Prevention and management of ovarian hyperstimulation syndrome

Mathur, Raj; Evbuomwan, Isaac; Jenkins, Julian

doi:10.1054/cuog.2001.0243

Cited by 14 publications

(16 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The odds ratio for AMH alone was 1.7856, (P= 0.0003) and for E2 was 1.0005, (P= 0.0455). No precise cut-off level for E2 during stimulation has been agreed upon by consensus 5 . Normally, a high or rapidly rising E2 on the day of trigger is a predictor of OHSS 13 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…polycystic ovarian syndrome (PCOS). It is also more common in cycles where clinical pregnancy occurred, and where human chorionic gonadotropins (hCG) used for ovulation trigger and luteal support 5 .…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

show abstract

“…Whereas critical OHHS is associated with tense ascites, hematocrit >55%, oliguria/anuria, thromboembolism and acute respiratory distress syndrome. 5,6 Several factors have been demonstrated to independently increase the risk of developing OHSS such as age < 30 years, polycystic ovaries, high serum estradiol at HCG trigger or rapidly rising serum estradiol, previous episodes of OHSS, large number of small follicles (8 to 12 mm) seen on ultrasonography during ovarian stimulation, use of HCG as opposed to progesterone, for luteal phase support after IVF, large number of oocytes retrieved (>20), and high anti-mullerian hormone (>3.36 ng/mL). [5][6][7] Management is essentially supportive until the condition resolves spontaneously.…”

Section: -3mentioning

confidence: 99%

“…Mild and moderate OHHS can be managed on an outpatient basis. 6 Analgesia using paracetamol or codeine is appropriate. Non-steroidal antiinflammatory drugs should not be used.…”

Section: -3mentioning

confidence: 99%

A rare case of clomiphene citrate induced moderate ovarian hyperstimulation syndrome

Barhate

Dudhwadkar

Jhaveri

et al. 2016

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

“…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 . Secondary preventive measures include coasting 18 , withholding hCG and cycle cancellation 20 , cryopreservation of all embryos 21 , intravenous administration of albumin 22 or hydroxyethyl starch (HES) 23 during or immediately after oocyte retrieval, use of cabergoline 24 or the vasopressin V1a receptor antagonist, relcovaptan 25 .…”

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

View full text Add to dashboard Cite

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.

show abstract

Prevention and management of ovarian hyperstimulation syndrome

Cited by 14 publications

References 8 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

A rare case of clomiphene citrate induced moderate ovarian hyperstimulation syndrome

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

Contact Info

Product

Resources

About