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Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertil Steril 2024; 121:230-245. [PMID: 38099867 DOI: 10.1016/j.fertnstert.2023.11.013] [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: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 02/05/2024]
Abstract
Ovarian hyperstimulation syndrome is a serious complication associated with assisted reproductive technology. This systematic review aims to identify who is at high risk for developing ovarian hyperstimulation syndrome, along with evidence-based strategies to prevent it and replaces the document of the same name last published in 2016.
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Alvarado Franco CA, Bernabeu García A, Suñol Sala J, Guerrero Villena J, Albero Amorós S, Llacer J, Delgado Navas RA, Ortiz JA, Pitas A, Castillo Farfan JC, Bernabeu Pérez R. Conventional ovarian stimulation vs. delayed single dose corifollitropin alfa ovarian stimulation in oocyte donors: a prospective randomized study. Tail trial. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1239175. [PMID: 37965590 PMCID: PMC10642283 DOI: 10.3389/frph.2023.1239175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
The present study compares two protocols for ovarian controlled stimulation in terms of number of cumulus-oocyte complexes and metaphase II oocytes. We employed a single injection of 150mcg of corifollitropin alfa after a 7-day oral contraceptive pill-free interval for TAIL group and a conventional administration of corifollitropin alfa after a 5-day OCP-free interval with additional rFSH from 8th of ovarian controlled stimulation. Prospective, randomized, comparative, non-inferiority, opened and controlled trial carried out in 180 oocyte donors 31 were excluded, 81 were randomized to the control group and 68 to the TAIL group. No differences were found in the number of follicles larger than 14 and 17 mm at triggering day. However, a lower number of cumulus-oocyte complexes and metaphase II oocytes were obtained in TAIL group compared to the control group, expressed as median (interquartile range): 10.5 (5.5-19) vs. 14 [11-21] and 9 (4-13) vs. 12 (9-17) respectively. Additionally, the incidence of failed retrieval or metaphase II oocytes = 0 was higher in TAIL group 7(10.3%) vs. 1(1.2%) p = 0.024. The use of a single injection of corifollitropin alfa after a 7-day oral contraceptive pill-free interval in oocyte donors resulted in a lower number of cumulus-oocyte complexes and metaphase II oocytes. No additional rFSH was administered in this group. Clinical Trial Registration: https://www.clinicaltrialsregister.eu/ctr-search/trial/2019-001343-44/results.
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Affiliation(s)
| | | | - Jordi Suñol Sala
- Department of Gynecology, Instituto Bernabeu, Palma de Mallorca, Spain
| | | | | | - Joaquin Llacer
- Department of Gynecology, Instituto Bernabeu, Alicante, Spain
| | | | | | - Anna Pitas
- Clinical Trials Project Manager, Instituto Bernabeu, Alicante, Spain
| | - Juan Carlos Castillo Farfan
- Department of Gynecology, Instituto Bernabeu, Alicante, Spain
- Community Medicine and Reproductive Health Chair, Miguel Hernandez University, Elche, Spain
| | - Rafael Bernabeu Pérez
- Community Medicine and Reproductive Health Chair, Miguel Hernandez University, Elche, Spain
- Management Department, Instituto Bernabeu, Alicante, Spain
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Yanagihara Y, Tanaka A, Nagayoshi M, Tanaka I, Shinohara R, Fukushima F, Tanaka A, Ohno M, Yamaguchi T, Itakura A. A modified GnRH antagonist method in combination with letrozole, cabergoline, and GnRH antagonist for PCOS: Safe and effective ovarian stimulation to treat PCOS and prevent OHSS. Reprod Med Biol 2022; 21:e12429. [PMID: 34934404 PMCID: PMC8656185 DOI: 10.1002/rmb2.12429] [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] [Received: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To analyze the therapeutic efficacy of a modified controlled ovarian stimulation (COS) protocol for polycystic ovary syndrome (PCOS) that does not cause ovarian hyperstimulation syndrome (OHSS) while maintaining oocyte quality. METHOD This study is a retrospective cohort study of reproductive medicine at St. Mother Clinic. We analyzed ART clinical outcomes, embryonic development, and hormone levels in 175 PCOS patients treated with four COS (GnRH agonist based long protocol, Group A; GnRH antagonist protocol with HCG trigger, Group B; GnRH antagonist protocol with GnRH agonist trigger, Group C, and the modified COS group) between 2010 and 2021. RESULTS Of 175 patients with PCOS, 45 and 130 patients underwent 47 and 136 oocyte retrieval cycles, 75 and 250 embryo transfer cycles with the modified COS, and with conventional methods, respectively. The cumulative pregnancy rate at one trial was a significantly higher result than in Group A and higher than in Groups B and C (cumulative pregnancy rate at one trial of Group A, B, C, and modified COS: 40.0%, 54.5%, 56.3%, and 72.3%, respectively). With this method, not clinically problematic OHSS and higher clinical outcomes than in conventional methods were observed. CONCLUSION This modified COS can significantly improve clinical outcomes and eliminate OHSS.
