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Abedi F, Zarei B, Elyasi S. Albumin: a comprehensive review and practical guideline for clinical use. Eur J Clin Pharmacol 2024; 80:1151-1169. [PMID: 38607390 DOI: 10.1007/s00228-024-03664-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Nowadays, it is largely accepted that albumin should not be used in hypoalbuminemia or for nutritional purpose. The most discussed indication of albumin at present is the resuscitation in shock states, especially distributive shocks such as septic shock. The main evidence-based indication is also liver disease. In this review, we provided updated evidence-based instruction for definite and potential indications of albumin administration in clinical practice, with appropriate dosing and duration. METHODS Data collection was carried out until November 2023 by search of electronic databases including PubMed, Google Scholar, Scopus, and Web of Science. GRADE system has been used to determine the quality of evidence and strength of recommendations for each albumin indication. RESULTS A total of 165 relevant studies were included in this review. Fluid replacement in plasmapheresis and liver diseases, including hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis, have a moderate to high quality of evidence and a strong recommendation for administering albumin. Moreover, albumin is used as a second-line and adjunctive to crystalloids for fluid resuscitation in hypovolemic shock, sepsis and septic shock, severe burns, toxic epidermal necrolysis, intradialytic hypotension, ovarian hyperstimulation syndrome, major surgery, non-traumatic brain injury, extracorporeal membrane oxygenation, acute respiratory distress syndrome, and severe and refractory edema with hypoalbuminemia has a low to moderate quality of evidence and weak recommendation to use. Also, in modest volume paracentesis, severe hyponatremia in cirrhosis has a low to moderate quality of evidence and a weak recommendation. CONCLUSION Albumin administration is most indicated in management of cirrhosis complications. Fluid resuscitation or treatment of severe and refractory edema, especially in patients with hypoalbuminemia and not responding to other treatments, is another rational use for albumin. Implementation of evidence-based guidelines in hospitals can be an effective measure to reduce inappropriate uses of albumin.
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Affiliation(s)
- Farshad Abedi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box, Mashhad, 91775-1365, Iran
| | - Batool Zarei
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box, Mashhad, 91775-1365, Iran.
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box, Mashhad, 91775-1365, Iran.
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Lee YJ, Kim JS, Jo JC, Kim Y, Im HS, Kim H, Koh S, Min YJ, Park SH, Ahn JW, Choi Y. Risk factors of menopause after allogeneic hematopoietic cell transplantation in premenopausal adult women. Eur J Haematol 2023. [PMID: 37308461 DOI: 10.1111/ejh.14027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Allogeneic hematopoietic stem-cell transplantation (HCT) is the only curative option for most hematologic malignancies. However, HSCT can cause early menopause and various complications in premenopausal women. Therefore, we aimed to investigate risk factors predicting early menopause and its clinical implications among survivors post HCT. METHODS We retrospectively analyzed 30 adult women who had received HCT at premenopausal status between 2015 and 2018. We excluded patients who had received autologous stem cell transplantation, had relapsed, or died of any cause within 2 years of HCT. RESULTS The median age at HCT was 41.6 years (range, 22-53). Post-HCT menopause was identified in 90% of myeloablative conditioning (MAC) HCT and 55% of reduced-intensity conditioning (RIC) HCT (p = .101). In the multivariate analysis, the post-HCT menopausal risk was 21 times higher in a MAC regimen containing 4 days of busulfan (p = .016) and 9.3 times higher in RIC regimens containing 2-3 days of busulfan (p = .033) than that of non-busulfan-based conditioning regimens. CONCLUSIONS Higher busulfan dose in conditioning regimens is the most significant risk factor affecting post-HCT early menopause. Considering our data, we need to decide on conditioning regimens and individualized fertility counseling before HCT for premenopausal women.
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Affiliation(s)
- Yoo Jin Lee
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Jeong Sook Kim
- Department of Obstetrics, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Youjin Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Hyeon-Soo Im
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Hyeyeong Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - SuJin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Young Joo Min
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Sang-Hyuk Park
- Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Jun Woo Ahn
- Department of Obstetrics, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Yunsuk Choi
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Spontaneous and iatrogenic ovarian hyperstimulation syndrome in the absence of FSHR mutations: a case report of two unexpected cases. BMC Med Genomics 2023; 16:45. [PMID: 36882810 PMCID: PMC9990314 DOI: 10.1186/s12920-023-01473-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a complication of controlled ovarian hyperstimulation (COH). It is a potentially life-threatening condition that usually occurs either after human chorionic gonadotropins (hCG) administration in susceptible patients or as a result of an implanting pregnancy, regardless of whether it was achieved by natural conception or infertility treatments. Despite many years of clinical experience regarding the adoption of preventive measures and the identification of patients at high risk, the pathophysiology of OHSS is poorly understood and no reliable predictive risk factors have been identified. CASES PRESENTATION We report about two unexpected cases of OHSS following infertility treatments, occurring after freeze-all strategy with embryo cryopreservation approaches. The first case developed spontaneous OHSS (sOHSS), despite efforts to prevent its manifestation by a segmentation approach, including frozen embryo replacement cycle. The second case developed a late form of iatrogenic OHSS (iOHSS), even though the absence of any risk factors. No mutations in the follicle-stimulating hormone (FSH) receptor (FSHR)-encoding gene were detected, suggesting that the high levels of hCG due to the twin implanting pregnancies could be the only triggering factor of OHSS outbreak. CONCLUSION Freeze-all strategy with embryo cryopreservation cannot entirely prevent the development of OHSS, which may occur in its spontaneous form independently from the FSHR genotype. Although OHSS remains a rare event, all infertile patients requiring ovulation induction or controlled ovarian stimulation (COS) may be at potential risk of OHSS, either in the presence or in the absence of risk factors. We suggest closely monitoring cases of pregnancy following infertility treatments in order to provide early diagnosis and adopt the conservative management.
