Complication Of Assisted Reproductive Technology Research Articles

Tubal Stump Ectopic Pregnancy with Acute Abdomen: A Rare Case Report

Ectopic pregnancy, characterized by the implantation of the gestational sac outside the uterine cavity, is a grave condition. The objective of this study is to report a case of recurrent ectopic pregnancy in the residual site of the same fallopian tube, which had undergone unilateral salpingectomy due to ectopic pregnancy five years prior. Despite its rarity in the literature, tubal stump ectopic pregnancy poses higher risks of maternal mortality and morbidity compared to other types of tubal ectopic pregnancies. It is important to note that a history of salpingectomy does not exclude the possibility of ipsilateral recurrent ectopic pregnancy. Furthermore, this is the first documented case of stump tubal ectopic pregnancy from Turkey.

Ovarian Hyperstimulation Syndrome: Severe Form (About a Case)

Ovarian hyperstimulation syndrome is an iatrogenic complication of assisted reproductive technology and is characterised by cystic ovarian hypertrophy and fluid displacement from the intravascular space to a third space due to increased capillary permeability and ovarian neoangiogenesis. The mortality rate is not zero and is mainly related to the occurrence of thromboembolic accidents with the particularity of affecting both venous and arterial territories. Severe forms may require prolonged hospitalization in intensive care and the curative treatment is purely symptomatic.

Brain edema after oocyte retrieval: a case report

BackgroundBrain edema is a rare and serious complication of assisted reproductive technology (ART). The increased intracranial pressure and injured brain parenchyma are life-threatening and may even result in death. The pathogenesis may involve increased vascular permeability mediated by vascular endothelial growth factor and other vasoactive substances, including interleukin 6, interleukin 1β, angiotensin II, insulin-like growth factor 1, transforming growth factor β, and the renin–angiotensin system.Case presentationWe presented a unique case report of a 29-year-old woman developed sudden irritability, blurred consciousness, and vomiting 8 h after oocyte retrieval. Blood examinations showed hyponatremia and cranial computed tomography showed swelling of the brain parenchyma. After therapeutic use of hypertonic saline and mannitol infusion, the patient’s consciousness recovered and her neurological state improved.ConclusionsBrain edema is a rare and serious complication of ART. Quick infusion of hypertonic salt solution and mannitol is a key treatment. A good prognosis can be achieved after prompt treatment.

Outcome in a series of 1135 twin pregnancies: does the type of conception play a role?

The rate of twin pregnancies conceived via assisted reproductive technology has increased markedly in recent years. The elevated number of multiple pregnancies is the most serious and frequent complication of assisted reproductive technology. Twin pregnancies are associated with higher rates of obstetrical complications, preterm delivery, and perinatal morbidity and mortality than singleton pregnancies. This study aimed to investigate the association between the mode of conception and obstetrical and perinatal outcomes in twin pregnancies, adjusting for parity, age, and chorionicity. This was a retrospective cohort study of 1135 twin pregnancies between May 2006 and April 2021. All spontaneous (n=369) and assisted reproductive technology-conceived (n=766) twin pregnancies with antenatal care and delivery in the Universitari Quiron-Dexeus Hospital, Barcelona, Spain, a tertiary obstetrical care center, were studied according to chorionicity. The mean maternal age was higher among assisted reproductive technology twin pregnancies than among naturally conceived ones, and there were also less parous women in the assisted reproductive technology twin group. The global survival rates in both groups of twins were practically identical, namely 744 of 766 (97.1%) assisted reproductive technology twins and 357 of 369 (96.8%) spontaneously conceived twins. Patients with dichorionic assisted reproductive technology twins had a higher incidence of gestational diabetes (relative risk, 1.69; 95% confidence interval, 1.10-2.59) and gestational hypertension or preeclampsia (relative risk, 2.75; 95% confidence interval, 1.60-4.729). Monochorionic diamniotic assisted reproductive technology twins had a higher risk for gestational diabetes (relative risk, 4.12; 95% confidence interval, 1.35-12.56). We analyzed the gestational age at delivery, onset of labor, type of delivery, rate of preterm births, weight discordance, rate of small for gestational age neonates and intrauterine growth restriction, and admission to the neonatal intensive care unit. We could not find any statistical differences between monochorionic diamniotic assisted reproductive technology twins and spontaneously conceived twins. Among dichorionic twins, those conceived by assisted reproductive technology had an earlier gestational age at delivery (36.3±2.29 vs 36.6±2; P<.05) and we found statistical differences in the onset of labor with more cesarean deliveries (relative risk, 1.27; 95% confidence interval, 1.06-1.51). When adjusting for cofounding factors (maternal age, parity, chorionicity), the type of conception remained an independent risk factor for gestational hypertension and preeclampsia but not for gestational diabetes or cesarean delivery. Pregnancy outcomes are comparable between assisted reproductive technology and spontaneously conceived twins, and when adjusted for confounding factors, only the risk for gestational hypertension and preeclampsia remained increased in the assisted reproductive technology group.

