Abstract
SummaryObjectiveOvarian hyperstimulation syndrome (OHSS) is a serious iatrogenic condition, predominantly related to the hormone used to induce oocyte maturation during IVF treatment. Kisspeptin is a hypothalamic neuropeptide that has recently been demonstrated to safely trigger final oocyte maturation during IVF treatment even in women at high risk of OHSS. However, to date, the safety of kisspeptin has not been compared to current hormonal triggers of oocyte maturation.DesignWe conducted a retrospective single‐centre cohort study investigating symptoms and clinical parameters of early OHSS in women at high risk of OHSS (antral follicle count or total number of follicles on day of trigger ≥23) triggered with human chorionic gonadotrophin (hCG) (n = 40), GnRH agonist (GnRHa; n = 99) or kisspeptin (n = 122) at Hammersmith Hospital IVF unit, London, UK (2013‐2016).Results Clinical Parameters of OHSS: Median ovarian volume was larger following hCG (138 ml) than GnRHa (73 ml; P < .0001), and in turn kisspeptin (44 ml; P < .0001). Median ovarian volume remained enlarged 20‐fold following hCG, 8‐fold following GnRHa and 5‐fold following kisspeptin compared to prestimulation ovarian volumes. Mean (±SD) ascitic volumes were lesser following GnRHa (9 ± 44 ml) and kisspeptin (5 ± 8 ml) than hCG (62 ± 84 ml; P < .0001). Symptoms of OHSS were most frequent following hCG and least frequent following kisspeptin. Diagnosis of OHSS: The odds ratio for OHSS diagnosis was 33.6 (CI 12.6‐89.5) following hCG and 3.6 (CI 1.8‐7.1) following GnRHa, when compared to kisspeptin.ConclusionTriggering oocyte maturation by inducing endogenous gonadotrophin release is preferable to the use of exogenous hCG in women at high risk of OHSS.
Highlights
Ovarian hyperstimulation syndrome (OHSS) is a largely iatrogenic condition that is associated with significant morbidity and even mortality in otherwise healthy women undergoing fertility treatment.[1]
The hormone used to induce oocyte maturation plays a critical role in the risk of OHSS following IVF treatment, with exogenous human chorionic gonadotrophin being the most frequent aetiological agent.[1]
Ovarian hyperstimulation syndrome results from the release of vasoactive substances from the ovary, such as vascular endothelial growth factor (VEGF A) due to excessive ovarian stimulation after triggering oocyte maturation during IVF treatment
Summary
Ovarian hyperstimulation syndrome (OHSS) is a largely iatrogenic condition that is associated with significant morbidity and even mortality in otherwise healthy women undergoing fertility treatment.[1] The hormone used to induce oocyte maturation plays a critical role in the risk of OHSS following IVF treatment, with exogenous human chorionic gonadotrophin (hCG) being the most frequent aetiological agent.[1] Ovarian hyperstimulation syndrome results from the release of vasoactive substances from the ovary, such as vascular endothelial growth factor (VEGF A) due to excessive ovarian stimulation after triggering oocyte maturation during IVF treatment. We sought to characterise clinical parameters of OHSS (ovarian volume, ascitic volume) and symptoms of OHSS following different triggers of oocyte maturation (hCG, GnRHa or kisspeptin) in women at high risk of early OHSS (antral follicle count or total number of follicles on day of trigger ≥23)
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