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Wu Z, Fang L, Liu B, Jia Q, Cheng JC, Sun YP. Biomarkers identification in follicular fluid of women with OHSS by using UPLC-MS method. Front Endocrinol (Lausanne) 2023; 14:1131771. [PMID: 36967756 PMCID: PMC10031058 DOI: 10.3389/fendo.2023.1131771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
To figure out the differentially changed metabolites and disturbed pathways in follicular fluid (FF) of patients with OHSS in comparison to the control group undergoing in vitro fertilization (IVF), we conducted this metabolomic analysis between two groups, the OHSS group included 30 patients treated with oocyte retrieval and developed OHSS in the next 7-14 days, while another 30 patients without OHSS tendency were selected as the control group. The FF samples were obtained during the process of oocyte retrieval. FF samples were analyzed using ultra-high liquid chromatography-tandem mass spectrometry (UPLC-MS). The results identified a total of 59 differentially changed metabolites, including 33 decreased metabolites (P < 0.01) and 26 increased metabolites (P < 0.01) in FF of OHSS compared with the control group. 12 metabolites could be the most valuable biomarkers for OHSS based on ROC results. Our correlation analyses showed that deoxyinosine levels were found positively correlated with serum estradiol (E2) levels in OHSS patients, while L-isoleucine, pyruvic acid, maleamate, and arachidonic acid were found to be positively correlated with the number of retrieved oocytes. Furthermore, 4-hydroxyphenylacetaldehyde, deoxycorticosterone, creatinine, and creatine were found to be negatively associated with serum E2 levels, while 4-hydroxyphenylacetaldehyde, L-carnitine, isovaleric acid and L-2-hydroxyglutaric acid were negatively related with the number of oocytes retrieved in OHSS patients. Taken together, our study provides better identification of OHSS FF metabolic dynamics, suggesting the metabolic compounds can be used as valuable predictors or treatment targets of OHSS.
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Affiliation(s)
| | - Lanlan Fang
- *Correspondence: Ying-Pu Sun, ; Lanlan Fang,
| | | | | | | | - Ying-Pu Sun
- *Correspondence: Ying-Pu Sun, ; Lanlan Fang,
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Schon SB, Kelley AS, Jiang C, Xu M, Menke M, Marsh EE. Emergency department utilization for ovarian hyperstimulation syndrome. Am J Emerg Med 2022; 60:134-139. [PMID: 35964549 DOI: 10.1016/j.ajem.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a rare, but serious, risk of assisted reproductive technologies. In severe cases, patients may present to the emergency department (ED) for assessment, treatment of related complications, and even in-patient admission. Significant effort has been made to reduce the incidence and complications of OHSS; however, it is unknown if these strategies have decreased patient presentation for treatment in the ED. PURPOSE To assess ED utilization for OHSS over time and to examine admission rates, patient demographics, and charges. METHODS Retrospective longitudinal study utilizing data from the Nationwide Emergency Department Sample Database and the National ART Surveillance System. All ED visits between 2006 and 2016 with an ICD-9 or -10 diagnosis of OHSS were included. Demographics including age, geographic location, and income quartile and alternative diagnoses, admission rates, overall charges, and number of stimulation cycles annually were assessed. RESULTS The number of ovarian stimulation cycles steadily increased from 2006 (n = 110,183) to 2016 (n = 157,721), while the number of OHSS-related ED visits remained relatively stable (APC 2.08, p = 0.14). Admission rates for OHSS decreased from 52.7% in 2006 to 33.1% in 2016 (APC -4.43%, p < 0.01). The average charge for OHSS-related ED visits almost doubled from 2006 to 2016 (APC 8.53, p < 0.01) and was significantly higher than charges for non-OHSS-related visits for age-matched controls (p < 0.01). CONCLUSION Despite an increase in total stimulation cycles, there was no significant change in the estimated number of patients presenting to the ED; however, admission rates significantly declined. These observations suggest a possible shift in the severity and/or management of OHSS during the study period.
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Affiliation(s)
- Samantha B Schon
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Angela S Kelley
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Charley Jiang
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Min Xu
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Marie Menke
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Erica E Marsh
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
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Bainvoll L, Mandelbaum RS, Violette CJ, Matsuzaki S, Ho JR, Wright JD, Paulson RJ, Matsuo K. Association between hospital treatment volume and major complications in ovarian hyperstimulation syndrome. Eur J Obstet Gynecol Reprod Biol 2022; 272:240-246. [PMID: 35405452 DOI: 10.1016/j.ejogrb.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/24/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE An inverse relationship between hospital volume and adverse patient outcomes has been established for many conditions, but has not yet been examined in ovarian hyperstimulation syndrome (OHSS). Given the rarity of severe OHSS, but potential for high morbidity, this study aimed to elucidate the effect of hospital volume on inpatient OHSS-related complications. METHODS This is a retrospective observational study querying the National Inpatient Sample, 1/2001-12/2011. Study population was 11,878 patients with OHSS treated at 735 hospitals. Annualized hospital OHSS treatment volume was grouped as: low-volume (1 case/year), mid-volume (>1 but < 3.5 cases/year), and high-volume (≥3.5 cases/year). Main outcome measure was major complication rates stratified by hospital treatment volume, assessed by multinomial regression and binary logistic regression models. RESULTS A total of 2,415 (20.3%) patients were treated at low-volume centers, 5,023 (42.3%) at mid-volume centers, and 4,440 (37.4%) at high-volume centers. Patients treated at high-volume centers were more likely to be older and less comorbid with higher incomes and lower body mass index (P < 0.05). High-volume hospitals were more likely to be urban-teaching centers with large bed capacity (P < 0.001). Overall, 1,624 (13.7%) patients experienced a major complication during hospitalization. Patients treated at high-volume hospitals had lower rates of major complications (high: 11.0%, mid: 15.2%, low: 15.6%, P < 0.001). On multivariable analysis, treatment at high-volume hospitals was independently associated with a nearly 20% lower rate of major complications (odds ratio 0.82, 95% confidence interval 0.70-0.97, P = 0.021). CONCLUSION Our study suggests that higher hospital treatment volume for OHSS may be associated with improved outcomes.