Risk Factors and Method for Predicting Ovarian Hyperstimulation Syndrome (OHSS) in the In Vitro Fertilization Program

Ovarian hyperstimulation syndrome (OHSS) is the most severe and life-threatening complication of assisted reproductive technologies (ART). OHSS is based on an excessive ovarian response to ovarian stimulation; however, the pathogenesis has not been fully understood yet. The most serious complications of OHSS are thromboembolic complications and ovarian torsion. The current study describes the risk factors for the development of ovarian hyperstimulation syndrome and proposes a method for individual prediction of the syndrome. This study was designed to investigate 671 treatment cycles in the IVF program for 2009-2018. All patients were divided into 2 groups. Group 1 (n=56) included women who developed OHSS during the IVF procedure. Group 2 (n=615) consisted of women who did not have this complication during the IVF procedure. All the observation and examination outcomes were entered into a specially developed questionnaire, and then into an MS Excel spreadsheet. The material was processed by variable statistics using Statistica 10.0. Analyzing of the recorded data revealed that the rate of OHSS was higher in the group of younger women, 30.76±3.67 years, in comparison with 32.78±4.40 years in the group of patients without OHSS (p<0.05). The analysis of the initial phase of the reproductive system has confirmed that the group of patients with OHSS had a higher level of prolactin, 462.84±191.56 mIU/L in comparison with 363.43±187.84 mIU/L, which corresponded to the group of women without OHSS (p<0.05). Patients with OHSS significantly less often had obesity, in 7.15±1.04% of cases, while none of the patients from the group without OHSS suffered from it (p<0.05). OHSS is the most severe iatrogenic complication of ART, therefore it is extremely important to consider risk factors and take timely preventive measures. This study has established a high relationship between the above risk factors and ovarian hyperstimulation syndrome and proposed a model for predicting this syndrome.

Predictive Factors Associated with Ovarian Hyperstimulation Syndrome in Indonesian Women Undergoing IVF

Background: In line with the increasing practice of in-vitro fertilization, it is crucial to pay attention onitscomplications. The most common iatrogenic complication of assisted reproductive technologies (ART)is ovarian hyperstimulation syndrome (OHSS). Several characteristics are useful in identifying high-riskpatients in order to prevent OHSS.Method: This study analysed characteristics of age, body mass index (BMI), antral follicle count (AFC),estradiol levels, and the number of oocytes between two unpaired groups of 20 women with OHSS and 19women, who did not experience OHSS.Results: The characteristics of AFC (p = 0.012), estradiol levels (p &lt;0.001), and the number of oocytes (p&lt;0.001) showed were significantly different between the two groups. Women with higher AFC were morelikely to have OHSS, with OR of 3.33 (95% CI 0.77–14.31). Additionally, women with higher levels ofestradiol and number of oocytes were also more likely to have OHSS, OR 76.5 (95% CI 9.66–605.67) and81 (95% CI 4.2–1561.6), respectively. Other patient’s characteristics did not differ significantly (p&gt; 0.05).Conclusions: Women with AFC above ten follicles, estradiol levels above 3000 pg/ml, and oocytes countof more than 12 were more likely to develop OHSS.

Predicting Ectopic Pregnancy Using Human Chorionic Gonadotropin (hCG) Levels and Main Cause of Infertility in Women Undergoing Assisted Reproductive Treatment: Retrospective Observational Cohort Study.

