Form Of Ovarian Hyperstimulation Syndrome Research Articles

Serum progesterone concentrations on the day of oocyte retrieval above 9.23 ng/ml may predict ovarian hyperstimulation syndrome risk in in vitro fertilized patients.

The aim of our study was to evaluate serum progesterone levels on the day of oocyte retrieval as a promising biomarker inorder to evaluate the risk of ovarian hyperstimulation syndrome in a group with controlled ovarian hyperstimulation protocols using either gonadotropin antagonists or agonists (GnRH), compare with a natural cycle control group. Patients were divided into 3 groups (148 patients in total): control group in the natural cycle, patients treated with GnRH agonist and patients treated with GnRH antagonist. When we compared both controlled ovarian hyperstimulation (COH) protocol groups with the control group, we found statistically higher levels of progesterone in patients after COH (control versus long protocol group: 1.43 ± 1.28 ng/ml versus 8.95 ± 5.95 ng/ml; P < 0.001; control versus GnRH antagonist group: 1.43 ± 1.28 ng/ml versus 7.18 ± 5.13 ng/ml; P < 0.001). According to receiver operating characteristic (ROC) analysis, the level of serum progesterone on the day of oocyte retrieval, above which the risk of ovarian hyperstimulation syndrome (OHSS) is associated with a more than fourfold higher risk (OR 4.24; 95% CI 2.6 - 6.9) was found to be 9.23 ng/ml, with AUC: 0.896, P = 0.026 (95% CI 0.845 - 0.947). Progesterone level on the day of oocyte retrieval may be used as an additional sensitivity marker in treatment of early forms as well by freezing of embryos in prevention of late forms of OHSS.

Comparative study between agonist and antagonist protocols in PCOS patients undergoing ICSI: a cross-sectional study

BackgroundPolycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting 5–10% of women of reproductive age. The syndrome is surrounded by controversies regarding both its diagnosis and treatment. The introduction of long-acting GnRH agonists in the late 1980s revolutionized the approach to ovarian stimulation in assisted reproductive technologies by providing the means to downregulate endogenous pituitary gonadotropin secretion and thereby prevent a premature luteinizing hormone surge during exogenous gonadotropin stimulation. The relatively recent introduction of GnRH antagonists in clinical practice has provided another option for ovarian stimulation in IVF. The purpose of this study was to compare the efficacy of the fixed GnRH antagonist vs. GnRH agonist long protocol in patients with polycystic ovary syndrome treated by ICSI.ResultsThere is a statistically significant difference between both groups in view of the received dose of gonadotrophin (1901.7 ± 400.6 vs. 1789 ± 368 with p = .004) and duration of stimulation (11.3 ± 0.8 vs. 10.3 ± 1.1 with p = .017). There is no significant difference between both groups in view of pregnancy outcome (37% vs. 32% with p = .125). There is a significant difference between both groups in view of ovarian hyperstimulation syndrome (OHSS) incidence where the rates were 15%, 6%, and 1.5% vs. 4.5%, 2.5%, and .05% with p = 0.04 for mild, moderate, and severe, respectively, form of OHSS in group 1 and group 2.ConclusionThe antagonist protocol may be the preferred stimulation protocol for PCOS patients treated by ICSI in view of the reduction of OHSS incidence rates without compromising the pregnancy outcome.

Risk of spontaneous preterm labor in pregnancies achieved by in vitro fertilization and complicated with severe form of ovarian hyperstimulation syndrome: A case control study.

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.

Reducing the trigger dose of recombinant hCG in high-responder patients attending an assisted reproductive technology program: an observational study.

Decreasing the dose of human chorionic gonadotropin (hCG) used to trigger final oocyte maturation in assisted reproductive technology programs is regarded as a useful intervention in the prevention of ovarian hyperstimulation syndrome, but the minimal effective dose has not been yet identified. In this study, the capacity of a reduced dose of recombinant hCG (r-hCG) to provide adequate oocyte maturation was tested for the first time. Thirty-five high-responder patients received a dose of 125 µg (half of the standard dose) of r-hCG for triggering final oocyte maturation. The number of oocytes retrieved per patient and the proportion of mature oocytes were evaluated. As a result, a mean number of 14 oocytes were retrieved, of which 85% were found to be mature (MII). There was only one patient developing a moderate form of ovarian hyperstimulation syndrome and not requiring hospitalization. It is suggested that r-hCG at 125 µg can be effective in triggering final oocyte maturation in high-responder patients. Additional properly powered and controlled studies are needed to support this contention.

