Ovarian Hyperstimulation Syndrome In Patients Research Articles

Intravenous albumin administration for the prevention of severe ovarian hyperstimulation syndrome: a systematic review and meta-analysis

OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovarian stimulation, which in its severe form can be life-threatening. Several strategies for its prevention have been proposed so far. A Cochrane meta-analysis of relevant randomized controlled trials (RCTs) in 2003, suggested that intravenous albumin administration is beneficial for the prevention of severe OHSS in high risk patients. Since then, further RCTs have evaluated the effectiveness of this intervention. The purpose of this systematic review and meta-analysis was to reappraise the currently available evidence, providing answer to the question: Does intravenous albumin administration reduce the risk of severe OHSS occurrence in high risk patients subjected to ovarian stimulation with gonadotrophins and GnRH analogues for in-vitro fertilization (IVF)? DESIGN: Systematic review and meta-analysis. MATERIALS AND METHODS: A computerized literature search in MEDLINE, EMBASE and CENTRAL, covering the period until December 2007, was performed independently by two reviewers, in order to identify studies which answered the above research question. For the same purpose, extensive hand-searching of reference lists of all relevant publications and review articles, was also performed. Only RCTs comparing intravenous albumin administration versus placebo or no treatment in patients at high risk for OHSS were considered eligible. RESULTS: From this process, seven RCTs (n=1058 patients) were identified. The meta-analysis of these studies did not detect a statistically significant difference in the incidence of severe OHSS in patients that received intravenous albumin (n=529) and those who did not (n=529) (odds ratio [OR]: 0.89, 95% CI: 0.54-1.47; heterogeneity: p=0.08; fixed effects model). The same was true regarding the incidence of moderate/severe OHSS (OR: 0.78 95% CI: 0.26-2.32; heterogeneity: p=0.02; random effects model). Moreover, no statistically significant differences were present regarding the probability of pregnancy (OR: 0.81 95% CI: 0.63-1.06; heterogeneity: p=0.62; fixed effects model) and early pregnancy loss (OR: 1.47 95% CI: 0.73-2.95; heterogeneity: p=0.09; fixed effects model) between patients who received intravenous albumin and those who did not. CONCLUSIONS: Based on the best available evidence, intravenous albumin administration in high risk patients does not prevent the occurrence of severe OHSS. This should be taken into consideration when implementing strategies for severe OHSS prevention.

Risk factors for ovarian hyperstimulation syndrome in Thai patients using gonadotropins for in vitro fertilization

A prospective observational study was conducted to identify risk factors for ovarian hyperstimulation syndrome (OHSS) in Thai patients using gonadotropins for in vitro fertilization. Outpatients receiving a short and a long protocol of ovarian stimulation with a recombinant follicle-stimulating hormone (rec FSH) at a Bangkok hospital were enrolled. Patients in the short protocol received rec FSH and the gonadotropin-releasing-hormone agonist buserelin acetate by subcutaneous injection after blood sampling on day 2 of the patient's cycle. When one or more follicles reached a diameter of 18 mm as determined by ultrasonography and the serum estradiol (E(2)) concentration exceeded 400 pg/mL, patients received human chorionic gonadotropin (hCG); oocytes were retrieved 34-36 hours later. The long protocol differed only in that patients received nasal buserelin acetate and rec FSH 10 days before the cycle started and on day 2 of the cycle. Serum levels of E(2), luteinizing hormone, and FSH were monitored at baseline. In addition to E(2) concentration and follicle size and number, patients' weight, waist circumference, complete blood counts, and C-reactive protein (CRP) levels were monitored at intervals. Patients were instructed to notify the hospital of any symptoms of OHSS. Of 117 patients enrolled, 13 had moderate OHSS and 1 had severe OHSS; all recovered. Patients with OHSS were significantly younger, had significantly lower body mass index, and had significantly higher E(2) before hCG injection, total number of follicles, total number of oocytes retrieved, and white blood cell and neutrophil counts after hCG injection. Patients with polycystic ovary syndrome were significantly more likely to have OHSS. CRP levels were higher in OHSS patients, but the difference was not significant. Multiple logistic regression showed that the combination of serum E(2) peak concentration of > or =4500 pg/mL and total number of oocytes retrieved of > or =15 predicted the occurrence of moderate-to-severe OHSS; 12 of 14 study patients who met these criteria had OHSS. Serum E(2) peak concentrations of > or =4500 pg/mL and total number of oocytes > or =15 may be useful indicators for identifying patients at high risk for moderate-to-severe OHSS.