BackgroundEctopic pregnancy (EP) is a serious complication of assisted reproductive technology (ART). However, there is no acknowledged mathematical model for predicting EP in the ART population.ObjectiveThe goal of the research was to establish a model to tailor treatment for women with a higher risk of EP.MethodsFrom December 2015 to July 2016, we retrospectively included 1703 women whose serum human chorionic gonadotropin (hCG) levels were positive on day 21 (hCG21) after fresh embryo transfer. Multivariable multinomial logistic regression was used to predict EP, intrauterine pregnancy (IUP), and biochemical pregnancy (BCP).ResultsThe variables included in the final predicting model were (hCG21, ratio of hCG21/hCG14, and main cause of infertility). During evaluation of the model, the areas under the receiver operating curve for IUP, EP, and BCP were 0.978, 0.962, and 0.999, respectively, in the training set, and 0.963, 0.942, and 0.996, respectively, in the validation set. The misclassification rates were 0.038 and 0.045, respectively, in the training and validation sets. Our model classified the whole in vitro fertilization/intracytoplasmic sperm injection–embryo transfer population into four groups: first, the low-risk EP group, with incidence of EP of 0.52% (0.23%-1.03%); second, a predicted BCP group, with incidence of EP of 5.79% (1.21%-15.95%); third, a predicted undetermined group, with incidence of EP of 28.32% (21.10%-35.53%), and fourth, a predicted high-risk EP group, with incidence of EP of 64.11% (47.22%-78.81%).ConclusionsWe have established a model to sort the women undergoing ART into four groups according to their incidence of EP in order to reduce the medical resources spent on women with low-risk EP and provide targeted tailor-made treatment for women with a higher risk of EP.

Emergent complication of assisted reproductive technology: Clinical analysis of 17 pregnant women with adnexal torsion

BackgroundThe purpose of this study was to evaluate the clinical symptoms, surgical management, and outcomes of pregnant women with adnexal torsion due to assisted reproductive technology. MethodsIt was a retrospective study that include 17 pregnant women with adnexal torsion, in which the maternal age, type of fertilization, gestational age, clinical symptoms, ultrasonic findings, side affected by the disease, surgical method, and pregnancy outcomes were evaluated. ResultsA total of 17 patients with adnexal torsion were included in this study, of which 8 patients conceived by in vitro fertilization-embryo transfer (IVF-ET), 1 by artificial insemination (AIH), and the other 8 conceived naturally after ovulation induction. About 14 were reported to have occurred in the first trimester of pregnancy, 1 case in the second trimester, and the other 2 in the third trimester. Clinical symptoms were abdominal pain with or without nausea and vomiting. 14 cases occurred in the right adnexa and the other 3 in the left. 5 of the patients underwent laparoscopy, and the other 12 underwent laparotomy. 8 cases were of full- term delivery, 6 twins gave birth prematurely, and 3 patients had inevitable abortion. ConclusionsAdnexal torsion is an acute onset of lower abdominal pain in women, which seldom occurs during pregnancy. However, because of the wide application of assisted reproductive technology (ART), its incidence has increased. Early diagnosis and treatment can lead to better results.

2278 Spontaneous vs. Assisted Reproductive Technology-related Ectopic Pregnancy – Are There Any Differences?

Study Objective Extrauterine pregnancy (EUP) is a complication of assisted reproductive technology (ART). Data regarding specific clinical characteristics and treatment success rate of ART-related EUP are scant. This study assessed differences in clinical presentation, management and treatment success rate between spontaneous and ART-related EUP. Design A retrospective cohort study that included EUP diagnosed between 2007-2017. Setting Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel Patients or Participants 412 EUP diagnosed between 2007-2017. Interventions Electronic medical record data of 278 spontaneous EUP were compared to 125 ART-related EUP (36 after ovulation induction and 89 after in vitro fertilization (IVF)). Symptoms, laboratory tests, ultrasound findings and treatment modalities were compared between groups. Measurements and Main Results Women with spontaneous EUP were more likely to be symptomatic than those who conceived after IVF (81.8% vs. 68.5%, p=0.022). Surgery was used as first-line treatment in 21.9% of spontaneous pregnancies, as compared to 37.1% of IVF pregnancies (p=0.004). IVF cases required additional methotrexate following conservative treatment failure less often than did those with spontaneous EUP (33.3% vs. 55.2%, p=0.019). Conclusion Women with IVF-related EUP were less symptomatic upon presentation and underwent surgery for first-line treatment more often than those with spontaneous EUP did. The type of conception was not a prognostic factor for success of first-line conservative treatment. Observation alone was more successful among IVF pregnancies.