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Affiliation(s)
- Yasuho Yanagihara
- Department of Obstetrics and GynecologySaint Mother ClinicKitakyushuJapan
- Department of Obstetrics and GynecologyJuntendo University School of MedicineBunkyo‐kuJapan
| | - Atsushi Tanaka
- Department of Obstetrics and GynecologySaint Mother ClinicKitakyushuJapan
- Department of Obstetrics and GynecologyJuntendo University School of MedicineBunkyo‐kuJapan
| | - Motoi Nagayoshi
- Department of Obstetrics and GynecologySaint Mother ClinicKitakyushuJapan
| | - Izumi Tanaka
- Department of Obstetrics and GynecologySaint Mother ClinicKitakyushuJapan
| | - Rina Shinohara
- Department of Obstetrics and GynecologySaint Mother ClinicKitakyushuJapan
| | - Fumihisa Fukushima
- Department of Obstetrics and GynecologySaint Mother ClinicKitakyushuJapan
| | - Akihiro Tanaka
- Department of Obstetrics and GynecologySaint Mother ClinicKitakyushuJapan
| | | | | | - Atsuo Itakura
- Department of Obstetrics and GynecologyJuntendo University School of MedicineBunkyo‐kuJapan
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Abstract
In vitro fertilization is indicated for infertile women with polycystic ovarian syndrome (PCOS) after unsuccessful treatment with ovulation induction agents or in women deemed high-risk of multiple gestations who are ideal candidates for single embryo transfers. PCOS patients are at increased risk of ovarian hyperstimulation syndrome; therefore, attention should be made in the choice of in vitro fertilization treatment protocol, dose of gonadotropin utilized, and regimen to achieve final oocyte maturation. Adopting these strategies in addition to close monitoring may significantly reduce the ovarian hyperstimulation syndrome risk. Future developments may improve pregnancy outcomes and decrease complications in PCOS women undergoing fertility treatment.
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Fatum M, Bergeron ME, Ross C, Ding A, Bhevan A, Turner K, Child T. Rescue In Vitro Maturation in Polycystic Ovarian Syndrome Patients Undergoing In Vitro Fertilization Treatment who Overrespond or Underrespond to Ovarian Stimulation: Is It A Viable Option? A Case Series Study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2020; 14:137-142. [PMID: 32681626 PMCID: PMC7382681 DOI: 10.22074/ijfs.2020.6025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/03/2019] [Indexed: 11/22/2022]
Abstract
Background This study intends to present the role of rescue in vitro maturation (IVM) in polycystic ovarian syn-
drome (PCOS) patients undergoing in vitro fertilization (IVF) treatment who have inappropriate responses to ovarian
stimulation. Materials and Methods This was a retrospective case series study of five PCOS patients undergoing IVF treatment
considered for cycle cancellation due to increased risk of ovarian hyperstimulation syndrome (OHSS) as group A or
poor response to ovarian stimulation as group B. Patients in group A had high oestradiol levels and recruitment of high
numbers of small/intermediate sized follicles that did not meet the criteria for human chorionic gonadotropin (hCG)
triggering. Patients in group B responded inadequately to hormonal stimulation despite high gonadotropin dosage.
Treatment was changed to rescue IVM cycles after the patients provided consent. Results In group A, three IVF patients deemed to have high chances of developing OHSS as evidenced by high
oestradiol levels were converted to IVM. A total of the 58/68 oocytes retrieved were mature or matured in vitro. There
were 26 cleaving embryos obtained. Two patients had live births and one patient suffered a miscarriage. In group B,
rescue IVM was implemented in two patients due to poor ovarian response (POR). A total of 22/26 oocytes retrieved
were mature or matured in vitro. There were 13 cleaving embryos obtained. One patient had a live birth, whilst the
other suffered a miscarriage. Conclusion Rescue IVM could be a viable option in PCOS patients undergoing IVF treatment who are unable to
safely meet the criteria for hCG triggering due to overresponse to ovarian stimulation or ovarian resistance to high
doses of stimulation. Conversion to IVM can still result in reasonable oocyte retrieval and lead to clinical pregnancy
and live births without the risks of OHSS.