СУЧАСНИЙ ПІДХІД ЩОДО ПРОВЕДЕННЯ КОНТРОЛЬОВАНОЇ СТИМУЛЯЦІЇ ЯЄЧНИКІВ У ЦИКЛАХ ДОПОМІЖНИХ РЕПРОДУКТИВНИХ ТЕХНОЛОГІЙ У ЖІНОК ІЗ ВИСОКИМ РИЗИКОМ СИНДРОМУ ГІПЕРСТИМУЛЯЦІЇ ЯЄЧНИКІВ.

&lt;p&gt;Використання розроблених протоколів контрольованої стимуляції яєчників з антагоністом гонадотропін-рилізинг гормону з урахуванням рівня сироваткового прогестерону у програмі допоміжних репродуктивних технологій щодо жінок з високим ризиком розвитку синдрому гіперстимуляції яєчників дозволило зменшити кількість випадків середньо-тяжких форм синдрому гіперстимуляції яєчників (2,5 % проти 17,5 % у разі традиційної схеми з антагоністом гонадотропін-рилізинг-гормону; RR 0,14; 95 % ДІ 0,04–0,46), підвищити частоту настання клінічної вагітності (35,0 % проти 21,7 %; RR 1,62; 95 % ДІ 1,06–2,46)&lt;br /&gt;і пологів (33,3 % проти 16,7 %; RR 2,00; 95 % ДІ 1,25–3,21).&lt;/p&gt;

Acute respiratory failure following ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome is a serious and potentially life-threatening physiological complication that may be encountered in patients who undergo controlled ovarian hyperstimulation cycles. The syndrome is typically associated with regimes of exogenous gonadotropins, but it can be seen, albeit rarely, when clomiphene is administered during the induction phase. Although this syndrome is widely described in scientific literature and is well known by obstetricians, the knowledge of this pathological and potentially life-threatening condition is generally less than satisfactory among physicians. The dramatic increase in therapeutic strategies to treat infertility has pushed this condition into the realm of acute care therapy. The potential complications of this syndrome, including pulmonary involvement, should be considered and identified so as to allow a more appropriate diagnosis and management. We describe a case of a woman with an extremely severe (Stage 6) ovarian hyperstimulation syndrome who presented ascites, bilateral pleural effusion and severe respiratory failure treated with non-invasive ventilation. The patient was admitted to the intensive care unit because of severe respiratory failure, ascites, and bilateral pleural effusion due to ovarian hyperstimulation syndrome. Treatment included non-invasive ventilation and three thoracentesis procedures, plus the administration of albumin, colloid solutions and high-dose furosemid. Severe form of ovarian hyperstimulation syndrome is observed in 0.5-5% of the women treated, and intensive care may be required for management of thromboembolic complications, renal failure and severe respiratory failure. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and, in more severe cases, assisted ventilation. To our knowledge, there have been only two studies in English language medical literature that describe severe respiratory failure treated with non-invasive ventilation.

Recurrent spontaneous ovarian hyperstimulation secondary to hypothyroidism in an adolescent girl

