Kirkman, E. Navot, D. Raziel, A. Schenker, J. Simon, C. Van Steirteghem, A. Whelan III, J. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Materials and methods.
Increased early pregnancy loss in IVF patients with severe ovarian hyperstimulation syndrome. Arieh Raziel , Arieh Raziel. Oxford Academic. Google Scholar. Shevach Friedler. Morey Schachter. Deborah Strassburger. Eitan Mordechai. Raphael Ron-El. Select Format Select format. Permissions Icon Permissions. Table I. Open in new tab. Table II. Issue Section:.
Download all slides. The main symptoms are:. When OHSS is severe, or not treated early, it can cause serious complications. The swelling can be painful and can reach the liver, diaphragm and collect around the lungs and heart.
This can make breathing uncomfortable and cause shortness of breath. The kidneys can stop working properly and make very little urine. The blood becomes more concentrated and therefore more likely to cause clots. OHSS is much less common now than it was 10 years ago because our understanding has improved with research into the condition and especially in ways to prevent or reduce the chance of it happening.
Almost everyone gets a mild version of it which settles within a couple of days. It usually happens to women who are having IVF but can happen after ovulation induction treatment. It is important to recognise that any woman using fertility drugs is at some risk of OHSS.
Sometimes OHSS does not cause symptoms until the pregnancy has implanted and pregnancy hormone is being made, from about a week after your embryo has been transferred. The most frequently used classification system is the classification by Golan [ 2 ]. The incidence of severe OHSS itself is 0. Increased hemoconcentration and blood viscosity can cause thrombembolic events that might lead to potentially fatal cardiovascular or neurological events [ 5 ].
Although a number of potentially preventive measures have been proposed, complete prevention, especially of late onset OHSS, is still not possible [ 6 ]. The mechanism of action is pituitary desensitization with subsequent gonadotropin suppression.
Thereby, an actual decrease in OHSS incidence could be achieved. However, these can only be used after COH using an antagonist protocol. Hence, this results in an increased incidence of OHSS in patients with long protocol [ 7 — 9 ]. Although the first Cochrane review comparing the two stimulation protocols did not find significant differences in the incidence of OHSS [ 11 ], more recent meta-analyses clearly demonstrated that GnRH antagonists were associated with a significant reduction in the incidence of severe OHSS and, thus, the hospitalization rate [ 12 , 13 ].
Other factors that increase the risk for severe OHSS are presence of polycystic ovary syndrome and a lean body mass [ 15 ]. Despite the fact that there is high-level evidence for risk factors for the development of OHSS, as mentioned above, there are few studies about its influence on the course of severe OHSS.
According to recent guidelines, severe OHSS is an indication for hospitalization due to possible life-threatening complications [ 16 ]. Hence, the time until recovery must be considered a clinically important parameter.
This is of clinical impact since, from our experience, patients do suffer decreased quality of life due to OHSS-specific symptoms as well as hospitalization. Moreover, the duration of hospitalization is also of economic relevance. Predictive parameters that would allow assessment of recovery time would be desirable.
We, thus, aimed to examine possible influencing factors for the recovery time in severe OHSS. In addition to the type of protocol used for COH and the substance used for ovulation induction, we also focused on other possible influencing parameters. All OHSS patients with no reliable information available about the stimulation protocol were excluded from the study.
This applied only to women who had undergone COH at another department. In patients who had suffered from severe OHSS more than once, only the first hospitalization was included in the analysis. This resulted in a patient population of women. Women were hospitalized if they fulfilled at least one criterion of all of the following three groups of OHSS-specific signs:.
The above mentioned definition is included in the treatment protocol at our department. These are available in written form to all physicians and they are obliged to adhere to this management scheme.
We obtained a complete blood count with hematocrit, serum analysis of albumin, blood creatinine, blood urea and creatinine clearance, liver function parameters, and coagulation tests on a daily basis in all patients. The amount of excreted urine, hydric balance, body weight, and abdominal circumference were carefully checked every 24 hours.
Paracentesis was performed in patients with ascites that caused pain or compromised pulmonary function e. A transvaginal approach was used. Directly after the procedure, patients received ml human albumin see above. Patients had to wear full-length venous support stockings. Prophylactic low-molecular weight heparin therapy 5, Units subcutaneously, every 24 hours was given to all patients during in-patient treatment.