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Affiliation(s)
- Muhammad Fatum
- Oxford Fertility Unit, Institute of Reproductive Sciences, Oxford, United Kingdom. Electronic Address:
| | - Marie Eve Bergeron
- Oxford Fertility Unit, Institute of Reproductive Sciences, Oxford, United Kingdom.,Department of Obstetrics and Gynaecology, Faculty of Medicine, Centre Hospitalier Universitaire de Quebéc, Université Laval, Quebéc, QC, Canada
| | - Caroline Ross
- Oxford Fertility Unit, Institute of Reproductive Sciences, Oxford, United Kingdom
| | - Anni Ding
- Oxford Fertility Unit, Institute of Reproductive Sciences, Oxford, United Kingdom. Electronic Address:
| | - Ayesha Bhevan
- Oxford Fertility Unit, Institute of Reproductive Sciences, Oxford, United Kingdom
| | - Karen Turner
- Oxford Fertility Unit, Institute of Reproductive Sciences, Oxford, United Kingdom
| | - Tim Child
- Oxford Fertility Unit, Institute of Reproductive Sciences, Oxford, United Kingdom
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Atilgan R, Pala Ş, Yavuzkır Ş, Başpınar M, Yılmaz M, Ilhan N. What is the impact of short- and long-term supplementation of either cabergoline or clarithromycin on resolving rat ovarian hyperstimulation syndrome (OHSS) model? J OBSTET GYNAECOL 2019; 39:687-694. [PMID: 30892121 DOI: 10.1080/01443615.2018.1563774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aimed to evaluate the effects of coasting, cabergoline and clarithromycin in a rat ovarian hyperstimulation syndrome (OHSS) model. The 42 female Wistar rats were divided into seven groups: control, OHSS (was given 10 IU of pregnant mare serum gonadotropin for 4 consecutive days from day 22 and 30 IU hCG on the fifth day to induce OHSS ), coasting (hCG was applied on the 27th day after gonadotropin injections and the rats were decapitated on the 28th day), Cabergoline (100 mg/kg/d) and clarithromycin (100 mg/kg/d) were given (on the 26th day) with a short-term supplementation (on the 26th day) and long-term supplementation (from the 22nd to the 26th day) groups. The rats were decapitated on the 27th day. Cabergoline and clarithromycin significantly lowered VEGF-2 levels. Clarithromycin significantly reduced IL-1b and TNF-a and significantly increased IL-10 levels. Clarithromycin may be an effective drug for the treatment of OHSS. Impact statement What is already known on this subject? Ovarian hyper-stimulation syndrome (OHSS) is a self-limited disease, in which vascular endothelial growth factor (VEGF) plays the most important role and has a large clinical spectrum related with increased capillary permeability and fluid retention. Some treatment methods that block VEGF over-expression are used in treatment of OHSS. Clarithromycin is known to suppress the production of some pro-inflammatory molecules such as VEGF, IL-8, IL-1, IL-6 and TNF-a. In our study, we compared the efficacy of coasting, short- and long-term supplementation of clarithromycin and cabergoline on correcting OHSS parameters in an experimental study. What do the results of this study add? As a result of our study, we found that OHSS parameters improved better in early prophylactic treatment regimens. We have shown that clarithromycin may be a more effective treatment agent than coasting and cabergoline. What are the implications of these findings for clinical practice and/or further research? Although our study is important in that it is the first pilot study to show that clarithromycin is effective in the treatment of OHSS, there is a need for larger clinical trials.
