Influence of controlled ovarian stimulation protocols on ovarian hyperstimulation syndrome patterns during in vitro fertilization programs

Abstract

Different protocols of controlled ovarian stimulation have a significant influence on ovarian hyperstimulation syndrome (OHSS) patterns in women who undergo in vitro fertilization programs (IVF).The objective of this research was to evaluate the impact of different ovarian stimulation protocols on various clinical and laboratory parameters of OHSS, such as embryologic characteristics, hormonal changes, hemostasis, and IVF outcomes. The study was made on the basis of the MPUE “Center of Reproductive Medicine” (Minsk, Belarus) and included,in total, 718 women who underwent IVF for infertility treatment. 103 patients developed OHSS and were divided into two groups based on hormonal stimulation protocols: Group 1 included 60 women who were stimulated with gonadotrophin releasing hormone (GnRH) agonists protocol; Group 2 consisted of 43 women who were prescribed GnRH antagonists during ovarian stimulation.In Group 1 (ovarian stimulation protocol with GnRH agonists), we established significantly higher serum concentrations of estradiol and progesterone during IVF and more marked hemostatic shift towards hypercoagulation: statistically significant elevation of fibrinogen and D-dimes simultaneously with decrease in the primary anticoagulants (antithrombin III and protein С) functional activity. Also, Group 1 had a significantly higher incidence of the early form of OHSS and embryo transfer cancellation caused by a high risk of severe OHSS.OHSS that has developed after the GnRH agonists protocol of controlled ovarian stimulation is associated with higher risks of complications and lower chances of successful pregnancy, which is explained by hyperestrogenic state, elevated progesterone levels, marked hypercoagulation, and higher incidence of early OHSS, which leads to the necessity of embryo transfer cancellation.