Clinical anslysis for 38 cases with ovarian hyperstimulation syndrome

Objective To Search for the induced factors and therapeutic strategies for ovarian hyperstimulation syndrome(OHSS).Methods 38 cases with OHSS were retrospectively analyzed.Results All cases had symptoms of stomach and intestine,hcmachrosis and ascitic fluid.Human serum albumin through intravenous dripping was one of the most successful treatment as plasma expanders through restoration of effective blood volume.Paracentesis was necessary for critical OHSS patients with severe ascites and hydrothorax.Herus could decrease the cost of albumin significantly.Conclusions OHSS was the severe complication of ovarian stimulation.All patients with OHSS got completely recovered through intense care and effective treatment. Key words: Ovarian hyperstimulation syndrome; Superovulation

Metformin use in infertile patients with polycystic ovary syndrome: an evidence-based overview

Metformin is an insulin sensitizer currently used for treating type-2 diabetes mellitus and recently administered for inducing ovulatory menstrual cycles in oligo-amenorrhoeic patients with polycystic ovary syndrome (PCOS). The aim of the present review is to describe the efficacy of metformin as an ovulation inducer on the basis of the most important evidence-based medicine supported data, including meta-analyses and randomized controlled trials. Specifically, we reviewed the uses of metformin as first- and second-step treatment for PCOS related anovulatory infertility and as co-treatment in infertile PCOS patients who receive gonadotrophins. To date, there is evidence that metformin is effective for restoring normal menstrual cycles in anovulatory PCOS patients, and that it is more effective and cheaper than laparoscopic ovarian drilling as the second therapeutic step in PCOS patients previously defined as resistant to clomiphene citrate. Co-administration of metformin in PCOS patients treated with gonadotrophin improves the mono-ovulation rate and can prevent ovarian hyperstimulation syndrome in patients treated with gonadotrophins for IVF cycles.

Vascular Endothelial Growth Factor Production by Circulating Immune Cells Is Elevated in Ovarian Hyperstimulation Syndrome

Background Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic disease manifesting itself by ovarian enlargement and massive ascites with increased peritoneal capillary permeability. Although vascular endothelial growth factor (VEGF) is considered to play the main role in developing OHSS, its precise mechanism remains unclear. In this study, we examined possible roles of circulating immune cells in the pathogenesis of OHSS. Methods Peripheral blood mononuclear cells (PBMC) and plasma were collected from healthy non-pregnant volunteers and from patients receiving ovulation induction for IVF. PBMC were cultured for 48 h. Plasma and/or medium concentrations of VEGF, estradiol and progesterone were measured using enzyme-linked immunosorbent assay and radioimmunoassay kits. Results VEGF production by cultured PBMC and plasma concentrations of VEGF taken from patients with early onset OHSS (n = 12) were significantly higher than those in non-pregnant volunteers and patients without OHSS whose oocyte retrieval rates were similar to that of OHSS patients. OHSS patients were further classified into a high plasma VEGF concentration group and a high culture medium VEGF group. There was no significant correlation among VEGF production by PBMC and plasma concentration of VEGF, estradiol or progesterone. Conclusion Although mechanistic evidence has not been provided, our study does provide new evidence to suggest that circulating immune cells are involved in the pathogenesis of OHSS via VEGF production.