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Affiliation(s)
- Remzi Atilgan
- a Department of Obstetrics and Gynecology , Firat University School of Medicine , Elazig , Turkey
| | - Şehmus Pala
- a Department of Obstetrics and Gynecology , Firat University School of Medicine , Elazig , Turkey
| | - Şeyda Yavuzkır
- a Department of Obstetrics and Gynecology , Firat University School of Medicine , Elazig , Turkey
| | - Melike Başpınar
- a Department of Obstetrics and Gynecology , Firat University School of Medicine , Elazig , Turkey
| | - Mustafa Yılmaz
- b Department of Emergency Medicine , Firat University School of Medicine , Elazig , Turkey
| | - Nevin Ilhan
- c Department of Biochemistry , Firat University School of Medicine , Elazig , Turkey
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Kailasam C, Griffith H, Wilson P, Gordon U. The effect of early coasting on blastocyst development and outcome following blastocyst transfer in IVF/ICSI programme. JBRA Assist Reprod 2018; 22:301-306. [PMID: 30106541 PMCID: PMC6210612 DOI: 10.5935/1518-0557.20180053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective Coasting is a well-known strategy to decrease severity of Ovarian
Hyperstimulation Syndrome (OHSS). The purpose of this study is to assess the
effect of Coasting on blastocyst development and subsequent clinical outcome
following exclusive blastocyst transfer. Methods We conducted an observational cohort study of patients having blastocyst
transfer following IVF/ICSI treatment. Patients undergoing IVF/ICSI cycles
were included in the study. Patients at risk of OHSS were coasted. Outcome
following exclusive blastocyst transfer was compared between coasted and
non-coasted groups. The main outcome measures were the rate of blastocyst
development and live birth rates in coasted and non-coasted cycles. Within
coasted cycles, outcome was further analysed based on coasting duration and
serum estradiol (E2) drop (difference between peak E2
and E2 on day of HCG). Results A total of 166 coasted cycles and 656 non-coasted cycles had blastocyst
transfer. Blastocyst development (45.97% vs. 48.6%) and live birth rates
(45.18% vs. 43.44%) were not significantly different between coasted and
non-coasted cycles. The overall clinical pregnancy (54.21% vs. 49.08%) and
implantation rates (43.95% vs. 39.54%) following blastocyst transfer in
coasted cycles were not significantly different from those of non-coasted
cycles. Conclusion Coasting duration up to 6 days and drop in serum E2 levels did not
compromise blastocyst development, implantation, clinical pregnancy or live
birth rates. We conclude that coasting with subsequent blastocyst transfer
can be used as an effective strategy in patients at risk of OHSS with no
detrimental effects on blastocyst development or live birth outcome.
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Affiliation(s)
- Chandra Kailasam
- Bristol Centre for Reproductive Medicine Bristol United Kingdom Bristol Centre for Reproductive Medicine, Bristol, United Kingdom
| | - Heather Griffith
- Bristol Centre for Reproductive Medicine Bristol United Kingdom Bristol Centre for Reproductive Medicine, Bristol, United Kingdom
| | - Paul Wilson
- Bristol Centre for Reproductive Medicine Bristol United Kingdom Bristol Centre for Reproductive Medicine, Bristol, United Kingdom
| | - Uma Gordon
- Bristol Centre for Reproductive Medicine Bristol United Kingdom Bristol Centre for Reproductive Medicine, Bristol, United Kingdom
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Abide Yayla C, Ozkaya E, Beydilli Nacak G, Sanverdi I, Devranoglu B, Bostanci Ergen E, Kilicci C, Kutlu T. High estrogen exposure may not be detrimental on endometrial receptivity in women with PCOS. Gynecol Endocrinol 2018; 34:798-803. [PMID: 29658351 DOI: 10.1080/09513590.2018.1460344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The study aimed to assess the effect of high estrogen exposure and coasting on cycle outcome in women at risk for developing ovarian hyperstimulation syndrome (OHSS). Retrospective case-control study was conducted to figure out the outcomes of GnRH antagonist cycles in which women were at risk to develop OHSS. Women who underwent coasting (n = 100) were compared with a control group of women who did not undergo coasting (n = 287). Effect of endometrial estrogen exposure was determined by calculating area under curve of temporal estrogen measurements (AUCEM) through the cycle. Among 387 women with PCOS, 100 cases were required to undergo coasting to avoid OHSS. All participants reached to embryo transfer stage and clinical pregnancy rate was 44% in group with coasting whereas 39% in group without coasting (p > .05). AUCEM was a significant predictor for the cases who required coasting to avoid OHSS (AUC = 0.754, p < .001). Optimal cut off value was calculated to be 6762 with 71% sensitivity and 67% specificity. ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women with coasting (AUC = 0.496, p > .05). Consistently, ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women without coasting (AUC = 0.494, p > .05). In conclusion, neither coasting nor the high endometrial estrogen exposure was found to have detrimental effect on endometrial receptivity and cycle outcome in PCOS.