The effect of luteal GnRH antagonist on moderate and severe early ovarian hyperstimulation syndrome during in vitro fertilization treatment: a prospective cohort study.

Ovarian hyperstimulation syndrome (OHSS) is a serious complication of assisted reproductive technology (ART) treatment. However, there are limited data regarding the ability of the luteal GnRH antagonist cetrorelix to reduce the incidence of moderate and severe OHSS, and the mechanism remains unclear. Thus, we designed a study to assess the effectiveness of cetrorelix to prevent early moderate and severe OHSS in high-risk patients undergoing controlled ovarian stimulation for IVF/ICSI. In this prospective cohort study, 105 patients with high-risk OHSS undergoing cryopreservation of all embryos were divided into two groups according to their personal choice. The cetrorelix group (n = 65) received 0.25mg of cetrorelix by subcutaneous injection daily, from days 3 to 5 post-oocyte retrieval (POR); the control group (n = 40) received no drug. The primary outcome measures were the incidence and severity of early moderate and severe OHSS. Secondary measures included serum estradiol levels, ovarian volume, ascites volume, hematocrit values, and WBC count on days 3, 6, and 9 POR. VEGF and EGR-1 levels were assessed, and binary logistic regression analysis was applied to predict associations between clinical variables and OHSS. Ninety-six patients were examined. The incidence of moderate and severe OHSS was significantly lower in the cetrorelix group than in the control group (18.03% and 37.14%, respectively; P = 0.037). Serum estradiol (P = 0.013), white blood cell count (P = 0.031), ascites volume (P = 0.036), EGR-1 (P = 0.025), and VEGF levels (P = 0.015) were significantly higher in the control group on day 6 POR than on day 3 POR, while no increase was observed between day 3 POR and day 6 POR in the cetrorelix group, indicating a faster regression of OHSS symptoms. Cetrorelix intervention was associated with the incidence and severity of OHSS (OR 0.29, 95% CI 0.11-0.78, P = 0.014). Cetrorelix effectively reduces the incidence of early moderate and severe OHSS in high-risk women and decreases serum VEGF levels.