From on, patients were treated in accordance with the recommendations set forth by the Practice Committee of the American Society for Reproductive Medicine in [ 1 ]. In addition to the above mentioned treatment modalities, patients also received 0. Thus, the inpatient treatment-regimen had not changed during the observation period, apart from introduction of Cabergoline.
The above mentioned treatment protocol was available in written form to all physicians and they were obliged to adhere to this management scheme, in case of unclearness a telephone hotline with an IVF team member was at all times from in For the first analysis of predictive factors for duration of hospitalization, patients were subdivided in non-pregnant and pregnant patients, since pregnancy is known as a major risk factor for late onset OHSS and it can worsen the medical situation of an early onset OHSS [ 1 , 17 ].
All cases of early onset OHSS that occurred before embryo transfer all patient that had been hospitalized directly after embryo transfer and released home within 10 days, i. Usually, in case of severe OHSS, embryos would get cryoconserved and transferred in the next cycle. However, in a few cases with low quality of embryos embryo transfer in the same treatment cycle was chosen despite OHSS.
This was done only after patients had been informed extensively on their explicit wish. In the second step that included OHSS-specific parameters, pregnant and non-pregnant women were not analyzed separately. We analyzed the type of stimulation protocol long protocol vs. We also included the type of stimulation protocol as a predictive parameter in addition to the use of hCG for ovulation induction, since the fact that GnRH antagonist cycles have a lower risk of OHSS is also due to differences in follicular recruitment.
Accordingly, even when inducing ovulation with hCG, there is a significant reduced risk of OHSS in antagonist cycles as compared to agonist cycles [ 18 ]. For agonist triggering, 0. In addition, we also focused on the following parameters as possible predictive factors for the recovery time: age; body mass index BMI ; presence of polycystic ovary syndrome that was known to be associated with a higher incidence of OHSS [ 19 ]; number of retrieved oocytes; time between oocyte retrieval and hospitalization for OHSS; whether the patient suffered from early or late onset OHSS; the use of Cabergoline; and the year the patient was treated for OHSS years , i.
In the group of pregnant patients, we also included multiple pregnancies as a predictive factor. In a next step, we also included the following OHSS-specific parameters in the model: the initial hematocrit at the time of hospitalization and the maximum hematocrit seen in the course of regular, daily blood count controls and the need of paracentesis. Nominal variables are reported as numbers and frequencies, and continuous variables as medians and interquartile ranges IQR.
Statistical analysis was accomplished using Wilcoxon rank-sum tests where applicable and generalized linear models with a Poisson link function. Details about basic patient characteristics are provided in Table 1. Papanikolaou , Evangelos G. Email: Evangelos.
Papanikolaou vub. Oxford Academic. Google Scholar. Herman Tournaye. Willem Verpoest. Michel Camus. Andre Van Steirteghem. Paul Devroey. Revision received:. Cite Cite Evangelos G. Select Format Select format. Permissions Icon Permissions. Table I. Patient characteristics and stimulation protocol parameters. Type of OHSS. Open in new tab. Table II. Table III. Hormone, follicles, COCs and embryo parameters. SS early versus late. Table IV. Early pregnancy outcome of OHSS.
Aboulghar MA Bourgain C and Devroey P Delvigne A and Rozenberg S Kaiser UB Mathur R and Jenkins J Orvieto R Human Reproduction Vol. Issue Section:. Download all slides. View Metrics. Email alerts Article activity alert. Advance article alerts. New issue alert. Receive exclusive offers and updates from Oxford Academic. More on this topic Effect of rising hCG levels on the human corpus luteum during early pregnancy. Severe ovarian hyperstimulation syndrome following salvage of empty follicle syndrome: Case report.
Ovarian stimulation in intrauterine insemination with donor sperm: a randomized study comparing clomiphene citrate in fixed protocol versus highly purified urinary FSH. Perifollicular vascularity as a potential variable affecting outcome in stimulated intrauterine insemination treatment cycles: a study using transvaginal power Doppler.
Related articles in Web of Science Google Scholar. Related articles in PubMed 1-Nitropyrene exposure impairs embryo implantation through disrupting endometrial receptivity genes expression and producing excessive ROS. Enhanced SB expression in T and B lymphocytes in spontaneous preterm birth and preeclampsia.
Vision, Future, Cycle and Effect: A community life course approach to address prenatal alcohol exposure in central Australia.
Citing articles via Web of Science Most Read Most Cited Bleeding patterns after vaginal misoprostol for treatment of early pregnancy failure. Right-sided ovulation favours pregnancy more than left-sided ovulation.
0コメント