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Affiliation(s)
- Cigdem Abide Yayla
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Enis Ozkaya
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Gulay Beydilli Nacak
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Ilhan Sanverdi
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Belgin Devranoglu
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Evrim Bostanci Ergen
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Cetin Kilicci
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Tayfun Kutlu
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
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9
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Chen Y, Yang T, Hao C, Zhao J. A Retrospective Study of Letrozole Treatment Prior to Human Chorionic Gonadotropin in Women with Polycystic Ovary Syndrome Undergoing In Vitro Fertilization at Risk of Ovarian Hyperstimulation Syndrome. Med Sci Monit 2018; 24:4248-4253. [PMID: 29925074 PMCID: PMC6042308 DOI: 10.12659/msm.910743] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF) are given letrozole before a trigger injection of human chorionic gonadotropin (hCG) to lower estrogen (E2) levels, but can experience ovarian hyperstimulation syndrome (OHSS). The aim of this study was to evaluate the effect of oral letrozole, prior to administration of hCG, on the outcome of IVF and development of OHSS. Material/Methods Retrospective clinical review included 181 cases of women with PCOS who underwent IVF cycles with intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) (IVF/ICSI-ET). The day before the use of hCG, cases were divided into a letrozole-treated group (N=78) and a non-letrozole group (N=103). An oral dose of 2.5 mg qd of letrozole was given when the peak level of E2 was ≥4000 pg/ml during ovarian stimulation and ceased before the day of egg retrieval. Results The letrozole-treated group had a significant increase in the number of retrieved oocytes, viable embryos, and fresh ET rate (P>0.05); peak levels of E2, and E2 levels on the day of the egg retrieval, were significantly higher, and the fertilization rate was significantly lower (P<0.001). No significant differences were found in the rates of pregnancy, abortion, or ectopic pregnancy between the two groups (P>0.05). The incidence OHSS was lower in the letrozole-treated group, but this difference did not reach statistical significance (P>0.05). Conclusions Women with PCOS who underwent IVF, oral treatment with letrozole a day prior to treatment with hCG lowered E2 levels, but did not significantly reduce the incidence of OHSS.
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Affiliation(s)
- Yilu Chen
- Shandong University School of Medicine, Shandong, China (mainland).,Reproductive Center, Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Tanchu Yang
- Reproductive Center, Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Cuifang Hao
- Shandong University School of Medicine, Shandong, China (mainland).,Department of Assisted Reproduction, Yuhuangding Hospital, Yantai, Shandong, China (mainland)
| | - Junzhao Zhao
- Reproductive Center, Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
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Fu H, Sun J, Tan Y, Zhou H, Xu W, Zhou J, Chen D, Zhang C, Zhu X, Zhang Y, Wu X, Xi Z. Effects of acupuncture on the levels of serum estradiol and pituitary estrogen receptor beta in a rat model of induced super ovulation. Life Sci 2018; 197:109-113. [DOI: 10.1016/j.lfs.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/25/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
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11
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Bassiouny YA, Dakhly DMR, Bayoumi YA, Salaheldin NM, Gouda HM, Hassan AA. Randomized trial of combined cabergoline and coasting in preventing ovarian hyperstimulation syndrome during in vitro fertilization/intracytoplasmic sperm injection cycles. Int J Gynaecol Obstet 2017; 140:217-222. [PMID: 29055130 DOI: 10.1002/ijgo.12360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/16/2017] [Accepted: 10/20/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the efficacy of coasting alone, cabergoline alone, or combining both interventions for preventing ovarian hyperstimulation syndrome (OHSS) among high-risk patients undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycles. METHODS The present randomized controlled trial was conducted at the IVF unit of a university hospital in Cairo between October 28, 2013, and July 31, 2015. Patients undergoing IVF/ICSI considered at risk of OHSS were randomly allocated to coasting, cabergoline, or combined coasting and cabergoline. The primary outcome was the rate and degree of symptomatically assessed OHSS. Data were analyzed on a per-protocol basis. RESULTS There were 100 patients recruited to each group. The occurrence of early OHSS was lowest in the combination group compared with the other groups (P=0.002). CONCLUSION Combining coasting and cabergoline was associated with a lower OHSS rate compared with either therapy alone. CLINICALTRIALS.GOV: NCT01984320.