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Affiliation(s)
- Liat Bainvoll
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Caroline J Violette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Jacqueline R Ho
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Richard J Paulson
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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Oliveira e Souza L, Innecco Arêas JV, Rezende Campos MC, Innecco Arêas I, Martins Resende BA. Spontaneous ovarian hyperstimulation syndrome in a pregnant woman with hypothyroidism: a case report. F S Rep 2021; 2:433-439. [PMID: 34934984 PMCID: PMC8655400 DOI: 10.1016/j.xfre.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 01/19/2023] Open
Abstract
Objective To study a rare case of spontaneous ovarian hyperstimulation syndrome in a naturally conceived pregnancy associated with overt hypothyroidism. Design Case report. Setting Endocrinology private practice. Patient(s) A 32-year-old woman who was 13 weeks pregnant with bilaterally enlarged ovaries presumed to be secondary to hypothyroidism. Intervention(s) Administration of levothyroxine and titration of the dose. Main Outcome Measure(s) Regression of signs and symptoms of spontaneous ovarian hyperstimulation syndrome after 12 weeks of therapy. Result(s) The patient was diagnosed with severe hypothyroidism, as confirmed by her elevated thyroid-stimulating hormone level. Ultrasound evaluation revealed ovarian enlargement secondary to multiple contiguous cysts with anechoic content. The patient was administered levothyroxine 175 μg/day. Results of hormonal studies demonstrated thyroid function normality at week 12 after treatment. Incomplete regression of ovarian cysts was also noticed within this period. At week 37, the patient developed preeclampsia, and cesarean delivery was recommended. An 8-month postpartum ultrasound evaluation revealed complete regression of the cysts. Conclusion(s) Spontaneous ovarian hyperstimulation syndrome secondary to hypothyroidism may be the cause of ovarian enlargement, and levothyroxine replacement seems an appropriate primary therapeutic option. Proper endocrinological assessment of patients is recommended as it may avoid unfavorable outcomes.
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Affiliation(s)
- Lucas Oliveira e Souza
- Department of Medicine, Minas Gerais Faculty of Medical Sciences, Belo Horizonte, Brazil
- Reprint requests: Lucas Oliveira e Souza, M.S., Al. Ezequiel Dias, 275 Centro, Belo Horizonte, Brazil.
| | | | | | - Isabela Innecco Arêas
- Department of Medicine, Minas Gerais Faculty of Medical Sciences, Belo Horizonte, Brazil
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Elmahal M, Lohana P, Anvekar P, Menda MK, Arti. Hyponatremia: An Untimely Finding in Ovarian Hyper-Stimulation Syndrome. Cureus 2021; 13:e16556. [PMID: 34431837 PMCID: PMC8380000 DOI: 10.7759/cureus.16556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/05/2022] Open
Abstract
In-vitro fertilization (IVF) is one of several methods to assist individuals to conceive. This is a case of a young lady who presented to the emergency department with a one-day history of mild abdominal pain, vomiting, and tiredness. She had undergone uneventful IVF with an embryo transfer procedure in a specialized center three days earlier. The initial clinical examination was unremarkable, but laboratory investigations showed low serum sodium and albumin levels with relatively high leucocyte count. Considering the recent history of IVF coupled with the deranged laboratory results, the patient was admitted to the hospital for further assessment and evaluation. On the second day, the patient developed severe abdominal pain and distension and she became more distressed. A diagnosis of ovarian hyperstimulation syndrome (OHSS) was established and the patient was admitted to the intensive care unit (ICU) as her condition deteriorated thereafter. Twelve days later, the patient was discharged from the hospital after a full recovery.
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Affiliation(s)
| | - Petras Lohana
- Internal Medicine, Liaquat University of Medical and Health Sciences Hospital, Karachi, PAK
| | - Priyanka Anvekar
- Internal Medicine and Surgery, Mahatma Gandhi Mission (MGM) Medical College and Hospital, Mumbai, IND
| | - Manoj K Menda
- Medicine, St Johns National Academy of Health Sciences, Bangalore, IND
| | - Arti
- Internal Medicine, Liaquat University of Medical and Health Sciences, Kunri, PAK
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Abstract
Alongside an interplay of a multitude of factors, attainment of a favorable pregnancy outcome is predicated on successful implantation, which in itself is a complex process anchored by balanced interchange with the hemostatic system. Among other etiologies, failure of implantation can result in infertility, and lead affected couples to consider assisted reproductive technology (ART) in an effort to fulfill their desire for procreation. Given the critical role of the hemostatic system in the process of implantation, documentation of a hypercoagulable state during controlled ovarian stimulation in the context of in vitro fertilization, as well as the potential association of its derangement in the setting of thrombophilia, with infertility, ART, ovarian hyperstimulation syndrome, and failure of implantation are explored. Additionally, current evidence addressing the relationship between ART and thromboembolism is examined, as is the role of therapy with heparin and aspirin to decrease thrombotic risk and improve ART-related pregnancy outcomes. Evidence-based recommendations from relevant professional societies are summarized.
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Affiliation(s)
- Ann Kinga Malinowski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
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Akbari Sene A, Ashrafi M, Alaghmand-Fard N, Mohammadi N, Mortezapour Alisaraie M, Alizadeh A. Anti-Müllerian Hormone Predictive Levels to Determine The Likelihood of Ovarian Hyper-Response in Infertile Women with Polycystic Ovarian Morphology. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2021; 15:115-122. [PMID: 33687164 PMCID: PMC8052798 DOI: 10.22074/ijfs.2020.134614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022]
Abstract
Background The objective of this study was to investigate serum levels of anti-Müllerian hormone (AMH) in
normal-ovulatory infertile women with polycystic ovarian morphology (PCOM) and their association with ovarian
hyper-response. Materials and Methods This prospective cohort study was carried out on 100 infertile women with PCOM who
were treated with an antagonist/agonist triggered stimulation protocol at Shahid Akbar-Abadi Hospital IVF Centre,
Tehran, Iran. Serum AMH levels were measured before starting the assisted reproductive technology (ART) cycle
and the ovarian hyper-response was evaluated by retrieved oocyte numbers, ooestradiol levels on the triggering
day, and the incidence of ovarian hyper-stimulation syndrome (OHSS) clinical signs and symptoms. Logistic re-
gression and the area under the curve (AUC) were used to estimate the effects of AMH and the accuracy of the test. Results Receiver operating characteristic (ROC) curve analysis showed that AMH could significantly predict ovar-
ian hyper-response in PCOM patients (AUC=0.73). The estimated threshold value was 4.95 ng/ml, with a specificity
of 74.58% (95% confidence interval [CI]: 50.85, 93.22) and sensitivity of 73.17% (95% CI: 48.78, 92.68). Logistic
regression results showed a significant interaction between AMH and body mass index (BMI, P=0.008), which indi-
cated that BMI had a moderation effect. Conclusion Individualized stimulation protocols for patients with isolated PCOM and AMH greater than 4.95 ng/ml
may significantly reduce the chances of developing OHSS. However, the AMH cut-off values to predict ovarian hyper-
response differ for different BMI categories among PCOM patients; thus, it becomes a more precise predictive marker
with increasing BMI.
