Reduced incidence of ovarian hyperstimulation syndrome by prophylactic infusion of hydroxyaethyl starch solution in an in-vitro fertilization programme

Abstract

Prophylactic infusion of human serum albumin can reduce or mitigate severe ovarian hyperstimulation syndrome (OHSS) in patients at high risk. Recently, concern has been expressed in the lay press regarding the potential viral transmissions with blood constituents. Hence, we looked for a safe non-biological substitute with comparable physical properties in order to cope with this concern. One hundred patients of our in-vitro fertilization (IVF) programme with oestradiol serum concentrations> or = 11010 pmol/l on the day of human chorionic gonadotrophin injection and/or > or = 20 oocytes retrieved and/or previous severe OHSS were infused with 1000 ml 6% hydroxyaethyl starch solution at the time of oocyte collection and 500 ml 48 h later. A total of 82 IVF patients at risk without prophylactic infusions during the preceding years served as controls. Both groups were identical according to patient's age, body mass index, androgen concentrations, peak oestradiol concentrations, number of retrieved oocytes, fertilization and pregnancy rates. There were seven cases of severe OHSS in untreated patients and two cases in the treatment group (P = 0.08). In moderate OHSS a significant difference became obvious with only ten cases in the treatment group and 32 cases in the control group (P < 0.00001). Hydroxyaethyl starch solution seems to be an effective and economic alternative in reducing severe and moderate OHSS during IVF treatment.

Pathophysiology of ovarian hyperstimulation syndrome and strategies for its prevention and treatment

“…In a RCT, infusion of 500 ml of HES 6% solution at the time of oocyte collection was more effective than both albumin and placebo [142]. Others also supported these findings [143,144]. HES is, therefore, a promising substance requiring further study.…”

Administration of Intravenous Albumin around the Time of Oocyte Retrieval Reduces Pregnancy Rate without Preventing Ovarian Hyperstimulation Syndrome: A Systematic Review and Meta-Analysis

“…An alternative approach is currently possible, since hydroxyethyl starch (HES), a synthetic compound of large molecular weight, can be used as a plasma volume expander. It was reported that HES could prevent OHSS in 100 high-risk women who were administered 6% HES in a volume of 1,000 ml at the time of oocyte retrieval, with a further 500 ml at embryo transfer [24] . In that report, no significant difference was observed in the incidence of severe OHSS between the treatment group and a historical control group, although the incidence of moderate OHSS was reduced.…”

The effect of duration of coasting and estradiol drop on the outcome of assisted reproduction: 13 years of experience in 1,068 coasted cycles to prevent ovarian hyperstimulation

“…Alterations in cycle regime, such as the use of lower gonadotropin doses (6), GnRH antagonist protocols (7), GnRH agonist rather than hCG (8), coadministration of metformin in women with polycystic ovarian syndrome (PCOS) (9), and the use of progesterone for luteal support (10), have all been demonstrated to significantly decrease OHSS risk. Other preventive measures, such as the cryopreservation of all embryos in an attempt to minimize the risk of ''late OHSS'' (11), follicular aspiration before hCG (12,13), and the administration of intravenous albumin (1,14) or hydroxyl-ethyl starch (15), have also been reported but remain unproven. More recently, reports have suggested a role for dopamine agonists, with a significant decrease in hematologic and clinical markers of OHSS as well as significant decrease in incidence of moderate OHSS compared with placebo by virtue of an inhibition of vascular permeability via dephosphorylation of the vascular endothelial growth factor receptor (16,17).…”