Vascular endothelial growth factor production by circulating immune cells is elevated in ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic disease manifesting itself by ovarian enlargement and massive ascites with increased peritoneal capillary permeability. Although vascular endothelial growth factor (VEGF) is considered to play the main role in developing OHSS, its precise mechanism remains unclear. In this study, we examined possible roles of circulating immune cells in the pathogenesis of OHSS. Peripheral blood mononuclear cells (PBMC) and plasma were collected from healthy non-pregnant volunteers and from patients receiving ovulation induction for IVF. PBMC were cultured for 48 h. Plasma and/or medium concentrations of VEGF, estradiol and progesterone were measured using enzyme-linked immunosorbent assay and radioimmunoassay kits. VEGF production by cultured PBMC and plasma concentrations of VEGF taken from patients with early onset OHSS (n = 12) were significantly higher than those in non-pregnant volunteers and patients without OHSS whose oocyte retrieval rates were similar to that of OHSS patients. OHSS patients were further classified into a high plasma VEGF concentration group and a high culture medium VEGF group. There was no significant correlation among VEGF production by PBMC and plasma concentration of VEGF, estradiol or progesterone. Although mechanistic evidence has not been provided, our study does provide new evidence to suggest that circulating immune cells are involved in the pathogenesis of OHSS via VEGF production.

Human albumin does not prevent ovarian hyperstimulation syndrome in assisted reproductive technology program: a prospective randomized placebo-controlled double blind study

We aimed to clarify the efficiency of IV human albumin in the prevention of ovarian hyperstimulation syndrome (OHSS). We found that human albumin at the described strength does not seem to either prevent or reduce the incidence of severe OHSS in high risk patients undergoing intracytoplasmic sperm injection (ICSI).

Effectiveness of treating ovarian hyperstimulation syndrome with cabergoline in two patients with gonadotropin-producing pituitary adenomas

To report the effect of cabergoline on ovarian hyperstimulation syndrome associated with gonadotropin-secreting pituitary adenomas. Case report. Outpatient practice. Two women with menstrual irregularity, enlarged ovaries, high E(2), and normal gonadotropin levels. Cabergoline treatment and transsphenoidal surgery. Estradiol levels, transvaginal ultrasonography, and pituitary magnetic resonance imaging. Transsphenoidal surgery showed pituitary adenoma staining for LH in both patients. Cabergoline was effective in reducing E(2) levels and decreasing ovarian size but ineffective in shrinking the pituitary adenomas. This is the first description of the effectiveness of cabergoline as the primary treatment of spontaneous ovarian hyperstimulation syndrome in patients with gonadotropin-producing pituitary adenomas.

O-166: FSH levels predict success in hyperresponders: How much “coasting” can a follicle withstand?