Ovarian hyperstimulation syndrome (OHSS) is characterized by ovarian enlargement due to multiple ovarian cysts and a fluid shift into the extravascular space [1]. Some forms of OHSS have reportedly occurred during spontaneous pregnancy such as multiple pregnancies and associated conditions including, hypothyroidism, polycystic ovary syndrome, and follicle-stimulating hormone receptor (FSHr) mutations [2–4]. This report describes a case of recurrent OHSS associated with hypothyroidism in an adolescent girl with a non-remarkable family history and normal FSHr. An 18-year-old adolescent girl was admitted to our hospital with symptoms of abdominal pain and distension. Transabdominal ultrasonography (USG) showed mild ascites and bilateral ovarian multilocular cysts extending into the midabdomen. The results of blood counts and electrolyte analyses were normal. The hormonal evaluation revealed undetectable human chorionic gonadotropin (hCG), normal follicle-stimulating hormone (FSH) (6.5 IU/L) and luteinizing hormone (LH) (9.2 IU/L), high estradiol (E2) (4.000 mIU/mL) and thyroid-stimulating hormone (TSH) (100 lU/mL; normal range 0.47–5 lU/mL), and low free thyroxine (4.5 pmol/L; normal range 11–24 pmol/L). Abdominal magnetic resonance imaging (MRI) showed massively enlarged bilateral multicystic structures of presumable bilateral ovarian origin extending into the midabdomen (Fig. 1). Pituitary MRI was normal. Conservative medical management comprising was considered due to the presence of moderate spontaneous OHSS. Oral thyroxine (levothyroxine at 100 lg/day) was instituted on the basis of hypothyroidism. Abdominal symptoms were relieved with the beginning of menstruation within 2 weeks. Four months later, the patient presented to our center with similar symptoms. USG findings were similar to bilateral multilocular cysts in both ovaries and mild ascites. Serum hormonal analysis revealed a higher E2 level (10.000 mIU/mL) with a high TSH (20 lU/mL) and normal free thyroxine (15 pmol/L). Blood counts and electrolyte analyses were normal. Observation and supportive medical treatment was considered. The patient was discharged after 10 days with complete resolution of all clinical symptoms. Oral thyroxine reached a dose of 200 lg/day. Hormonal tests for thyroid function were normal 2 months after her second admission and the ovarian cysts completely regressed after 6 months. Bidirectional DNA sequencing of the FSHr gene was performed by PCR amplification to rule out FSHr abnormality in this case. No differences in the DNA sequence in the 10 exons were observed between the wild-type FSHr gene and those obtained from the patient. The exact mechanism underlying the relationship between OHSS and hypothyroidism is not clearly understood. One explanation of this rare association is that TSH has weak FSH activity on mutated FSHr, causing ovarian stimulation [5]. Another explanation is based on the release of FSH and LH by low levels of thyroid hormones, in addition to the targeted activation of TSH release. This seemed to be the cause in our case as FSHr sequencing was normal. In the literature, all the reported recurrent form of O. Erol (&) H. Ayik A. U. Derbent Department of Obstetrics and Gynecology, Antalya Research and Education Hospital, 07050 Antalya, Turkey e-mail: dronurerol@hotmail.com

Can cabergoline prevent ovarian hyperstimulation syndrome in polycystic ovarian patients undergoing gonadotropin stimulation?

Can cabergoline prevent ovarian hyperstimulation syndrome in polycystic ovarian patients undergoing gonadotropin stimulation?

Ascites ultrafiltration and concentration-reinfusion in severe ovarian hyperstimulation syndrome

Mild forms of ovarian hyperstimulation syndrome are common in women undergoing in-vitro fertilization, affecting up to 33% of in-vitro fertilization cycles; 3-8% of cycles are complicated by moderate or severe ovarian hyperstimulation syndrome (Royal College of Obstetricians and Gynaecologists, 2006). To treat severe ovarian hyperstimulation syndrome, albumin and other colloid solutions are used intravenously to increase the perfusion pressure (Manaka et al, 1995; Balasch et al, 1996), heparin to restore coagulation (Balasch et al, 1996) and dopamine to increase renal blood flow (Brinsden et al, 1995), but these all have limited effects.

Treatment of Ovarian Hyperstimulation Syndrome

Mild forms of ovarian hyperstimulation syndrome (OHSS) do not require treatment. Moderate OHSS should be followed up on an outpatient basis with no specific treatment. Severe OHSS requires proper evaluation. Investigations are done to evaluate hematocrit, electrolytes, and kidney and liver function. Conservative treatment with intravenous (i.v.) fluids and close monitoring is usually done. Intensive care admission is indicated in cases with severe respiratory distress or major electrolyte imbalance with elevated serum creatinine. Crystalloids in the form of i.v. saline and colloids as albumin or hydroxyethyl starch are commonly used to expand intravascular volume. Dopamine can be used to improve diuresis, and prophylactic heparin is administered to prevent venous thrombosis. Diuretics are generally contraindicated because they may further contract intravascular volume. Abdominal or vaginal aspiration of ascitic fluid results in marked improvement of symptoms, improved diuresis, and shortened hospital stay. The current trend to treat patients with i.v. fluids, albumin, and to perform aspiration of ascitic fluid on an outpatient basis has been found to be a more cost-effective protocol of treatment.