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Affiliation(s)
- Azadeh Akbari Sene
- Shahid Akbar-Abadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mahnaz Ashrafi
- Shahid Akbar-Abadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Nasim Alaghmand-Fard
- Department of Obstetrics and Gynaecology, Shahid Akbar-Abadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Mohammadi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ahad Alizadeh
- Metabolic Diseases Research Centre, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
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Ferrier C, Boujenah J, Poncelet C, Chabbert-Buffet N, Mathieu D'Argent E, Carbillon L, Grynberg M, Darai E, Bendifallah S. Use of the EFI score in endometriosis-associated infertility: A cost-effectiveness study. Eur J Obstet Gynecol Reprod Biol 2020; 253:296-303. [PMID: 32920265 DOI: 10.1016/j.ejogrb.2020.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/06/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The management of endometriosis-related infertility is still under debate. The Endometriosis Fertility Index (EFI) score is performant to predict the occurrence of a spontaneous pregnancy following surgery, but was not evaluated in a cost-effectiveness perspective. Our objective was to quantify fertility outcomes, and costs of different care pathways for endometriosis-associated infertility after primary surgery, with a stratification on the EFI score. STUDY DESIGN We conducted a cost-effectiveness analysis based on a decision-tree model in a Tertiary-care university hospital. Extracted form a prospectively maintained database, 608 patients with endometriosis-associated infertility, who underwent laparoscopic treatment with an evaluation of the EFI score, were discriminated between different strategies: natural conception, immediate IVF-ICSI, delayed IVF-ICSI. The pregnancy rate and the live birth rate were the effectiveness outcomes. We considered direct and indirect costs in each strategies. The analysis was stratified according to the EFI score. RESULTS After surgery, 163 women with immediate IVF-ICSI (strategy I) were compared with 445 women who had natural conception attempts during a year (strategy II). After a year failure of natural conception attempts, 133 women continuing natural conception attempts (strategy III) were compared with 168 women who had delayed IVF-ICSI (strategy IV). The respective PR and LBR were 62.6 % and 52.1 % for strategy I, and 32.4 % and 23.8 % for strategy II. Compared to strategy II, strategy I was more costly and more effective (Incremental Cost Effectiveness Ratio (ICER): 31,469 €/pregnancy and 33,568 €/live birth)). No added benefit was observed for patients in strategy I with an EFI score [0-3] after two IVF-ICSI cycles. Strategy III was strongly dominant versus strategy IV for patients with an EFI score [9-10]. Compared to strategy III, strategy VI was more costly and more effective (ICER: 79,674 €/pregnancy, 53,188 €/pregnancy and 27,748 €/pregnancy respectively for patients with an EFI score [7-8], [4-6] and [0-3]). CONCLUSION Immediate IVF-ICSI after surgery is effective but associated with substantial costs for the healthcare system. Taking into account healthcare costs, the EFI is a useful score for helping a couple decide between different care pathways -natural conception, immediate or delayed IVF-ICSI- after surgery for endometriosis-associated infertility.
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Affiliation(s)
- Clément Ferrier
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculty of Medicine Pierre and Marie Curie, Sorbonne University, Paris, France; Groupe de Recherche Clinique GRC6-UPMC: Centre Expert En Endométriose (C3E), France.
| | - Jérémy Boujenah
- Department of Obstetrics, Gynecology and Assisted Reproductive Technologies Centers, Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique-Hôpitaux de Paris, Bondy, France; Faculty Paris 13, UFR SMBH Leonard de Vinci, Sobonne Paris Cité, Bobigny, France
| | - Christophe Poncelet
- Department of Gynaecology and Obstetrics, Centre Hospitalier René Dubos, Pontoise, France; Faculty Paris 13, UFR SMBH Leonard de Vinci, Sobonne Paris Cité, Bobigny, France
| | - Nathalie Chabbert-Buffet
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculty of Medicine Pierre and Marie Curie, Sorbonne University, Paris, France; Groupe de Recherche Clinique GRC6-UPMC: Centre Expert En Endométriose (C3E), France
| | - Emmanuelle Mathieu D'Argent
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculty of Medicine Pierre and Marie Curie, Sorbonne University, Paris, France; Groupe de Recherche Clinique GRC6-UPMC: Centre Expert En Endométriose (C3E), France
| | - Lionel Carbillon
- Department of Obstetrics, Gynecology and Assisted Reproductive Technologies Centers, Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique-Hôpitaux de Paris, Bondy, France; Faculty Paris 13, UFR SMBH Leonard de Vinci, Sobonne Paris Cité, Bobigny, France
| | - Michael Grynberg
- Faculty Paris 13, UFR SMBH Leonard de Vinci, Sobonne Paris Cité, Bobigny, France; Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris Sud, Assistance Publique - Hôpitaux de Paris, Clamart 92140, France; Université Paris-Sud, Université Paris Saclay, Le Kremlin Bicêtre, 94276, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculty of Medicine Pierre and Marie Curie, Sorbonne University, Paris, France; Groupe de Recherche Clinique GRC6-UPMC: Centre Expert En Endométriose (C3E), France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculty of Medicine Pierre and Marie Curie, Sorbonne University, Paris, France; Groupe de Recherche Clinique GRC6-UPMC: Centre Expert En Endométriose (C3E), France
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12
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Darii N, Pavlovic M, Doroftei B, Emil A. Unsuspected adverse effect of albumin in severe ovarian hyperstimulation syndrome: a case report. JBRA Assist Reprod 2019; 23:430-433. [PMID: 31058477 PMCID: PMC6798593 DOI: 10.5935/1518-0557.20190002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complications
of in vitro fertilization (IVF). We present a case of OHSS
maintained and aggraved by albumin administration. A 29-year-old woman with
severe OHSS was treated with albumin perfusion according to the guidelines. The
albumin was administered in order to maintain intravascular oncotic pressure and
to reverse the shift of fluid from the intravascular to the third space, but
this therapeutic measure resulted in inadvertent maintenance of the syndrome.
The treatment of OHSS is a delicate balance between invasive approaches, such as
paracentesis, administration of colloids and minimal therapeutic intervention,
particularly during pregnancy.