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Affiliation(s)
| | - Dina M R Dakhly
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Yomna A Bayoumi
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Noha M Salaheldin
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Hisham M Gouda
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Ayman A Hassan
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
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12
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İltemir Duvan ZC, Namlı Kalem M, Onaran Y, Aktepe Keskin E, Ayrım A, Pekel A, Kafalı H, Turhan N. The Effect of Coasting on Intracytoplasmic Sperm Injection Outcome in Antagonist and Agonist Cycle. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2017; 11:1-6. [PMID: 28367298 PMCID: PMC5215705 DOI: 10.22074/ijfs.2016.5144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 09/10/2016] [Indexed: 12/02/2022]
Abstract
Background Coasting can reduce the ovarian hyperstimulation syndrome (OHSS) risk
in ovulation induction cycles before intracytoplasmic sperm injection (ICSI). This study
aimed to investigate the effect of gonadotropin-releasing hormone (GnRH) agonist and
GnRH antagonist protocols to controlled ovarian hyperstimulation (COH) cycles with
coasting on the parameters of ICSI cycles and the outcome. Materials and Methods In a retrospective cohort study, 117 ICSI cycles were per-
formed and coasting was applied due to hyperresponse, between 2006 and 2011. The
ICSI outcomes after coasting were then compared between the GnRH agonist group
(n=91) and the GnRH antagonist group (n=26). Results The duration of induction and the total consumption of gonadotropins were
found to be similar. Estradiol (E2) levels on human chorionic gonadotropin (hCG) day
were found higher in the agonist group. Coasting days were similar when the two groups
were compared. The number of mature oocytes and the fertilization rates were similar in
both groups; however, the number of grade 1 (G1) embryos and the number of transferred
embryos were higher in the agonist group. Implantation rates were significantly higher
in the antagonist group compared to the agonist group. Pregnancy rates/embryo transfer
rates were higher in the antagonist group; however, this difference was not statistically
significant (32.8% for agonist group vs. 39.1% for antagonist group, P>0.05). Conclusion The present study showed that applying GnRH-agonist and GnRH-antago-
nist protocols to coasted cycles did not result in any differences in cycle parameters and
clinical pregnancy rates.
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Affiliation(s)
- Z Candan İltemir Duvan
- Department of Obstetrics and Gynaecology, School of Medicine, Turgut Ozal University, Ankara, Turkey
| | - Müberra Namlı Kalem
- Department of Obstetrics and Gynaecology, School of Medicine, Turgut Ozal University, Ankara, Turkey
| | - Yuksel Onaran
- Department of Obstetrics and Gynaecology, School of Medicine, Turgut Ozal University, Ankara, Turkey
| | - Esra Aktepe Keskin
- Department of Obstetrics and Gynaecology, School of Medicine, Turgut Ozal University, Ankara, Turkey
| | - Aylin Ayrım
- Department of Obstetrics and Gynaecology, School of Medicine, Turgut Ozal University, Ankara, Turkey
| | - Aslıhan Pekel
- Department of IVF-Embriology, School of Medicine, Turgut Ozal University, Ankara, Turkey
| | - Hasan Kafalı
- Department of Obstetrics and Gynaecology, School of Medicine, Turgut Ozal University, Ankara, Turkey; Department of Obstetrics and Gynaecology, School of Medicine, Gazi University, Ankara, Turkey
| | - Nilgün Turhan
- Department of Obstetrics and Gynaecology, School of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
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Madani T, Jahangiri N, Eftekhari-Yazdi P, Ashrafi M, Akhoond M. Is Coasting Valuable in All Patients with Any Cause of Infertility? Oman Med J 2016; 31:404-408. [PMID: 27974954 DOI: 10.5001/omj.2016.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to assess the influence of coasting duration on the number and quality of oocytes and fertilization rate in male factor infertile women and those with polycystic ovary syndrome (PCOS). METHODS In this prospective observational follow-up study, 114 patients undergoing coasting (53 women with male factor infertility and 61 women with PCOS) were evaluated at the Royan Institute Research Center, Iran, between 2010 and 2012. RESULTS The results were analyzed according to the coasting periods of 1-4 days. In normal females, the number of oocytes retrieved was significantly reduced after the second day (p = 0.004). In addition, a statistically significant drop was observed in the number of metaphase II oocytes and fertilization rate after the third day (p = 0.006 and p = 0.006, respectively). No significant differences were observed in the number and quality of oocytes retrieved and fertilization rate with regard to coasting days in PCOS patients. CONCLUSION Coasting with duration of more than three days should be performed with caution in normal females who are at risk of developing ovarian hyperstimulation syndrome.