Withdrawing gonadotropins to delay hCG administration is commonly used to prevent ovarian hyperstimulation syndrome in patients with elevated estradiol (E2) levels. However, this technique of “coasting” also places patients at risk for cycle cancellation due to unpredictably falling E2 levels when follicular growth is not supported by exogenous FSH. Our objective was to determine whether monitoring FSH during coasting could predict subsequent E2 levels, cycle cancelllation, and IVF outcomes. In patients who underwent a period of coasting, we compared FSH levels in IVF cycles that proceeded on to oocyte retrieval with those that were cancelled secondary to a significant drop (>20%) in E2 following hCG. From January 2004 to January 2006, all patients who coasted 1-4 days during an IVF cycle using a GnRH agonist and ejaculated spermatozoa were included. Baseline patient characteristics, duration of coasting, and FSH values on the IVF start day were recorded. Serum samples prepared by centrifugation at 3,000 rpm for seven minutes and stored at -80°C untill assayed. Serum samples during each day of coasting were collected and FSH measured on an Immulite 2000 Analyzer (DPC). FSH levels on the day of hCG trigger (D1), the day prior to hCG trigger (D-1), and two days prior to hCG trigger (D-2) were assessed. Single factor ANOVA, chi square, and t-test were used for analysis. One hundred and twenty-nine patients were identified within our inclusion criteria. Of these, 16 cycles were cancelled after coasting secondary to a decrease in E2>20% following hCG administration and 113 continued to oocyte retrieval. There was no difference in cancelled and non-cancelled cycles in patient age, BMI, parity, cause of infertility, number of prior IVF cycles, gonadotropins consumed, or duration of coasting. Baseline FSH values reflecting their endogenous gonadotropin secretion while on a GnRH agonist were also compared and found to be no different between the two groups. FSH values on the day of hCG were significantly lower in the cancelled cycles compared to non-cancelled 3.1 ± 1.8 vs. 5.5 ± 2.7 (p<0.01). The FSH of D-1 samples were also found to be lower in the cancelled group 5.36 ± 3.2 vs. 7.4 ± 3.8 (p<0.05). D-2 FSH values in cancelled cycles trended lower than retrieved cycles 7.6 ± 3.1 vs. 9.2 ± 5.6 but were not significant. In a sub-analysis, the group that proceeded to embryo transfer was then divided into those with FSH values <5 mIU/ml (n=57) and those ≥5mIU/ml (n=49) on the day of hCG trigger and their outcomes compared. This discriminatory value was based upon our previous work showing an association between the FSH levels <5 mIU/ml and impaired pregnancy rates. There was no difference in total oocyte yield (15.1 vs. 15.7) or MII (12.2 vs. 13.7) oocytes per patient. However, fertilization was markedly impaired 13.2% vs. 75.1% (P<0.01) in the group with lower FSH values on the day of hCG. Clinical pregnancy rate 53.6% vs. 60.2% (p=0.06) was also compromised in this group of patients. Measuring FSH levels during stimulation is a useful tool to guide clinical decision making in coasting patients. Profoundly low levels are predictive of a subsequent dramatic decrease in E2 which may be an indication to abandon coasting and supplement with low doses of gonadotropins. FSH values <5mIU/ml on the day of hCG also predict poor fertilization rates and may assist in counseling these patients on whether to proceed to oocyte retrieval.

A late complication of thrombosis in internal jugular vein and subclavian vein in a pregnant woman with ovarian hyperstimulation syndrome

A late complication of thrombosis in internal jugular vein and subclavian vein in a pregnant woman with ovarian hyperstimulation syndrome

A Cost Comparison of “Ganirelix Salvage” Protocol Versus “Coasting” Strategy for Patients at Risk for Ovarian Hyperstimulation Syndrome (OHSS)

A Cost Comparison of “Ganirelix Salvage” Protocol Versus “Coasting” Strategy for Patients at Risk for Ovarian Hyperstimulation Syndrome (OHSS)

Coasting Decreases Ovarian Hyperstimulation Syndrome in Patients at Risk. Is the Quality of Oocytes, Embryos and Pregnancy Rate the Price to Pay?

To determine the impact of coasting and hCG dose on the incidence of ovarian hyperstimulation syndrome (OHSS), clinical pregnancy rate, fertilization rate, and cumulative embryo score in hyper-responsive patients compared with normo-responsive patients.

Age dependent assessment of TFPI levels in follicular fluid of women undergoing IVF