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Affiliation(s)
- Natalia Darii
- Department of Gynecology, CHU de Charleroi, Montigny-le-Tilleul, Belgium
| | - Milenko Pavlovic
- Department of Gynecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for Gynecologic Laparoscopic Surgery (CECLAG), Department of Gynecology, Hospital Clínico La Florida, Santiago, Chile
| | - Bogdan Doroftei
- Department of Gynecology, University of Medicine and Pharmacology Gr T Popa Iasi, Romania
| | - Anton Emil
- Department of Gynecology, University of Medicine and Pharmacology Gr T Popa Iasi, Romania
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13
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Hirshberg B, Rheinboldt M. Multimodality imaging of acute locoregional and systemic complications in the setting of assisted reproduction. Emerg Radiol 2019; 26:205-219. [PMID: 30631995 DOI: 10.1007/s10140-018-01665-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/13/2018] [Indexed: 02/02/2023]
Abstract
Over the past 40 years since the first in vitro fertilization was performed, both the role of assisted reproductive technology (ART) in establishing viable pregnancy as well as the available treatment options have expanded enormously. Annually in the USA, nearly 2% of pregnancies now employ some form of ART assistance, with in vitro fertilization (IVF) being the most commonly utilized methodology. Both maternal and fetal risks are elevated in ART pregnancies, the latter including adverse outcome due to both increased gestational number as well as advanced maternal age. Maternal risks may be divided into locoregional and systemic complications. Adverse pelvic complications include those relating to gamete harvesting and transfer, ovarian hyperstimulation, the sequela of ectopic and heterotopic pregnancies, as well as ovarian torsion, all of which are elevated in the ART cohort. Ovarian hyperstimulation syndrome is the most commonly encountered complication, with both systemic and pelvic features relating to increased vascular permeability, hemoconcentration, and ascites. While life-threatening cases are relatively rare, moderate and severe manifestations may occur in up to 10% of ART cycles and, as such, are a not infrequent cause for ER visitation. Familiarity with the clinical and imaging manifestations of ART complications as well as their prognostic implications will facilitate a timely diagnosis and assist the interpreting radiologist in best expediting appropriate clinical care. In this article, we will briefly discuss the current methodology of ART then present an imaging-based multimodality review of the potentially encountered adverse maternal sequela, highlighting key diagnostic features and differential considerations as well as potential prognostic implications.
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14
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Namavar Jahromi B, Parsanezhad ME, Shomali Z, Bakhshai P, Alborzi M, Moin Vaziri N, Anvar Z. Ovarian Hyperstimulation Syndrome: A Narrative Review of Its Pathophysiology, Risk Factors, Prevention, Classification, and Management. IRANIAN JOURNAL OF MEDICAL SCIENCES 2018; 43:248-260. [PMID: 29892142 PMCID: PMC5993897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovulation induction that usually occurs after gonadotropin stimulation, followed by human chorionic gonadotropin administration, for infertility treatment. The existing knowledge about the pathophysiology, risk factors, and primary and secondary methods for the prevention of OHSS is reviewed in this manuscript. The clinical manifestations and characteristics of mild, moderate, severe, and critical forms of the syndrome are defined. The methods of handling affected cases as outpatient or in-hospital management methods as well as indications for hospitalization are summarized in this review. The clinical and biochemical routes of assessing and monitoring hospitalized patients with OHSS, various drugs and medical treatment strategies including indications for aspiration of the ascitic fluid and pleural effusion, and also rare indications for surgery are briefly explained in this article. Severe OHSS, which two decades ago was considered an iatrogenic life-threatening condition, can now be effectively prevented or managed during the early stages. An OHSS-free clinic can be established nowadays by carefully considering the endocrinology of ovulation and using appropriate and dose-adjusted pharmaceutical agents, which are summarized and discussed in this review.
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Affiliation(s)
- Bahia Namavar Jahromi
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;
,Department of Obstetrics and Gynecology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ebrahim Parsanezhad
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;
,Department of Obstetrics and Gynecology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shomali
- Department of Obstetrics and Gynecology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran;,Student Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pardis Bakhshai
- Department of Obstetrics and Gynecology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran;,Student Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahshid Alborzi
- Department of Obstetrics and Gynecology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran;,Student Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najmeh Moin Vaziri
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;
| | - Zahra Anvar
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;
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15
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Choux C, Barberet J, Ginod P, Cottenet J, Bruno C, Benzénine E, Sagot P, Fauque P. Severe ovarian hyperstimulation syndrome modifies early maternal serum beta-human chorionic gonadotropin kinetics, but obstetrical and neonatal outcomes are not impacted. Fertil Steril 2017; 108:650-658.e2. [DOI: 10.1016/j.fertnstert.2017.07.1160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/13/2017] [Accepted: 07/26/2017] [Indexed: 02/09/2023]
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16
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Saad AS, Mohamed KAA. Diosmin versus cabergoline for prevention of ovarian hyperstimulation syndrome. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Hebisha SA, Aboelazm BA, Sallam HN. GnRH Antagonist Cetrorelix Administration Before hCG for Protection of Ovarian Hyperstimulation Syndrome. J Obstet Gynaecol India 2017; 67:270-274. [PMID: 28706366 PMCID: PMC5491409 DOI: 10.1007/s13224-016-0952-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Studying the effect of GnRH antagonist administration on the day of hCG to cases of IVF/ICSI with estradiol level above 5000 ng/dl for protection of ovarian hyperstimulation syndrome. DESIGN Prospective study. MATERIALS AND METHODS Sixty patients undergoing controlled hyperstimulation COH, for IVF/ICSI using long agonist and E2 level on the day of hCG, are above 5000 ng/dl, 52 patients received single dose of cetrorelix 0.25 mg on the day of hCG, and 8 patients received two doses of 0.25 mg/day cetrorelix started one day before the day of hCG. RESULTS There was no significant difference regarding patients BMI, number of stimulation days, recombinant FSH dose, and number of retrieved oocytes. Clinical pregnancy rate was 76.6% (46/60), in patients received single dose of antagonist PR were significantly higher 80.7% (42/52) versus 50% (4/8) in patients received two doses p = 0.047. Live birth rate was 50% (30/60), abortion rate was 20% (12/60), and preterm delivery was 20% (12/60). Mean E2 was 6853.2 ng/dl. Six patients developed moderate ovarian hyperstimulation OHSS (6/60) 10% and no cases of severe OHSS. CONCLUSIONS GnRH antagonist administration on the day of hCG in cases undergoing IVF/ICSI with long agonist protocol is effective in protection of OHSS and does not affect the clinical pregnancy rate nor live birth rate.
