The management of predicted ovarian hyperstimulation involving gonadotropin-releasing hormone analog with elective cryopreservation of all pre-embryos

Amso, Nazar Najib; Ahuja, Kamal; Morris, Norman; Shaw, Robert W.

doi:10.1016/s0015-0282(16)53591-2

Cited by 81 publications

(30 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although early OHSS associated with hCG administration may still occur (76)(77)(78)(79), it is the increase in endogenous hCG associated with pregnancy that is responsible for secondary exacerbation of early OHSS or the development of late OHSS, and these more serious forms of the condition can thus be avoided (77,80,81). Where OHSS does occur after cryopreservation, the severity and duration of the condition appear to be reduced (82).…”

Section: Cryopreservation Of All Embryosmentioning

confidence: 99%

Preventing ovarian hyperstimulation syndrome: guidance for the clinician

Humaıdan

Quartarolo²,

Papanikolaou

2010

Fertility and Sterility

274

228

View full text Add to dashboard Cite

Section: Cryopreservation Of All Embryosmentioning

confidence: 99%

Preventing ovarian hyperstimulation syndrome: guidance for the clinician

Humaıdan

Quartarolo²,

Papanikolaou

2010

Fertility and Sterility

274

228

View full text Add to dashboard Cite

“…These include: intravenous administration of concentrated human albumin (Asch et al, 1993) or hydroxyethyl starch (Abramov et al, 2001) at the time of oocyte retrieval; freezing of all embryos after in vitro fertilization (IVF) (Amso et al, 1990;Wada et al, 1992); in vitro maturation of immature oocytes (Child et al, 2001); low dose of exogenous human chorionic gonadotrophin (hCG) (Smitz et al, 1990) or use of gonadotrophin-releasing hormone (GnRH) agonists (Shalev et al, 1994) for inducing ovulation; stepping down the gonadotrophins (Chen et al, 2003); administration of recombinant luteinizing hormone (rLH) instead of hCG (Rizk & Smitz, 1992;European Recombinant LH Study Group, 2001); cancellation of the cycle (Forman et al, 1990); follicular aspiration of one ovary 10 -12 hours after hCG administration (Tomazevic & Meden-Vrtovec, 1996); and cessation of gonadotrophin stimulation while continuing administration of GnRH agonist and withholding hCG (Sher et al, 1993). The latter method, known as 'coasting', has been reported as a cost-effective strategy to avoid cycle cancellation, which is often associated with significant emotional and financial costs to the couple (Tortoriello et al, 1998;Waldenstrom et al, 1999;Al-Shawaf et al, 2001;Isaza et al, 2002;Ulug et al, 2004;Mansour et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

The optimal length of ‘coasting protocol’ in women at risk of ovarian hyperstimulation syndrome undergoingin vitrofertilization

Nardo¹,

Cheema²,

Gelbaya³

et al. 2006

Human Fertility

View full text Add to dashboard Cite

Ovarian hyperstimulation syndrome (OHSS) is a serious and potentially life-threatening complication following ovarian stimulation for in vitro fertilization (IVF). Coasting is the practice whereby the gonadotrophins are withheld and the administration of human chorionic gonadotrophin (hCG) is delayed until serum oestradiol (E2) has decreased to what is considered to be a safe level, to prevent the onset of OHSS. This study aimed to assess the length of coasting on the reproductive outcome in women at risk of developing OHSS. Coasting was undertaken when the serum E2 concentrations were > or = 17000 pmol/L but < 21000 pmol/L. Daily E2 measurements were performed and hCG was administered when hormone levels decreased to < 17000 pmol/L. Eighty-one women who had their stimulation cycles coasted were grouped according to the number of coasting days. Severe OHSS occurred in one case, which represented 1.2% of patients who underwent coasting because of an increased risk of developing the syndrome. No difference was found between cycles coasted for 1 - 3 days and cycles coasted for > or = 4 days in terms of oocyte maturity, fertilization and embryo cleavage rates. Women in whom coasting lasted for > or = 4 days had significantly fewer oocytes retrieved (P < 0.05) and decreased implantation rate (P < 0.05) compared to those coasted for 1 - 3 days. Pregnancy rate/embryo transfer and live birth rate did not differ between groups. In conclusion, coasting appears to decrease the risk of OHSS without compromising the IVF cycle pregnancy outcome. Prolonged coasting is, however, associated with reduced implantation rates, perhaps due to the deleterious effects on the endometrium rather than the oocytes.

show abstract

“…5,6,7 Early identification of the patients at risk and prevention of OHSS is clinically important. Several methods have been recommended for minimizing the probability of the syndrome in high risk pa tients including canceling the cycle before administration of hCG or reduction of the ovulatory hCG dose, 8 withhold ing luteal support with hCG, 9 cryopreservation of all em bryos for further use in a non-stimulated cycle, 10 repeated aspiration of ovarian follicles and early corpus luteum cysts, 11 administration of human albumin at the time of hCG injection, 12 use of GnRh analogue to trigger ovulation, 13 and vaginal aspiration of ascites. 14 Ketoconazole, a broad-spectrum imidazole antimycotic agent, was recently reported to reduce the incidence of OHSS in PCOS women undergoing superovulation program by gonadotropins.…”

Section: Introductionmentioning

confidence: 99%

A double-blind, randomized, placebo-controlled study to assess the efficacy of ketoconazole for reducing the risk of ovarian hyperstimulation syndrome

Parsanezhad

Alborzi

Pakniat

et al. 2003

Fertility and Sterility

View full text Add to dashboard Cite

Background: In order to evaluate the role of ketoconazole in the prevention of ovarian hyperstimulation syndrome (OHSS) in women with polycystic ovary syndrome (PCOS) undergoing ovarian stimulation with gonadotropins, a prospective, random ized, double-blind, placebo controlled study was done on one-hundred and nine PCOS women that had been referred to be treated by gonadotropins.Methods: All 109 women were assigned for random allocation. Group A (50 patients) received two ampoules of hMG beginning on day 2 or 3 of the cycle and ketoconazole (50 mg/every 48 hours) starting on the first day of hMG treatment. Group B (51 patients) received the same protocol of hMG combined with one tablet of pla cebo every 48 hours. Main outcome measures were follicular development, E2 levels, and pregnancy rate.Results: The total number of hMG ampoules and duration of treatment to attain ovarian stimulation was higher in group A (p<0.0001). Serum E2 level and number of patients with dominant follicles on day 9 of the cycle were higher in group B (p<0.0001). There was no significant difference between serum E2 level and total number of follicles at the time of hCG administration in the two groups. The cancellation rate and OHSS rate were similar in the two groups.Conclusion: Ketoconazole has no effect in prevention of OHSS in PCOS pa tients undergoing ovarian stimulation. It may however reduce the rate of folliculogenesis and steroidogenesis.

show abstract

The management of predicted ovarian hyperstimulation involving gonadotropin-releasing hormone analog with elective cryopreservation of all pre-embryos

Cited by 81 publications

References 5 publications

Preventing ovarian hyperstimulation syndrome: guidance for the clinician

Preventing ovarian hyperstimulation syndrome: guidance for the clinician

The optimal length of ‘coasting protocol’ in women at risk of ovarian hyperstimulation syndrome undergoingin vitrofertilization

A double-blind, randomized, placebo-controlled study to assess the efficacy of ketoconazole for reducing the risk of ovarian hyperstimulation syndrome

Contact Info

Product

Resources

About