Background Tissue factor pathway inhibitor (TFPI) is a multivalent Kunitz-type serine proteinase inhibitor which plays a central role in the extrinsic pathway of blood coagulation. A significant role of TFPI for the follicular development has been discussed in recent studies, and thrombotic complications during IVF procedure are a common problem. To elucidate the pathophysiological mechanisms underlying these problems, we have measured TFPI levels in human follicular fluid (hFF) of women undergoing in vitro fertilisation (IVF). Methods Total TFPI concentrations were determined in hFF of 28 women undergoing IVF treatment, 6 of whom developed an ovarian hyperstimulation syndrome (OHSS). Results and conclusions This is the first study to demonstrate an age-dependance of TFPI concentrations in hFF. Additionally, TFPI levels in hFF of women developing OHSS were determined as 323 ± 66.8 ng/mL (mean ± SD) in comparison with 279 ± 137 ng/mL for non-OHSS patients. Our findings demonstrate that, unlike the decreased TFPI levels found in OHSS patients' blood, there is no statistically significant difference in hFF TFPI levels between OHSS and non-OHSS patients. Furthermore, we could show that the outcome of the IVF procedure is not correlated with TFPI levels in hFF.

Prediction of Severity of Symptoms in Iatrogenic Ovarian Hyperstimulation Syndrome by Follicle-Stimulating Hormone Receptor Ser680Asn Polymorphism

The ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of ovarian stimulation treatments for in vitro fertilization (i.v.f.). Recently, three different mutations of the FSH receptor (FSHr) have been identified in patients who presented recurrent spontaneous OHSS. This prompted us to study a possible association between coding polymorphisms of the FSHr and the occurrence of iatrogenic OHSS. We sequenced the region of the FSHr gene encompassing the A307T and S680N polymorphisms of exon 10 of FSHr in 37 Caucasian females who developed OHSS after an IVF cycle in our fertility clinic, 130 Caucasian female patients who were treated by i.v.f. but never developed OHSS, and 99 Caucasian female controls. The FSHr allele frequencies in the Caucasian control population were identical to what has already been published (39% S680 61% N680). The control i.v.f. population was enriched in the S680 allele compared with the Caucasian control population (51% S680; 49% N680; P = 0.016). The OHSS population had a even higher enrichment in the S680 allele compared with the Caucasian control population (57% S680; 43% N680; P = 0.010). These results were unexpected, because the frequency of the S680 allele was previously found to be increased among poor responders to FSH stimulation. In a second phase, we studied FSHr allele frequencies according to the severity of OHSS. Interestingly, a significant enrichment in the allele N680 was observed as the severity of OHSS increased (P = 0.034). Bearing in mind the limitations of the small number of patients studied and the possibility of sampling biases, these results suggest that the genotype in position 680 of the FSHr cannot predict which patients will develop OHSS, but could be a predictor of severity of symptoms among OHSS patients.

Serum leptin concentrations in patients with severe ovarian hyperstimulation syndrome during in vitro fertilization–embryo transfer treatment

To investigate the changes in serum leptin concentration in the conception cycle of severe ovarian hyperstimulation syndrome (OHSS). Prospective longitudinal study of 66 IVF-ET cycles between May 2000 and June 2002. Infertility outpatient clinic at a Japanese medical school. Infertile patients undergoing IVF-ET cycles at the infertility outpatient clinic were divided into three groups consisting of group 1 (conception-cycle patients with severe OHSS, n = 9), and group 2 (conception cycle, non-OHSS, n = 28), and group 3 (nonconception cycle, non-OHSS, n = 29). Blood samples were collected at five different periods. Period I, on the first day of ovarian stimulation with FSH; period II, at hCG administration before oocyte retrieval; period III, 7 days after oocyte retrieval; period IV, 14 days after oocyte retrieval; and period V, 21 days after oocyte retrieval. Serum leptin concentration. The serum leptin concentration was low in the OHSS group compared with that of the non-OHSS groups in all serum samples, with significant levels at periods III (vs. groups 2 and 3; P<.05) and IV (vs. group 3; P<.01). A twofold increase of leptin concentration from period I to period II (P<.05) was observed in all groups. The change pattern in serum leptin concentration might provide a great contribution to the pathophysiology development of OHSS patients during assisted reproductive treatment.

Prevalence of thrombophilia in women with severe ovarian hyperstimulation syndrome and cost-effectiveness of screening.