Prevention of OHSS: Current strategies and new insights

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic and potentially life threatening condition that affects young healthy patients. Many strategies have been proposed to prevent this syndrome. However, to avoid OHSS without compromising on IVF outcome is still a challenge. The most important action is to identify patients at risk even before ovarian stimulation is initiated and to give them special attention. Coasting is the most popular method to avoid/minimize OHSS. Cycle cancellation, cryopreservation, GnRH antagonists, GnRH agonists, i.v. albumin are other strategies that can provide some kind of benefit but do not completely avoid both early and late forms of OHSS and/or cannot be applied to every patient. Recent studies demonstrate that dopamine agonists can prevent or minimize OHSS without affecting IVF outcome but clinical protocols are not well established yet.

Intravenous administration (IVI) of calcium (CA) effectively prevents the development of mild and severe forms of ovarian hyperstimulation syndrome (OHSS)

OBJECTIVE: We offer a model of OHSS pathophysiology related to the cellular effects of Ca ions. This model predicts that OHSS can be prevented by IVI of Ca ions. The objective was to investigate the influence of IVI of Ca ions after hCG trigger on clinical symptoms and frequency of mild and moderate forms of OHSS in women at high risk of OHSS.

Blood group and ovarian hyperstimulation syndrome

Blood group does not constitute a risk factor for the onset of the early form of ovarian hyperstimulation syndrome in women "at risk."

A woman with polycystic ovary syndrome treated for infertility by in vitro fertilization

A 25-year-old South Asian woman presented at an infertility unit with a 2-year history of anovulatory infertility. She had experienced irregular and infrequent periods for over a decade. Endocrine profile (follicle-stimulating hormone, luteinizing hormone, thyroid-function test, prolactin, testosterone), oral glucose tolerance test and pelvic ultrasonography were performed. Polycystic ovary syndrome, in accordance with the recent Rotterdam consensus (2004) criteria. The patient failed to conceive by conventional ovulation-induction therapies with clomifene and gonadotropins. She subsequently underwent an in vitro fertilization cycle, to which she over-responded and developed a severe form of ovarian hyperstimulation syndrome. The diagnosis of ovarian hyperstimulation syndrome was based on clinical and ultrasonographic features. She was hospitalized and needed extensive supportive care, including insertion of chest and abdominal drains.

Vitrification is a highly efficient method to cryopreserve human embryos in in vitro fertilization patients at high risk of developing ovarian hyperstimulation syndrome

This study aimed to evaluate the efficacy of embryo vitrification as an emergency procedure for patients at high risk of developing ovarian hyperstimulation syndrome (OHSS). A total of 69 embryos, derived from 24 patients for whom embryo transfer could not be performed because of the risk of developing OHSS, were vitrified and warmed for deferred embryo transfer. Surviving embryos were transferred, resulting in 10 clinical pregnancies, of which 4 were successfully delivered and the remaining 6 are still ongoing.

PREVALENCE OF INHERITED THROMBOPHILIA IN PATIENTS WITH SEVERE OVARIAN HYPERSTIMULATION SYNDROME

To determine the prevalence of markers of inherited thrombophilia in patients with severe form of ovarian hyperstimulation syndrome (OHSS) DESIGN AND METHODS: Blood samples were analysed for markers of thrombophilia (mutation of factor V - Leiden, mutation of methylentetrahydrofolat reductase (MTHFR) C677T and mutation of prothrombin G20210A). The study group consisted of women who had undergone controlled ovarian hyperstimulation for IVF complicated by severe OHSS (group A, n = 50). Results were compared with two controls groups - women who underwent ovarian hyperstimulation for IVF without developing OHSS (group B, n = 93) and healthy pregnant women with no history of infertility (group C, n = 196). We have found 7 out of 50 patients from group A positive for Leiden mutation (heterozygous) 11 out of 93 from group B (heterozygous), p = 0.71 OR 1.21 (0.39 3.70) and 10 out of 196 from group C (heterozygous), p = 0.03 OR 3.03 (0.97 9.28). Polymorphism of MTHFR 677T gene was detected in 17 out of 50 patients (heterozygous) from group A, in 36 out of 93 patients from group B (35 heterozygous, 1 homozygous) and in 93 out of 196 patients from the group C (86 heterozygous, 7 homozygous) with no statistical significance. We found an increased prevalence of factor V Leiden mutation in Czech infertile women. However carriers of Leiden mutation had no enhanced risk of development severe form of OHSS during stimulation.