Risk of ovarian torsion in patients with ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is a serious complication of assisted reproductive technology (ART) for which hospital admission is required in severe cases to prevent life-threatening complications or for treatment of ovarian torsion. In OHSS, high ovarian volumes increase the risk of torsion, however population-based data evaluating incidence and complications of OHSS-related ovarian torsion are lacking. To examine the incidence of OHSS-related ovarian torsion and severe medical complications as well as to profile the characteristics of and interventions required for women with OHSS and ovarian torsion. A retrospective analysis of the Nationwide Inpatient Sample between 2001-2015 was performed. This database represents over 97% of the United States population. Hospital discharge records of women <50 years of age with OHSS and no other ovarian pathology were extracted and weighted. Women with and without ovarian torsion were compared. A classification-tree model was utilized to identify patterns of patient characteristics associated with ovarian torsion. There were 14,623 women admitted with OHSS during the study period, and 313 (2.1%, 95% confidence interval [CI] 1.9-2.4) had ovarian torsion. Of all women admitted with OHSS, 1330 (9.1%) women were pregnant, and pregnant women had a greater risk of torsion compared to non-pregnant women (3.2% vs. 2.0%, OR 1.6 95%CI 1.1-2.2, P=0.008). Severe medical complications, including ascites, electrolyte imbalance, hemorrhage, sepsis/shock, venous thromboembolism, stroke, myocardial infarction, pneumonia, pleural effusion, respiratory failure, intestinal obstruction, or kidney injury occurred in 8,322 (56.9%) women with OHSS overall. Women admitted with OHSS-related torsion had lower rates of medical complications (31.6% vs. 57.5%, OR 0.34 95%CI 0.25-0.44, P<0.001) and more rarely required paracentesis (5.8% vs. 31.1%, OR 0.14 95% CI 0.08-0.22, P<0.001). However, 11.5% of women with ovarian torsion underwent oophorectomy. There were no fatalities in the ovarian torsion group, while 9 (0.06%) deaths occurred among all OHSS patients. Median total charges for the index admission were higher in those with torsion compared to those without ($18,650 versus $10,943, net difference $7,707, P<0.001). Rates of ovarian torsion were lower in urban teaching centers (1.8%) compared to urban-non-teaching (2.6%) or rural (4.3%) hospitals (P<0.001), however oophorectomy rates were not different (P=0.123). Oophorectomy rates differed by region and were lowest in the West (0%) and highest in the Northeast (25%) (P<0.001). On classification tree analysis, the highest incidence of ovarian torsion (10%) was in women in urban non-teaching or rural hospitals located in the South after 2012. Of women admitted with OHSS, one in fifty had ovarian torsion, and oophorectomy, a devastating outcome for fertility-seeking patients, was performed in over 10%. Torsion occurred more frequently in pregnant patients and was associated with fewer medical complications, supporting the hypothesis that torsion in OHSS results from increased ovarian volumes rather than increased capillary permeability. Rates of torsion and oophorectomy also differed based on hospital teaching status and geographic region, respectively. As outpatient management of non-severe OHSS is increasing, there should be heightened awareness regarding the risk of torsion and prompt medical evaluation provided if torsion is suspected.

Effect of low-dose aspirin on the development of ovarian hyperstimulation syndrome and outcomes of assisted reproductive techniques in the women with PCOS, a randomized double-blinded clinical trial

ObjectiveOvarian hyperstimulation syndrome (OHSS) is a major complication of assisted reproductive technologies (ART). Polycystic ovary syndrome (PCOS) is a risk factor for OHSS. The aim of this randomized clinical trial (RCT) was to study the effect of low-dose aspirin (LDA) on the development of OHSS and ART outcomes in PCOS during ART. Materials and methodsThis double-blinded placebo controlled RCT was performed on 232 PCOS infertile women in their first ART cycles during 2010–2016. LDA and placebo capsules were prepared, packed and specified by code numbers in similar shapes. One package was given to every woman and asked to take one capsule/day since the 21st day of her cycle prior to the gonadotropin stimulation. Gonadotropin releasing hormone agonist long protocol and triggering by human chorionic gonadotropin were used. Development of moderate to severe OHSS and their ART outcomes were documented then the codes were broken and data analyzed. Chi-square and Mann–Whitney U tests were used for the statistical analyses. ResultsEighteen cases that did not follow the study design were excluded. 214 cycles remained for the final analyses with 109 cases in LDA and 105 in the placebo group. Rate of the moderate to severe OHSS in LDA group was 34.9% compared to 30.5% in placebo group (P = 0.494). Fertilization rate was 71.8% vs 65.1% (P = <0.001) and the mean number of grade III embryos were 3.28 ± 3.53 vs 1.46 ± 1.42 (P = 0.014) in LDA and placebo groups, respectively. The mean number of the oocytes in different grades, total and frozen embryos also implantation and clinical pregnancy rates were not different between the groups. ConclusionModerate to Severe OHSS was not decreased but fertilization rate and the mean number of poor quality embryos were increased in LDA arm. Registration numberIRCT 201105216541N1.

Factors that Influence The Occurrence of Multiple Pregnancies after Intracytoplasmic Injection Cycles with Two or Three Fresh Embryo Transfers.

