Ovarian Hiperstimulation Syndrome: incidence in a public service of assisted reproduction and literature review

Abstract

IntroductionThe ovarian hyperstimulation syndrome (OHSS), although uncommon, is an important complication of assisted reproduction because of its morbidity and possible lethal outcome. ObjectiveTo verify the incidence of OHSS in public service of assisted reproduction and review the literature. MethodA descriptive retrospective study of patients enrolled in the Assisted Reproduction Laboratory of Hospital Pérola Byington who had 15 or more oocytes retrieved during controlled ovarian stimulation cycle, period 2010-2012. A literature search was conducted in the databases Medline, Scopus and SciELO including articles indexed between 2010 and 2013. ResultsOHSS was observed in 17 cycles (1.9%) of 857 performed. The mean age was 33.2 years, with a mean of 21.6 oocytes retrieved and 11.5 mature oocytes. Hospitalization and ascites puncture was required in five cases. There was no fatal outcome. The literature suggests that methods used to predict the ovarian response help to prevent OHSS, as antral follicle count, serum estradiol and anti-mullerian hormone. Evidence indicates that stimulation with GnRH antagonist and triggering with GnRH agonist, with or without vitrification of embryos are safe strategies for patients with high risk for OHSS. ConclusionThe incidence of OHSS was found to be within the range of literature. Although none of the approaches for the prevention of OHSS is fully effective, the majority demonstrates a decreasing incidence in high-risk patients.