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Affiliation(s)
- Tahereh Madani
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Nadia Jahangiri
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Poopak Eftekhari-Yazdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mahnaz Ashrafi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Department of Obstetrics and Gynecology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Akhoond
- Department of Statistics, Mathematical Sciences and Computer Faculty, Shahid Chamran University of Ahvaz, Ahvaz, Iran
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Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertil Steril 2016; 106:1634-1647. [PMID: 27678032 DOI: 10.1016/j.fertnstert.2016.08.048] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/15/2022]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is an uncommon but serious complication associated with assisted reproductive technology (ART). This systematic review aims to identify who is at high risk, how to prevent OHSS, and the treatment for existing OHSS.
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Fouda UM, Sayed AM, Elshaer HS, Hammad BEM, Shaban MM, Elsetohy KA, Youssef MA. GnRH antagonist rescue protocol combined with cabergoline versus cabergoline alone in the prevention of ovarian hyperstimulation syndrome: a randomized controlled trial. J Ovarian Res 2016; 9:29. [PMID: 27184139 PMCID: PMC4869387 DOI: 10.1186/s13048-016-0237-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to compare the efficacy of antagonist rescue protocol (replacing GnRH agonist with GnRH antagonist and reducing the dose of gonadotropins) combined with cabergoline versus cabergoline alone in the prevention of ovarian hyperstimulation syndrome (OHSS) in patients pretreated with GnRH agonist long protocol who were at high risk for OHSS. Methods Two hundred and thirty six patients were randomized in a 1:1 ratio to the cabergoline group or the antagonist rescue combined with cabergoline group. Both groups received oral cabergoline (0.5 mg/day) for eight days beginning on the day of HCG administration. In the antagonist rescue combined with cabergoline group, when the leading follicle reached 16 mm, GnRH agonist (triptorelin) was replaced with GnRH antagonist (cetrorelix acetate) and the dose of HP-uFSH was reduced to 75 IU/day. HCG (5,000 IU/I.M) was administered when the serum estradiol level dropped below 3500 pg/ml. The study was open label and the outcome assessors (laboratory staff and the doctor who performed oocyte retrieval) were blind to treatment allocation. Results The incidence of moderate/severe OHSS was significantly lower in the antagonist rescue combined with cabergoline group [5.08 % Vs 13.56 %, P value =0.025, OR = 0.342, 95 % CI, 0.129–0.906]. Four cycles were cancelled in the cabergoline group. There were no significant differences between the groups with respect to the number of retrieved oocytes, metaphase II oocytes, high quality embryos and fertilization rate. Moreover, the implantation and pregnancy rates were comparable between both groups. Conclusion GnRH antagonist rescue protocol combined with cabergoline is more effective than cabergoline alone in the prevention of OHSS. Trial registration Clinical trial.gov (NCT02461875).
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Affiliation(s)
- Usama M Fouda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Al-Ainy Hospital, Al-Saraya Street, Cairo, Egypt.
| | - Ahmed M Sayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Al-Ainy Hospital, Al-Saraya Street, Cairo, Egypt
| | - Hesham S Elshaer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Al-Ainy Hospital, Al-Saraya Street, Cairo, Egypt
| | - Bahaa Eldin M Hammad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Al-Ainy Hospital, Al-Saraya Street, Cairo, Egypt
| | - Mona M Shaban
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Al-Ainy Hospital, Al-Saraya Street, Cairo, Egypt
| | - Khaled A Elsetohy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Al-Ainy Hospital, Al-Saraya Street, Cairo, Egypt
| | - Mohamed A Youssef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Al-Ainy Hospital, Al-Saraya Street, Cairo, Egypt
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Wang YQ, Luo J, Xu WM, Xie QZ, Yan WJ, Wu GX, Yang J. Can steroidal ovarian suppression during the luteal phase after oocyte retrieval reduce the risk of severe OHSS? J Ovarian Res 2015; 8:63. [PMID: 26400057 PMCID: PMC4579791 DOI: 10.1186/s13048-015-0190-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 09/12/2015] [Indexed: 06/16/2024] Open
Abstract
Background Ovarian stimulation in IVF cycle results in luteal supraphysiological steroid concentrations especially for high response patients. The aim of this study was to evaluate the efficacy of ovarian steroid hormone suppression in luteal phase after oocyte retrieval for preventing severe ovarian hyperstimulation syndrome (OHSS) in high-risk patients with embryo cryopreservation. Methods 281 patients with high risk of OHSS were enrolled in this study among 4735 infertile women undergoing their first IVF treatment. The subjects were allocated into treatment and control group. The treatment group (n = 161) received letrozole (n = 43), mifepristone (n = 51), cetrotide (n = 39) and three-drug combinations (n = 28) during the luteal phase after oocyte retrieval, respectively. The control group (n = 120) received no medicine. Fertilization rate, good embryo rate, serum steroid concentration, clinical outcome, and incidence of severe OHSS were compared between the two groups. Results On days 2, 5 and 8 after oocyte retrieval, serum estradiol levels in the letrozole and three-drug combination therapy group were significantly lower than in the other three groups at the same time (P < 0.001, respectively). There were no significantly difference of serum luteinizing hormone concentration on days 2, 5 and 8 and progesterone concentration on day 8 after oocyte retreival among the five groups (P > 0.05, respectively). Compared with the control group, the incidence of severe OHSS, the paracentesis rate, the duration of hospitalization and the days of luteal phase in each subgroup of treatment groups was not significantly decreased (P > 0.05, respectively). Conclusions Our findings indicate that steroidal ovarian suppression in luteal phase after oocyte retrieval seems to be unable to prevent severe OHSS in high-risk patients with embryo cryopreservation.