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18
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Gebril A, Hamoda H, Mathur R. Outpatient management of severe ovarian hyperstimulation syndrome: a systematic review and a review of existing guidelines. HUM FERTIL 2017; 21:98-105. [PMID: 28554223 DOI: 10.1080/14647273.2017.1331048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of assisted reproductive treatment. Management of women with severe OHSS has traditionally included hospitalisation for close monitoring and supportive treatment. The aim of this review is to assess the evidence for safety and efficacy of outpatient management of severe OHSS. A systematic review of studies describing outpatient management options was performed. Current guidance from advisory bodies was also reviewed. Outpatient management has been found in observational studies to be safe and cost-effective compared to inpatient management. Paracentesis of ascitic fluid seems to be effective treatment for severe OHSS along with supportive management including maintenance of fluid balance and preventative measures against thrombo-embolism. GnRH antagonist was shown in few studies to be effective in treatment of early severe OHSS although further research is required to assess its role in this context. Appropriate outpatient set up and protocols are essential to provide safe outpatient management for women with severe OHSS.
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Affiliation(s)
- Amr Gebril
- a Department of Obstetrics and Gynaecology, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Haitham Hamoda
- b King's College Hospital NHS Foundation Trust , London , UK
| | - Raj Mathur
- c Department of Reproductive Medicine , Central Manchester University Hospital NHS Foundation Trust , Manchester , UK.,d Maternal and Fetal Health Research Centre, Division of Developmental Biology & Medicine , University of Manchester , Manchester , UK
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19
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Durst MA, Wicklow B, Narvey M. Atypical case of preterm ovarian hyperstimulation syndrome. BMJ Case Rep 2017; 2017:bcr-2016-217517. [PMID: 28228430 DOI: 10.1136/bcr-2016-217517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Preterm ovarian hyperstimulation syndrome is a rare syndrome in which preterm infant girls have hypogastric, upper leg and labial swelling accompanied by elevated serum oestradiol levels and ovarian follicular cysts on ultrasound. Our case is an infant born at 23 weeks gestational age who at 30 weeks postconceptional age (PCA) developed elevated 17-hydroxyprogesterone on her newborn screen with associated clitoromegaly and a ventral groove on the inferior aspect of the erectile tissue. An initial pelvic ultrasound at 32 weeks PCA demonstrated a normal appearing uterus, but the ovaries were not visualised. At 39 weeks PCA, follicular ovarian cysts were noted bilaterally (31×26×21 mm on left and 38×25×36 mm on right). Without treatment, oestradiol and testosterone levels began normalising by 42 weeks PCA. After this point, the right ovarian cysts had resolved and the left ovarian cyst continued to diminish in size.
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Affiliation(s)
- Michelle A Durst
- University of Manitoba, Department of Paediatrics and Child Health, Winnipeg, Manitoba, Canada
| | - Brandy Wicklow
- University of Manitoba, Department of Paediatrics and Child Health, Section of Paediatric Endocrinology, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Narvey
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Department of Paediatrics and Child Health, Section of Neonatology, Winnipeg, Manitoba, Canada
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20
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Bellapu S, Guttman J. Use of Point-of-Care Ultrasound for the Diagnosis of Ovarian Hyperstimulation Syndrome. J Emerg Med 2016; 52:e101-e104. [PMID: 27998636 DOI: 10.1016/j.jemermed.2016.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/09/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) occurs when ovaries are overstimulated and enlarged due to fertility treatments resulting in a shift of serum from the intravascular space to the third space, mainly the abdominal cavity. It is the most serious complication of ovarian hyperstimulation for assisted reproduction. CASE REPORT We present the case of a 40-year-old woman who presented with abdominal bloating and nausea 2 weeks after undergoing in vitro fertilization (IVF); she was diagnosed by an outside radiology ultrasound as having a ruptured ovarian cyst. A point-of-care emergency ultrasound performed by the emergency physician made the diagnosis of ovarian hyperstimulation syndrome. This led to more expedient management and obstetrical consultation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Abdominal bloating and nausea are common presenting complaints in pregnant women. OHSS is a rare but potentially fatal complication of IVF. Recognition and early diagnosis by the emergency physician can lead to appropriate intervention and consultation.
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Affiliation(s)
- Sowdhamani Bellapu
- Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Joshua Guttman
- Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
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21
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Prévention du syndrome d'hyperstimulation ovarienne. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S512-S524. [DOI: 10.1016/j.jogc.2016.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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22
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Ata B, Urman B. Thrombophilia and assisted reproduction technology-any detrimental impact or unnecessary overuse? J Assist Reprod Genet 2016; 33:1305-1310. [PMID: 27423663 PMCID: PMC5065550 DOI: 10.1007/s10815-016-0771-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/01/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The aim of this study is to provide an overview of the studies investigating a possible association between thrombophilia and assisted reproductive technology (ART) outcome. METHODS This is a literature review. RESULTS Congenital thrombophilias (CoT) are reported to be associated with pregnancy loss. However, the association between CoT and early pregnancy loss is weak and does not necessarily support causation. CoT are more likely to be associated with late fetal loss. Even though data pooled from case-control and cohort studies suggest an increased risk of ART failure in women with CoTs, there seems no association when the analysis is confined to better quality cohort studies. The evidence supporting anticoagulation to improve ART outcome in CoT carriers is weak. Likewise, studies on antiphospholipid antibodies (APAs) and ART outcome suffer from multiple methodological limitations and a detrimental impact of APA positivity is controversial. Empirical administration of heparin or low molecular weight heparin to women with recurrent ART failures is supported by weak evidence. Importantly, thrombophilias are likely to increase thrombotic complications after ovarian stimulation for ART. CONCLUSIONS Current evidence does not support routinely testing for or treatment of thrombophilia in the setting of ART nor in couples with implantation failure. A careful personal and family history should be obtained and a risk assessment for thrombotic complications should be made in every woman undergoing ovarian stimulation. If positive, testing for thrombophilia is warranted.
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Affiliation(s)
- Baris Ata
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Davutpasa Caddesi No: 4, Topkapi, Istanbul, 34010, Turkey
| | - Bulent Urman
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Davutpasa Caddesi No: 4, Topkapi, Istanbul, 34010, Turkey.