Multiple pregnancies are an important complication of assisted reproductive technology (ART). The present study aims to indentify the risk factors for multiple pregnancies independent of the number of transferred embryos. This retrospective study reviewed the medical records of patients who underwent intracytoplasmic sperm injection (ICSI) cycles in Royan Institute between October 2011 and January 2012. We entered 12 factors that affected the number of gestational sacs into the poisson regression (PR) model. Factors were obtained from two study populations-cycles with double embryo transfer (DET) and cycles that transferred three embryos (TET). We sought to determine the factors that influenced the number of gestational sacs. These factors were entered into multivariable logistic regression (MLR) to identify risk factors for multiple pregnancies. A total of 1000 patients referred to Royan Institute for ART during the study period. We included 606 eligible patients in this study. PR analysis demonstrated that the quality of transferred embryos and woman's age had a significant effect on the number of observed sacs in patients who underwent ICSI with DET. There was no significant predictive variable for multiple pregnancies according to MLR analysis. Our findings demonstrated that both regression models (PR and MLR) had the same outputs. A significant relation existed between age and fertilization rate with multiple pregnancies in patients who underwent ICSI with TET. Single embryo transfer (SET) should be considered with the remaining embryos cryopreserved to prevent multiple pregnancies in women younger than 35 years of age who undergo ICSI cycles with high fertilization rates and good or excellent quality embryos. However, further prospective studies are necessary to evaluate whether SET in women with these risk factors can significantly decrease multiple pregnancies and improve cycle outcomes.

A Brief Review of Stroke associated with Assisted Reproductive Technology

Strokes related to assisted reproductive technology are rare, but can be devastating. In order to understand how stroke can occur as a complication of assisted reproductive technology, both the normal physiology of ovulation and the hormonal manipulations used to maximize pregnancy will be examined. In particular, the danger of thrombotic complications related to ovarian hyperstimulation syndrome will be reviewed including the pathophysiology, clinical features, risk factors and treatment.

The Dual Role of PEDF in the Pathogenesis of OHSS: Negating Both Angiogenic and Inflammatory Pathways.

Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of assisted reproductive technologies. This complex syndrome is known to involve massive angiogenesis and inflammation. We have previously established the anti-angiogenic involvement of pigment epithelium-derived factor (PEDF) in the pathophysiology and treatment of OHSS. Evaluate the anti-inflammatory role of PEDF in OHSS. In vivo mouse OHSS model and in vitro cultures of granulosa cells. Changes in the expression of PEDF, IL-6, IL-8, and vascular endothelial growth factor (VEGF) were measured by quantitative PCR and ELISA; OHSS symptoms were recorded (body and ovarian weight gain and peritoneal vascular leakage quantified by the modified Miles's assay). Rat granulosa cell-line stimulated with lysophosphatidic acid (LPA), exhibited a significant increase in IL-6 expression, concomitantly with a decrease in PEDF level (P < .01). Co-stimulation with recombinant PEDF (rPEDF) decreased the expression of IL-6 significantly (P < .05). Furthermore, the expression of IL-6 and IL-8 increased in LPA-stimulated human primary granulosa cells (P < .01). Co-stimulation with rPEDF decreased the expression of LPA-induced IL-6 and IL-8 mRNA and protein by 4- and 2- to 5-fold, respectively. IL-8-stimulated human primary granulosa cells exhibited increased expression of VEGF mRNA; co-stimulation with hCG induced a significantly higher increase in the expression of VEGF mRNA (P < .001), which was counteracted by rPEDF. Subcutaneous injection of 0.5 mg/kg rPEDF to OHSS-induced mice reduced the increased expression of IL-6 in the ovary (P < .01) and alleviated the severity of all OHSS parameters. Our findings provide a framework that correlates down-regulation of OHSS symptoms caused by PEDF with both angiogenic and inflammatory pathways.

Ovarian Hyperstimulation Caused by Gonadotroph Pituitary Adenoma--Review.

Ovarian hyperstimulation syndrome (OHSS) occurs mostly as an iatrogenic complication of assisted reproductive technology. Gonadotroph pituitary adenomas are rarely associated with OHSS. To the authors' knowledge, to date only 30 cases of spontaneous ovarian stimulation associated with gonadotroph adenomas have been reported in women and only 2 in children. The most common symptoms in such cases included menstrual disturbances, abdominal or pelvic pain, abdominal distension and increased girth. Galactorrhea, nausea and vomiting were also reported. Neurological symptoms occurred when the size of the pituitary tumor reached at least 20 mm. Transvaginal ultrasound examination usually demonstrated enlarged multicystic ovaries. MRIs of the pituitary revealed macroadenomas up to 61 mm in maximum diameter. The hormonal profiles of the reported cases showed normal or elevated FSH levels, suppressed LH levels, elevated estradiol levels and supranormal concentrations of prolactin. Transsphenoidal surgery is the therapy of choice, however other treatment modalities can be utilized in selected cases.

