Abstract
Objectives:The purpose of this study was to examine the potential impact of severe Ovarian hyper stimulation syndrome (OHSS) on the risk of preterm birth. Severe ovarian hyperstimulation syndrome is a serious complication in the methods of in vitro fertilization. The pathophysiology of this process is not clear enough and the treatment is symptomatic. Human chorionic gonadotropin (h-CG) is the most important known cause of this condition. Findings of other authors often do not match when it comes to complications that may occur in pregnancy.Methods:In the Gynecology and Obstetrics Clinic “Narodni Front” a case control study was conducted on 50 female patients with severe forms of OHSS in the period from January 2008 to March 2015. A control group was created based on age and it involved 59 patients with pregnancy achieved with IVF/ICSI during the same period, but in which OHSS did not occur.Results:Patients with the pregnancy complicated by OHSS, had a considerably higher rate of preterm labor, whether this was labor before gestation week 37 (56.0% vs. 30.5%) or before gestation week 34 (34.0% vs. 6.8%); significantly lower weight of newborns, as in the newborns with low body weight <2500g (45.6% vs. 25.0%) and specially in the newborn with very low body weight <1500 grams (19.1% vs. 3.8%), as well as preterm premature rupture of membranes (PPROM), (11.76% vs. 1.59%).Conclusions:Pregnancy achieved by the IVF/ICSI method in which severe form of OHSS has been developed could have an increased risk of preterm birth.
Highlights
Ovarian hyper stimulation syndrome (OHSS) is one of the most serious and sometimes life-threatening complications in the methods of in vitro fertilization
The control group consisted of 59 patients in whom there has been no development of OHSS and who achieved their pregnancy by IVF during the same time period and who were of appropriate age
The weight of newborns was significantly lower in the OHSS group, especially in newborns with very low body weight, less than 1500 grams (19.1% in OHSS vs. 3.8% in control), p=0.000
Summary
OHSS is one of the most serious and sometimes life-threatening complications in the methods of in vitro fertilization. The severe form of OHSS occurs with an incidence of 0.5 to 5%.1. It is considered that the most important factor for the development of this, often life-threatening condition, is hCG.[2] It can be divided into early and late. The late OHSS form occurs ten or more days after administration of hCG and occurs as a result of endogenous production of hCG. The late form has a tendency to be more severe and more difficult to predict.[3] An increased secretion of mediators by granulosa and lutein cells, among which a special place occupies a vascular endothelial growth factor (VEGF), leads to an increased permeability of the capillaries and the accumulation of fluid in the so-called third space. In accordance with the fact that the pathophysiological process is not sufficiently defined; there is no specific treatment, so the therapy is primarily symptomatic.[5]
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