To determine the prevalence of markers of thrombophilia in patients with severe ovarian hyperstimulation syndrome (OHSS) and to evaluate the cost-effectiveness of screening for factor V Leiden and prothrombin G20210A mutations in women entering an IVF program. Case-control study and cost-effectiveness analysis. University teaching hospital. Women undergoing controlled ovarian hyperstimulation for IVF complicated by severe OHSS (group 1, n = 20), women undergoing controlled ovarian hyperstimulation for IVF without development of severe OHSS (group 2, n = 40), and healthy control subjects (group 3, n = 100). Investigation of markers of thrombophilia. Estimate of number of IVF patients needed to detect a case of severe OHSS and thrombosis associated with thrombophilia genetic mutation was calculated from the available data. Blood samples were analyzed for inherited (resistance to activated protein C due to the factor V Leiden mutation; prothrombin G20210A mutation; deficiencies in antithrombin, protein C, and protein S) and acquired (presence of circulating lupus anticoagulants and/or anticardiolipin antibodies; deficiencies of antithrombin and protein S; acquired protein C resistance) markers of thrombophilia. The cost of preventing one thrombotic event in a patient developing severe OHSS after IVF and having factor V Leiden or prothrombin G20210A mutations was calculated. None of the OHSS patients or controls had antithrombin, protein C, or free protein S deficiencies. All of them tested negative for antiphospholipid antibodies. No patient in group 1 had the factor V Leiden or prothrombin G20210A mutations. The prothrombin G20210A mutation was detected in 1 out of 40 patients (2.5%) in group 2. Both factor V Leiden and prothrombin G20210A mutations were detected in two of the control subjects (2%) (group 3). The estimated cost of preventing one thrombotic event arising as a consequence of screening for factor V Leiden and prothrombin G20210A mutation is a minimum of 418,970 dollars and 2,430,000 dollars, respectively. The prevalence of thrombophilia is not increased in women with severe OHSS. Screening for V Leiden and prothrombin G20210A mutation in an IVF general population is not cost-effective.

A double-blind, randomized, placebo-controlled study to assess the efficacy of ketoconazole for reducing the risk of ovarian hyperstimulation syndrome

Objective To evaluate the role of ketoconazole in prevention of ovarian hyperstimulation syndrome (OHSS) in women with the polycystic ovary syndrome (PCOS) undergoing ovarian stimulation with gonadotropins. Design Prospective, randomized, double-blind, placebo-controlled study. Setting University hospitals. Patient(s) One hundred nine women with PCOS who were referred for treatment with gonadotropins. Intervention(s) Fifty patients were randomly assigned to receive two ampoules of hMG beginning on day 2 or 3 of the cycle and ketoconazole (50 mg every 48 hours) starting on the first day of hMG treatment. Fifty-one patients received the same amount of hMG plus one tablet of placebo every 48 hours. Main outcome measure(s) Follicular development, E 2 level, and pregnancy rate. Result(s) The total number of hMG ampoules and duration of treatment to attain ovarian stimulation were higher among ketoconazole recipients. The serum E 2 level and number of patients with dominant follicles on day 9 of the cycle were greater in placebo recipients. Serum E 2 level and total number of follicles at the time of hCG administration did not differ between the two groups. The cancellation rate and OHSS rate were similar in the two groups. Conclusion(s) Ketoconazole does not prevent OHSS in patients with PCOS who are undergoing ovarian stimulation. It may reduce the rate of folliculogenesis and steroidogenesis.

Hypercoagulability, high tissue factor and low tissue factor pathway inhibitor levels in severe ovarian hyperstimulation syndrome: possible association with clinical outcome.

