Does decreasing the intramuscular hCG Dose reduce the risk of ovarian hyperstimulation syndrome?

Abstract

ObjectiveTo determine if decreasing the intramuscular (IM) hCG dose in patients with estradiol levels greater than 3,000 pg/mL reduces the risk of ovarian hyperstimulation syndrome (OHSS) occurrence.DesignRetrospective cohort study in a university hospital-based practice.Materials and MethodsWe reviewed 411 IVF cycles from 288 women between January 1, 2006 and September 21, 2010. We included patients whose serum estradiol (E2) level on hCG trigger day was ≥3,000 pg/mL (Range 3,007-8,841 pg/mL). Stepwise multiple logistic regression (MLR) was performed to examine if OHSS was predicted by age, body mass index (BMI), number oocytes retrieved (a marker for number of follicles), E2 level at trigger, hCG trigger dose, or serum hCG level after trigger. MLR was then used to determine if OHSS rates were decreased in cycles where the IM hCG trigger dose was decreased from 10,000 IU to 7,500 IU or 5,000 IU. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated.ResultsTabled 1Risk of OHSS by hCG DoseDose (IU)Mean E2 Level, pg/mL (range)Mean Age, years (range)Mean # Oocytes (range)OHSS, n (%)Adjusted OR (95% CI)P100004,037 (3,007-8,772)34 (25-46)22 (9-46)9/59 (15)Referent75004,978 (3,082-8,716)33 (21-42)22 (8-50)10/45 (22)1.5 (0.5-4.6)0.4550006267 (4,229-8,841)34 (30-37)26 (15-36)2/5 (40)5.9 (0.7-46.5)0.09 Open table in a new tab ConclusionDecreasing the hCG trigger dose for IVF does not reduce the risk of OHSS occurrence in women with elevated estradiol levels. The best predictors of OHSS are age and number of oocytes retrieved (a marker for number of follicles). ObjectiveTo determine if decreasing the intramuscular (IM) hCG dose in patients with estradiol levels greater than 3,000 pg/mL reduces the risk of ovarian hyperstimulation syndrome (OHSS) occurrence. To determine if decreasing the intramuscular (IM) hCG dose in patients with estradiol levels greater than 3,000 pg/mL reduces the risk of ovarian hyperstimulation syndrome (OHSS) occurrence. DesignRetrospective cohort study in a university hospital-based practice. Retrospective cohort study in a university hospital-based practice. Materials and MethodsWe reviewed 411 IVF cycles from 288 women between January 1, 2006 and September 21, 2010. We included patients whose serum estradiol (E2) level on hCG trigger day was ≥3,000 pg/mL (Range 3,007-8,841 pg/mL). Stepwise multiple logistic regression (MLR) was performed to examine if OHSS was predicted by age, body mass index (BMI), number oocytes retrieved (a marker for number of follicles), E2 level at trigger, hCG trigger dose, or serum hCG level after trigger. MLR was then used to determine if OHSS rates were decreased in cycles where the IM hCG trigger dose was decreased from 10,000 IU to 7,500 IU or 5,000 IU. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated. We reviewed 411 IVF cycles from 288 women between January 1, 2006 and September 21, 2010. We included patients whose serum estradiol (E2) level on hCG trigger day was ≥3,000 pg/mL (Range 3,007-8,841 pg/mL). Stepwise multiple logistic regression (MLR) was performed to examine if OHSS was predicted by age, body mass index (BMI), number oocytes retrieved (a marker for number of follicles), E2 level at trigger, hCG trigger dose, or serum hCG level after trigger. MLR was then used to determine if OHSS rates were decreased in cycles where the IM hCG trigger dose was decreased from 10,000 IU to 7,500 IU or 5,000 IU. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated. ResultsTabled 1Risk of OHSS by hCG DoseDose (IU)Mean E2 Level, pg/mL (range)Mean Age, years (range)Mean # Oocytes (range)OHSS, n (%)Adjusted OR (95% CI)P100004,037 (3,007-8,772)34 (25-46)22 (9-46)9/59 (15)Referent75004,978 (3,082-8,716)33 (21-42)22 (8-50)10/45 (22)1.5 (0.5-4.6)0.4550006267 (4,229-8,841)34 (30-37)26 (15-36)2/5 (40)5.9 (0.7-46.5)0.09 Open table in a new tab ConclusionDecreasing the hCG trigger dose for IVF does not reduce the risk of OHSS occurrence in women with elevated estradiol levels. The best predictors of OHSS are age and number of oocytes retrieved (a marker for number of follicles). Decreasing the hCG trigger dose for IVF does not reduce the risk of OHSS occurrence in women with elevated estradiol levels. The best predictors of OHSS are age and number of oocytes retrieved (a marker for number of follicles).