Abstract
Objectives: Evaluation of outcome follicular aspiration compared to coating procedure for infertile women undergoing ICSI regarding frequency and severity of ovarian hyperstimulation syndrome (OHSS). Patients & Methods: Infertile PCOS women underwent controlled ovarian stimulation with luteal phase GnRH-agonist long down-regulation protocol. Women developed serum E2 level > 4000 pg/ml and/or >20 follicles of ≥10 mm in diameter were randomly divided to receive coasting strategy (Coasting group) or TVU-guided aspiration (Aspiration group). When ≥3 follicles were ≥18 mm and serum E2 level was and 10,000 IU was administered 36 h before oocyte retrieval, and ICSI was performed 72-hr thereafter and the frequency of moderate-to-severe OHSS was determined. Results: 82 women developed criteria for categorization and 21 women (25.6%) developed moderate-to-severe OHSS; 5 women of aspiration and 16 of Coasting group; with significantly (P = 0.005) lower frequency in aspiration group. Twenty women developed ascites; 3 women had clinically detectable, while 17 women had US detected ascites with significantly (P = 0.039) higher frequency among women that had coasting. All other manifestations of OHSS were significantly lower with aspiration procedure. Both coasting and aspiration therapy significantly reduced serum E2 and ovarian diameter on day of hCG injection compared to estimates taken at time of categorization. Conclusion: Coasting procedure prior to hCG injection could decrease incidence of OHSS and lessens its manifestation. Follicular aspiration provided more superior results and improved outcome of these women. Any of these modalities could be provided to infertile high-risk women according to the availability of experiences and patients’ selection.
Highlights
Ovarian stimulation (OS) is crucial for pregnancy success in assisted reproductive technology treatments [1]
Follicular aspiration provided more superior results and improved outcome of these women. Any of these modalities could be provided to infertile high-risk women according to the availability of experiences and patients’ selection
On day of hCG injection, estimated serum E2 levels significantly decreased in patients of both groups in comparison to levels estimated at time of categorization, but were still significantly higher compared to basal E2 levels
Summary
Ovarian stimulation (OS) is crucial for pregnancy success in assisted reproductive technology treatments [1]. Ovarian hyperstimulation syndrome (OHSS) in hyper-responders to OS is common despite being self-limited [2]. It is a severe complication for patients undergoing IVF/ICSI [3]. Vascular endothelial growth factor (VEGF) plays the most important role in pathogenesis of OHSS and is related to concomitant increased capillary permeability and fluid retention [2]. Presence of genetic mutations is already known to be involved in OHSS [4]. Women who had follicle-stimulating hormone receptor variant asparagine/serine in amino acid 680 are at higher risk for OHSS during IVF [5]. A potential link was suggested between OHSS and mutations of the FLT4 gene which encodes Fms-related tyrosine kinase 4 [4]. Production of some pro-inflammatory molecules such as IL-8, IL-1, IL-6 and TNF-α was incriminated in pathogenesis of OHSS [2]
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