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Khalil MAM, Ghazni MS, Tan J, Naseer N, Khalil MAU. Spontaneous Bacterial Peritonitis and Anasarca in a Female Patient with Ovarian Hyperstimulation Syndrome Complicated by Respiratory and Kidney Failure. Case Rep Gastroenterol 2016; 10:423-430. [PMID: 27721728 PMCID: PMC5043260 DOI: 10.1159/000446766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/11/2016] [Indexed: 11/19/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) was first described in 1960. It may occur as a complication of gonadotropin hormone therapy during assisted pregnancy or for primary infertility. A 26-year-old female patient with polycystic ovarian syndrome and primary infertility was treated to conceive. She received intravenous gonadotropin-releasing hormone (GnRH) along with follicle-stimulating hormone in an outside private clinic. She presented to the emergency department with abdominal and chest pain, loose stool, vomiting, shortness of breath and decreasing urine output. She was found to have edema, ascites, effusion and acute kidney injury (AKI). Considering the symptoms preceding the drug history and anasarca, a diagnosis of severe OHSS was made. Ascites was further complicated by spontaneous bacterial peritonitis (SBP), which had already been reported before. We speculate that low immunity due to decreased immunoglobulin in patients with OHSS makes them prone to SBP. In our case, septicemia secondary to SBP and fluid loss due to capillary leakage from OHSS resulted in AKI and respiratory failure. This critically ill patient was treated in a special care unit, and she fully recovered with supportive measures. Severe OHSS may present as anasarca including ascites which can develop SBP leading to sepsis and multiorgan failure.
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Affiliation(s)
| | | | - Jackson Tan
- Department of Nephrology, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - Nazish Naseer
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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24
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Pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization. Fertil Steril 2016; 105:791-797.e2. [DOI: 10.1016/j.fertnstert.2015.11.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 11/17/2022]
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25
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Petrie KF, Carter RMP, Carter RMP, Sadighi A, Choong AMTL, Davies AH, Wong ALA. An IVF pregnancy, a neck lump and shortness of breath. Clin Med (Lond) 2015; 15:562-4. [PMID: 26621946 PMCID: PMC4953259 DOI: 10.7861/clinmedicine.15-6-562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present the case of a young primigravida, conceived with in vitro fertilisation, referred with unilateral neck swelling and pleuritic chest pain. Our case highlights the potential complexity of the management of the complications of assisted conception techniques. The discussion explores important considerations in the management of such patients.
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Affiliation(s)
- Kyle F Petrie
- Department of Acute Medicine, Chelsea and Westminster Hospital, London UK
| | | | - Rebecca M P Carter
- Department of Acute Medicine, Chelsea and Westminster Hospital, London UK
| | - Ash Sadighi
- Department of Acute Medicine, Chelsea and Westminster Hospital, London UK
| | | | - Alun H Davies
- Imperial Vascular Unit, St Mary's and Charing Cross Hospitals, London, UK
| | - Audrey L A Wong
- Department of Acute Medicine, Chelsea and Westminster Hospital, London, UK
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26
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Smith V, Osianlis T, Vollenhoven B. Prevention of Ovarian Hyperstimulation Syndrome: A Review. Obstet Gynecol Int 2015; 2015:514159. [PMID: 26074966 PMCID: PMC4446511 DOI: 10.1155/2015/514159] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/29/2015] [Indexed: 01/01/2023] Open
Abstract
The following review aims to examine the available evidence to guide best practice in preventing ovarian hyperstimulation syndrome (OHSS). As it stands, there is no single method to completely prevent OHSS. There seems to be a benefit, however, in categorizing women based on their risk of OHSS and individualizing treatments to curtail their chances of developing the syndrome. At present, both Anti-Müllerian Hormone and the antral follicle count seem to be promising in this regard. Both available and upcoming therapies are also reviewed to give a broad perspective to clinicians with regard to management options. At present, we recommend the use of a "step-up" regimen for ovulation induction, adjunct metformin utilization, utilizing a GnRH agonist as an ovulation trigger, and cabergoline usage. A summary of recommendations is also made available for ease of clinical application. In addition, areas for potential research are also identified where relevant.
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Affiliation(s)
- Vinayak Smith
- Alice Springs Hospital, Department of Obstetrics and Gynaecology, Alice Springs, NT 0870, Australia
| | - Tiki Osianlis
- Monash IVF, 252 Clayton Road, Clayton, VIC 3168, Australia
| | - Beverley Vollenhoven
- Monash IVF, 252 Clayton Road, Clayton, VIC 3168, Australia
- Monash Health, Women's and Children's Program, Monash Medical Centre, Clayton Road, Clayton, VIC 3168, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3168, Australia
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27
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Corbett S, Shmorgun D, Claman P. The prevention of ovarian hyperstimulation syndrome. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 36:1024-1033. [PMID: 25574681 DOI: 10.1016/s1701-2163(15)30417-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To review the clinical aspects of ovarian hyperstimulation syndrome and provide recommendations on its prevention. OPTIONS Preventative measures, early recognition, and prompt systematic supportive care will help avoid poor outcomes. OUTCOMES Establish guidelines to assist in the prevention of ovarian hyperstimulation syndrome, early recognition of the condition when it occurs, and provision of appropriate supportive measures in the correct setting. EVIDENCE Published literature was retrieved through searches of Medline, Embase, and the Cochrane Library from 2011 to 2013 using appropriate controlled vocabulary ([OHSS] ovarian hyperstimulation syndrome and: agonist IVF, antagonist IVF, metformin, HCG, gonadotropin, coasting, freeze all, agonist trigger, progesterone) and key words (ovarian hyperstimulation syndrome, ovarian stimulation, gonadotropin, human chorionic gonadotropin, prevention). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English. There were no date restrictions. Searches were updated on a regular basis and incorporated in the guideline to February 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Summary Statements 1. The particular follicle-stimulating hormone formulation used for ovarian stimulation does not affect the incidence of ovarian hyperstimulation syndrome. (I) 2. Coasting may reduce the incidence of severe ovarian hyperstimulation syndrome. (III) 3. Coasting for longer than 3 days reduces in vitro fertilization pregnancy rates. (II-2) 4. The use of either luteinizing hormone or human chorionic gonadotropin for final oocyte maturation does not influence the incidence of ovarian hyperstimulation syndrome. (I) 5. There is no clear published evidence that lowering the human chorionic gonadotropin dose will result in a decrease in the rate of ovarian hyperstimulation syndrome. (III) 6. Cabergoline starting from the day of human chorionic gonadotropin reduces the incidence of ovarian hyperstimulation syndrome in patients at higher risk and does not appear to lower in vitro fertilization pregnancy rates. (II-2) 7. Avoiding pregnancy by freezing all embryos will prevent severe prolonged ovarian hyperstimulation syndrome in patients at high risk. (II-2) 8. Pregnancy rates are not affected when using gonadotropin-releasing hormone (GnRH) agonists in GnRH antagonist protocols for final egg maturation when embryos are frozen by vitrification for later transfer. (II-2) Recommendations 1. The addition of metformin should be considered in patients with polycystic ovarian syndrome who are undergoing in vitro fertilization because it may reduce the incidence of ovarian hyperstimulation syndrome. (I-A) 2. Gonadotropin dosing should be carefully individualized, taking into account the patient's age, body mass, antral follicle count, and previous response to gonadotropins. (II-3B) 3. Cycle cancellation before administration of human chorionic gonadatropin is an effective strategy for the prevention of ovarian hyperstimulation syndrome, but the emotional and financial burden it imposes on patients should be considered before the cycle is cancelled. (III-C) 4. Gonadotropin-releasing hormone (GnRH) antagonist stimulation protocols are recommended in patients at high risk for ovarian hyperstimulation syndrome (OHSS). The risk of severe OHSS in patients on GnRH antagonist protocols who have a very robust ovarian stimulation response can be reduced by using a GnRH agonist as a substitute for human chorionic gonadotropin to trigger final oocyte maturation. (I-B) 5. A gonadotropin-releasing hormone (GnRH) antagonist protocol with a GnRH agonist trigger for final oocyte maturation is recommended for donor oocyte and fertility preservation cycles. (III-C) 6. Albumin or other plasma expanders at the time of egg retrieval are not recommended for the prevention of ovarian hyperstimulation syndrome. (I-E) 7. Elective single embryo transfer is recommended in patients at high risk for ovarian hyperstimulation syndrome. (III-C) 8. Progesterone, rather than human chorionic gonadotropin, should be used for luteal phase support. (I-A) 9. Outpatient culdocentesis should be considered for the prevention of disease progression in severe ovarian hyperstimulation syndrome. (II-2B).
