: -0.49, -17.4; P = 0.036]. Despite the incidence of moderate and severe OHSS was lower in CI+ than in CI-, this difference didn't reach the significance level (2.7% vs 5.4%; p = 0.3) and (0.9% versus 2.7%; ), respectively. The other COH and ICSI outcomes didn't show any statistically significant differences. Conclusion: Adding oral cabergoline to calcium infusion is effective than calcium infusion alone in the reduction of overall OHSS incidence as well as its severity at comparable pregnancy outcomes.

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“…12,13 OHSS can be prevented by giving agonist trigger in antagonist cycle. But in our study, agonist protocol was used in majority of patients, hence this could not be applied.…”

mentioning

confidence: 99%

Correlation between number of mature eggs retrieved and live birth rate in IVF treatment

Rana¹,

Bavishi²,

Bavishi³

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONThe development of assisted reproductive technologies has revolutionized the treatment of Infertility. The 1 st IVF baby Louise Brown was born in 1978 by the pioneering efforts of Prof Edwards and Steptoe for which Prof Edwards was honoured with the Nobel Prize in medicine in 2010. The first IVF was natural cycle IVF in which one oocyte during natural cycle was retrieved. In natural cycle of a female one mature oocyte is released so that the rate of cancellation of cycle was high and success was less. 1In order to overcome that controlled ovarian hyper stimulation was introduced to facilitate multifollicular development and hence multiple oocyte and availability of more than one embryo for transfer. But this procedure can cause complication like OHSS, higher order multiple pregnancy and increased cost also. Many oocytes are discarded during various stages of laboratory procedures of IVF.2 The primary aim of IVF treatment is to achieve a live birth at term. So the critical question remains that how many mature oocytes per stimulation cycle is most suitable to achieve a live birth with low risk of complications.Many studies have focused on the relation between oocyte number and clinical pregnancies and have shown conflicting results. Some studies have analyzed the relation in between number of oocytes and live birth rate in fresh transfer.1 Our study is to determine the association in between the number of oocytes retrieved and a live birth ABSTRACT Background: There is a strong association between the number of eggs and clinical pregnancy rates in IVF. But a few studies have shown conflicting results. Aim was to determine the relation between number of mature eggs retrieved and live birthrate in one complete IVF cycle (fresh and all frozen transfers included) and hence determine the optimum number of oocytes. Setting private IVF centre doing around 2000 cycles per year. Methods: Retrospective analysis of 1140 infertile women between 20 and 45 years who underwent self-stimulation IVF in our centre, primary outcome studied was cumulative live birth rate in one complete IVF cycle. Secondary outcome was the number of cases of moderate and severe OHSS. Results: Maximum LBR in patients where 10-15 egg were retrieved in fresh embryo transfer and cumulative LBR was maximum when more than 15 eggs were retrieved. No case of severe OHSS and one case of moderate OHSS in the group where more than 15 eggs were retrieved. Conclusions: The percentage of live birth increases with increasing number of mature eggs in IVF treatment. The incidence of OHSS was negligible.

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Ovarian hyperstimulation syndrome: pathophysiology and prevention

Cited by 190 publications

References 49 publications

A Case of Partial Hydatidiform Mole Presenting with Ovarian Hyperstimulation and Early Preeclampsia

A Case of Partial Hydatidiform Mole Presenting with Ovarian Hyperstimulation and Early Preeclampsia

Calcium infusion plus or minus cabergoline for prevention of ovarian hyperstimulation syndrome: Randomized double-blind placebo-controlled trial

Correlation between number of mature eggs retrieved and live birth rate in IVF treatment

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