Exclusion of coding-region mutations in luteinizing hormone and follicle-stimulating hormone receptor genes as the cause of ovarian hyperstimulation syndrome

To sequence the coding regions of the luteinizing hormone receptor (LHR) and follicle-stimulating hormone receptor (FSHR) genes to find out if polymorphisms in them are responsible for the severe form of ovarian hyperstimulation syndrome (OHSS) in Swedish patients. A mutation analysis of gonadotropin receptor genes from women undergoing gonadotropin treatment. The Fertility Unit of Karolinska University Hospital Huddinge, Stockholm, Sweden. A set of 10 well-characterized patients with severe OHSS, and 10 control women who did not develop OHSS after FSH stimulation. An additional 11 patients and 41 control women were screened for a two-amino-acid insertion in the first exon of the LHR gene. None. Changes in the sequence of the receptor genes between patients and controls. No association was found between polymorphisms of the coding region of LHR or FSHR genes and the development of OHSS. Incidence of the two-amino-acid insertion in the first exon of the LHR gene was slightly higher in patients than in controls, but no statistically significant difference was seen. LHR and FSHR coding polymorphisms are not a major cause of severe OHSS in Swedish patients.

A Case of Internal Jugular Vein Thrombosis after in vitro Fertilization

Severe clinical ovarian hyperstimulation syndrome (OHSS) may occur after ovarian stimulation with gonadotropins A hypercoagulable state, a serious form of OHSS, is due to hemoconcentration as a result of a shifting of the intravascular fluid into the third space. Antiphospholipid syndrome is also a well-known hypercoagulable state, which manifests as an arterial or venous thrombosis and recurrent fetal loss. If OHSS, combined with a hypercoagulable state, such as antiphospholipid syndrome, develops, the potential of a thrombosis can be synergistically enhanced, creating a vicious cycle that results in serious thromboembolic complications. A 30-year-old woman, with an unusual right internal jugular venous thrombosis, occurring secondary to the development of OHSS and antiphospholipid syndrome, was treated. (Korean Circulation J 2004;34 (2):214-219)

Ovarian hyperstimulation syndrome: an endocrinopathy?

Ovarian hyperstimulation syndrome remains a significant but incompletely understood complication of ovarian stimulation. Evidence has accumulated regarding a role for various cytokines, in particular vascular endothelial growth factor, in its occurrence. However, the pathogenesis of ovarian hyperstimulation syndrome is likely to be complex and may involve a network of interacting cytokines and endocrine factors. Recent studies suggest links between specific cytokines and specific functional abnormalities in severe ovarian hyperstimulation syndrome. Two clinical forms of ovarian hyperstimulation syndrome may be distinguished, based on time of onset, with implications for the prediction and prevention of ovarian hyperstimulation syndrome in clinical practice.

Limited ovarian stimulation (LOS), prevents the recurrence of severe forms of ovarian hyperstimulation syndrome in polycystic ovarian disease

Objectives: We aimed to test the possibility that LOS could be used to avoid the risk of occurrence of severe OHSS in PCOD patients with past history of severe OHSS in their previous IVF treatment. Study design: A prospective study, with patients stood as their own controls. Twenty patients with history of severe OHSS in their previous IVF treatment were included in the study. The patients received LOS cycles during the six months period commencing January 1998, a full dose of human chorionic gonadotropin (10,000 IU) was administered when the leading follicle reached a mean diameter of 12 mm, and oocytes retrieval 36 h later was followed by intracytoplasmic sperm injection (ICSI) and embryo transfer. Signs and symptoms of severe OHSS were recorded. Results: All patients produced mature oocytes, achieved fertilisation and eight clinical pregnancies were diagnosed. None of the patients re-experienced the symptoms of severe OHSS, and none required hospitalisation. Conclusion: We confirm that, in the studied group of patients, LOS helped in the prevention of the severe forms of OHSS in PCOD patients with past history of severe OHSS.