During ovarian gonadotrophin stimulation for ovulation induction or in vitro fertilization, a clinical severe ovarian hyperstimulation syndrome (OHSS) may occur. Only few studies have investigated the mechanism responsible for the alterations of the haemostatic system in women affected by severe OHSS. The aim of the present study was to investigate the correlation between the magnitude of ovarian stimulation and the increase in fibrin formation and degradation in severe OHSS. Twenty-five patients (age range 23-43 years) who were hospitalized for severe OHSS, 25 women undergoing in vitro fertilization who did not develop OHSS (case-control group) and 25 healthy age-matched women (healthy control group) were investigated. On the day of admission a number of haemostatic markers, including D-dimer, thrombin-antithrombin complexes (TAT), prothrombin fragment 1 + 2 (F1 + 2), plasmin-antiplasmin complexes (PAP), tissue factor (TF), tissue factor pathway inhibitor (TFPI) and von Willebrand factor antigen (vWF), were examined. In patients with severe OHSS, TF, D-dimer, TAT, F1 + 2, PAP and vWF antigen plasma levels were significantly higher than those observed both in the case-control group and in healthy controls, whereas TFPI levels were significantly lower (P < 0.005) with respect to both case-controls and healthy controls. D-Dimer levels were related with serum oestradiol levels and oocyte number recovered (r = 0.45, P < 0.001 and r = 0.47, P < 0.001, respectively). D-Dimer and TAT levels were significantly (P < 0.05 and P < 0.005, respectively) higher in OHSS patients with unsuccessful pregnancy outcome (D-dimer, 226.5, 56-1449 ng/ml; TAT, 19.8, 3.1-82.6 microg/l) with respect to those with successful outcome of pregnancy (D-dimer, 145, 29-330 ng/ml; TAT, 5.0, 1.0-19.6 microg/l). Our data indicate that a marked hypercoagulability with alterations of TF and TFPI levels is detectable in patients with severe OHSS and that it is related to the clinical outcome.

Administration of methylprednisolone to prevent severe ovarian hyperstimulation syndrome in patients undergoing in vitro fertilization

Objective: To determine whether administration of methylprednisolone to high-risk women undergoing IVF/ICSI helps reduce the development of OHSS. Design: Retrospective clinical controlled study. Setting: IVF unit. Patient(s): One thousand ten women who underwent IVF/ICSI from January 9, 1997, to December 31, 1999. Ninety-one patients who were at high risk for OHSS were identified by using standard criteria. Intervention(s): Methylprednisolone, 16 mg/d starting on day 6 of the stimulation and tapered after the first pregnancy test (day 13 after embryo transfer). Main Outcome Measure(s): Occurrence of OHSS. Result(s): A significantly lower proportion of methylprednisolone recipients than untreated participants developed OHSS (10.0% vs. 43.9%). Treatment recipients had more oocytes retrieved and more embryos fertilized than did untreated participants. Methylprednisolone treatment was equally effective in preventing OHSS in all causes of infertility and was effective independent of the number of IVF trials and pregnancy rates. Conclusion(s): Treatment with methylprednisolone appears to reduce the risk for OHSS. This treatment thus helps to avoid hospitalization, reduces cycle cancellations, and improves the cost-effectiveness of IVF cycles.

Metabolic characteristics of women who developed ovarian hyperstimulation syndrome.

The aim of this study was to investigate whether a higher incidence of hyperinsulinism is found in women who have suffered from ovarian hyperstimulation syndrome (OHSS) as compared with other IVF patients. Additionally, we also assessed whether any abnormalities in the haemostatic system were more frequent in women with a past history of OHSS. A pilot study was carried out involving OHSS patients and matched IVF patients. Homeostasis model assessment (HOMA) of insulin sensitivity was calculated. The main outcome measures were: insulin sensitivity, coagulation anomalies, factor V Leiden mutations, methylene tetrahydrofolate reductase (MTHFR) polymorphism and prothrombin gene mutation, protein C and protein S deficiency. No increased incidence in hyperinsulism nor in abnormalities of the haemostatic system were observed. This pilot study does not provide evidence for an increased prevalence of hyperinsulinism among women who have developed OHSS in the past.