Preventing ovarian hyperstimulation syndrome: guidance for the clinician

Humaıdan, Peter; Quartarolo, Jens P.; Papanikolaou, Evangelos

doi:10.1016/j.fertnstert.2010.03.028

Cited by 270 publications

(248 citation statements)

References 123 publications

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“…Normally, a high or rapidly rising E2 on the day of trigger is a predictor of OHSS 13 . However, other studies revealed that high serum level of E2 alone is a poor predictor of OHSS [13][14][15] .…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Two cases of venous thromboses and none of OHSS were reported [13]. In this context, planned ovarian stimulation during a remission phase, use of protocols to avoid high serum E 2 levels, concomitant therapy with medications such as anticoagulants, corticosteroids, or immunosuppressants, prevention of OHSS [7], single embryo transfer and natural progesterone administered vaginally for luteal phase support may optimize the outcomes of women with SLE or APS undergoing ovarian stimulation [6].…”

Section: Discussionmentioning

confidence: 99%

“…To prevent ovarian hyperstimulation syndrome (OHSS), a major adverse outcome of IVF cycles in women with autoimmune rheumatologic diseases [6], a protocol based on the use of a GnRH antagonist was favored so that leuprolide acetate could be employed for final oocyte maturation if deemed necessary [7]. Baseline laboratory values included FSH of 4.5 IU/L, E 2 of 77 pg/ml and antral follicle count of 17.…”

Section: Case Reportmentioning

confidence: 99%

Ovarian stimulation and embryo banking for fertility preservation in a woman with severe mixed connective tissue disease: is it safe?

Sioulas

Gracia

2011

J Assist Reprod Genet

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Objective To report the first case of using assisted reproductive technologies (ART) for fertility preservation in a patient with mixed connective tissue disease (MCTD), secondary pulmonary hypertension (PH) and antiphospholipid syndrome (APS). Design Case-report and review of the literature. Setting Academic infertility practice and tertiary care center. Patient(s) A 25-year-old woman with MCTD, complicated with PH and APS, who was scheduled for gonadotoxic therapy Intervention(s) Controlled ovarian hyperstimulation, egg retrieval, embryo banking. Main outcome measure(s) Successful ART cycle leading to embryo banking without worsening her underlying disease. Result(s) Following successful embryo cryopreservation, the patient experienced respiratory failure and other severe complications, resulting in a prolonged hospital stay. Conclusion(s) Controlled ovarian hyperstimulation for embryo banking in women with MCTD, PH and APS may pose a risk for potentially catastrophic complications. A multidisciplinary approach to these patients is necessary to optimize the outcomes of such procedures. More data are needed regarding the safety of fertility preservation technologies in patients with complex medical diseases.

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“…Primary prevention means tailoring IVF treatment protocols according to the patient's primary risk factors, while the secondary prevention means the methods used to prevent the progression to OHSS in patients already showed excessive response to ovarian stimulation 1 . Individualizing IVF protocol includes modification of the starting dose of FSH, use of antagonist protocol instead of long agonist protocol, lowering the dose of hCG needed to trigger ovulation 18 or using GnRHa for triggering ovulation in GnRH antagonist treated cycles 19 .…”

Section: Introductionmentioning

confidence: 99%

Aromatase Inhibitors Versus Cabergoline for the Prevention of Ovarian Hyperstimulation Syndrome: a Prospective, Randomized, Double-Blind Study

Attalla¹,

Elhamidb

2017

Evidence Based Women's Health Journal

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Objective: To evaluate the effect of the aromatase inhibitor letrozole in the prevention of ovarian hyperstimulation syndrome (OHSS) in patients at risk during controlled ovarian hyperstimul (COH). Design: This is a prospective, randomized, double-blind study on women at risk of the development of OHSS during COH using gonadotropin-releasing hormone (GnRH) antagonist protocol Patients and Methods: This research was conducted at the Center of Assisted Reproduction, Om El-kora Hospital, Tanta, Egypt. Sixty patients, who were considered at risk of the development of OHSS during COH were enrolled in this study. Ovarian stimulation was performed using GnRH, whereas cabergoline (0.25 mg) given twice daily or letrozole (2.5 mg) twice daily from the day of oocyte retrieval for one week. Results: In the cabergoline group, two cases (6.6%) developed mild OHSS and one case (3.3%) developed moderate OHSS versus 8 (26.6%) mild OHSS and 6 (20%) moderate OHSS in the letrozole group. On the other hand, there was no statistically significant difference in the number of cases that developed severe OHSS in both groups where only one case (3.3%) developed severe OHSS in the cabergoline group vs. two (6.6%) cases in the letrozole group. Conclusion: Although letrozle administration during the luteal phase of ART cycles can reduce the high E2 level in hyper-responding patients, but it cannot prevent the development of early OHSS. On the contrary, Cabergoline can effectively prevent the development of early OHSS.

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Preventing ovarian hyperstimulation syndrome: guidance for the clinician

Cited by 270 publications

References 123 publications

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

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

Ovarian stimulation and embryo banking for fertility preservation in a woman with severe mixed connective tissue disease: is it safe?

Aromatase Inhibitors Versus Cabergoline for the Prevention of Ovarian Hyperstimulation Syndrome: a Prospective, Randomized, Double-Blind Study

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