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Lodh M, Mukhopadhyay J, Sharma V. A case of severe ovarian hyperstimulation syndrome. Indian J Clin Biochem 2014; 29:386-9. [PMID: 24966492 PMCID: PMC4062660 DOI: 10.1007/s12291-013-0390-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/20/2013] [Indexed: 11/27/2022]
Abstract
Ovulation induction has been an important mode of treatment of infertility. Ovarian stimulation may result in a supraphysiologic response leading to an iatrogenic complication known as the ovarian hyperstimulation syndrome (OHSS). This syndrome is potentially a lethal condition, the pathophysiologic hallmark of which is the accumulation of massive extravascular exudate combined with profound intravascular volume depletion and hemoconcentration. We report a case of severe OHSS with very large ovaries in a 35 year old case of embryo transfer. The patient presented to the emergency department with abdominal pain, massive ascites, respiratory distress and amenorrhea. The patient was managed symptomatically with no complications. Although ovarian hyperstimulation is a rare entity, it is important that the physician recognizes this condition. Prompt diagnosis and successful management is likely to avoid serious and rapid development of complications.
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Affiliation(s)
- Moushumi Lodh
- />Department of Biochemistry, The Mission Hospital, Sector 2C, Imon Kalyan Sarani, Bidhannagar, Durgapur, 713212 West Bengal India
| | - Jheelam Mukhopadhyay
- />Department of Obstetrics and Gynaecology, The Mission Hospital, Durgapur, West Bengal India
| | - Vikas Sharma
- />Department of Radiology, The Mission Hospital, Durgapur, West Bengal India
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Saha PK, Goel P, Tandon R. Ovarian Hyperstimulation Syndrome (OHSS) Presented as Massive Hydrothorax. J Clin Diagn Res 2013; 7:2996-7. [PMID: 24551705 DOI: 10.7860/jcdr/2013/6623.3824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 08/01/2013] [Indexed: 11/24/2022]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of controlled ovarian stimulation. Although considered uncommon, the severe form is potentially fatal. Patient can present with varied clinical presentation like pain abdomen, abdominal distension or tachypnea. Diagnosis is made by careful history, examination and investigation. Treatment is conservative and supportive care. Here, we have presented a case of severe OHSS which was missed initially, as the doctor who had first seen probably was not aware of this disease.
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Affiliation(s)
- Pradip Kumar Saha
- Assistant Professor, Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education and Research , Sector 12, Chandigarh, India
| | - Poonam Goel
- Professor, Department of Obstetrics & Gynaecology, Government Medical College & Hospital , Sector-32, Chandigarh, India
| | - Rimpy Tandon
- Assistant Professor, Department of Obstetrics & Gynaecology, Government Medical College & Hospital , Sector-32, Chandigarh, India
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Fiedler K, Ezcurra D. Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment. Reprod Biol Endocrinol 2012; 10:32. [PMID: 22531097 PMCID: PMC3403873 DOI: 10.1186/1477-7827-10-32] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 04/24/2012] [Indexed: 11/13/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian stimulation (COS) as part of assisted reproductive technologies (ART). While the safety and efficacy of ART is well established, physicians should always be aware of the risk of OHSS in patients undergoing COS, as it can be fatal. This article will briefly present the pathophysiology of OHSS, including the key role of vascular endothelial growth factor (VEGF), to provide the foundation for an overview of current techniques for the prevention of OHSS. Risk factors and predictive factors for OHSS will be presented, as recognizing these risk factors and individualizing the COS protocol appropriately is the key to the primary prevention of OHSS, as the benefits and risks of each COS strategy vary among individuals. Individualized COS (iCOS) could effectively eradicate OHSS, and the identification of hormonal, functional and genetic markers of ovarian response will facilitate iCOS. However, if iCOS is not properly applied, various preventive measures can be instituted once COS has begun, including cancelling the cycle, coasting, individualizing the human chorionic gonadotropin trigger dose or using a gonadotropin-releasing hormone (GnRH) agonist (for those using a GnRH antagonist protocol), the use of intravenous fluids at the time of oocyte retrieval, and cryopreserving/vitrifying all embryos for subsequent transfer in an unstimulated cycle. Some of these techniques have been widely adopted, despite the scarcity of data from randomized clinical trials to support their use.
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Affiliation(s)
- Klaus Fiedler
- Kinderwunsch Centrum München (KCM) (Fertility Center Munich), Lortzingstr. 26, D-81241, Munich, Germany
| | - Diego Ezcurra
- Merck Serono S.A. – Geneva (an affiliate of Merck KGaA, Darmstadt, Germany), 9 Chemin des Mines, Geneva, CH-1202, Switzerland
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