Cardiovascular dysfunction in offspring of ovarian-hyperstimulated women and effects of estradiol and progesterone: a retrospective cohort study and proteomics analysis.

The cardiovascular dysfunction in children born with assisted reproductive technologies has been of great concern. However, the association of ovarian hyperstimulation syndrome (OHSS), a complication of assisted reproductive technologies, with worse cardiovascular functions and underlying mechanism remains unknown. The objective of the study was to assess the cardiovascular functions of children born to mothers with OHSS and investigate the underlying regulator(s). This was a retrospective cohort recruited in a university hospital. We assessed the cardiovascular functions by Doppler echography in 42 children born to OHSS women, 34 children of mothers with non-OHSS in vitro fertilization, and 48 spontaneously conceived (SC) children (mean age ∼ 4.5 y). Groups were matched for gestational age at delivery and birth weight. An isobaric tag for relative and absolute quantitation-labeled proteomics analysis was performed with another set of umbilical arteries from OHSS and SC pregnancies (n = 3 for both groups). Children of OHSS mothers showed a significantly decreased mitral ratio of early to late mitral peak velocities, reduced systolic and diastolic diameters of common carotid arteries, and impaired flow-mediated dilation compared with non-OHSS in vitro fertilization and SC children. Intima-media thickness and arterial stiffness indices were similar in the three groups. In the proteomics study, 1640 proteins were identified from OHSS and SC umbilical arteries, and 40 differentially expressed proteins were selected for further analysis. Estradiol and progesterone were identified as activated upstream regulators. Children born to ovarian-hyperstimulated women displayed cardiovascular dysfunctions. The underlying mechanisms may involve the effects of supraphysiological estradiol and progesterone levels.

Cardiovascular dysfunction in children born to women with ovarian hyperstimulation syndrome: a retrospective cohort study and proteomics analysis

Ovarian hyperstimulation syndrome (OHSS) is a complication of assisted reproductive technologies (ARTs). The cardiovascular dysfunction in children born with ARTs has been widely concerned. However, whether OHSS is associated with worse cardiovascular functions and the mechanisms underlying the association remain unknown.

Actinomycosis pelvic abscess after in vitro fertilization

To report a case of pelvic actinomycosis presenting as large, multiloculated abscesses after an in vitro fertilization (IVF) cycle for male factor infertility. A case report and literature review. University hospital. A 31-year-old nulligravid woman presenting with urinary retention, pelvic pain, and fever 6 days after transvaginal oocyte retrieval and an embryo transfer for male factor infertility. Intravenous and oral antimicrobial therapy, and computed tomography (CT)-guided drainage of pelvic abscesses. Clinical and radiologic resolution of symptoms and infection. The CT scan revealed several large, multiloculated pelvic and tuboovarian abscesses. The patient defervesced after 6 days of intravenous antibiotics, but the pelvic pain did not improve. After CT-guided drainage of the pelvic abscesses, the patient's symptoms improved. The drained material was cultured, and the patient was diagnosed with pelvic actinomycosis tuboovarian abscesses, an infrequent cause of tuboovarian abscess and a rare complication of assisted reproductive technology (ART). The patient was switched from intravenous to oral antibiotics and discharged home. Pelvic Actinomyces israelii presenting as pelvic abscesses may occur as a rare complication of ART. Physicians should consider a diagnosis of tuboovarian abscess in a patient reporting fever and pelvic pain after IVF and embryo transfer.

Management of severe ovarian hyperstimulation syndrome with thawed plasma

Severe ovarian hyperstimulation syndrome remains one of the life threatening complication of assisted reproductive technology. In refractory cases of late ovarian hyperstimulation syndrome (OHSS), clinicians are left with limited therapeutic options. We report a case of refractory OHSS which was managed successfully using thawed plasma. Thawed plasma transfusion could be potential therapeutic option for managing patients with severe ovarian hyperstimulation not responding to conventional treatment.