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Affiliation(s)
- Ya-Qin Wang
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
| | - Jin Luo
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
| | - Wang-Min Xu
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
| | - Qin-Zhen Xie
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
| | - Wen-Jie Yan
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
| | - Geng-Xiang Wu
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
| | - Jin Yang
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
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Pratap D, Kumar P, Adiga SK. Advancing or postponing the day of human chorionic gonadotropin does not matter for the outcome in assisted reproductive technology. J Hum Reprod Sci 2014; 7:107-10. [PMID: 25191023 PMCID: PMC4150136 DOI: 10.4103/0974-1208.138868] [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] [Received: 09/02/2013] [Revised: 11/06/2013] [Accepted: 05/26/2014] [Indexed: 11/18/2022] Open
Abstract
CONTEXT: The primary outcome is to remove the worry of getting immature oocytes with early administration of human chorionic gonadotropin (hCG). AIM: The aim was to find out the association between the day of hCG administration and follicular response in relation to the number and maturity of oocytes, and fertilization rate in assisted reproduction to avoid weekend oocyte recovery (OR). SETTINGS AND DESIGN: Retrospective study was carried out in the university infertility clinic. MATERIALS AND METHOD: Controlled ovarian hyperstimulation (COH) in 94 patients undergoing assisted reproductive technology (2010-2011) with recombinant follicle stimulating hormone and timely gonadotropin-releasing hormone antagonist were analyzed regarding day of hCG from day 8-11. Oocyte maturity and fertilization was analyzed and correlated with the day of hCG administration. STATISTICAL ANALYSIS: Kruskal–Wallis test. RESULTS: The average number of >18 mm follicles observed from day 8-11 of hCG administration was not statistically different. However, the OR rate (54.2%), number of mature oocytes (92.5%), and fertilization rate (78.5%) was maximum in the patients where hCG was administered on day 8 of COH. CONCLUSIONS: The day of hCG administration between 8 and 11 does not affect the OR rate significantly although the number of oocytes recovered on day 8 are marginally higher compared with day 9-11. Hence, it is possible to safely avoid weekend oocyte retrieval, by delaying or advancing hCG administration without compromising the outcome.
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Affiliation(s)
- Deepika Pratap
- Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Pratap Kumar
- Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Satish Kumar Adiga
- Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Yumuşak ÖH, Kahyaoğlu S, Özgü Erdinç AS, Yılmaz S, Engin Üstün Y, Yılmaz N. Does the serum E2 level change following coasting treatment strategy to prevent ovarian hyperstimulation syndrome impact cycle outcomes during controlled ovarian hyperstimulation and in vitro fertilization procedure? Turk J Obstet Gynecol 2014; 11:159-164. [PMID: 28913010 PMCID: PMC5558327 DOI: 10.4274/tjod.48751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/23/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Ovarian hyperstimulation syndrome (OHSS) remains as a clinical problem for hyperresponder patients during controlled ovarian hyperstimulation and in vitro fertilization (COH-IVF) procedure. Herein, we aimed to evaluate the COH-IVF outcomes in hyperresponder patients managed with coasting treatment strategy for OHSS prevention regarding the establishment of clinical pregnancy as an endpoint of the treatment cycle. MATERIALS AND METHODS The medical records related to the COH-IVF outcome in 119 hyperresponder patients who have exhibited a serum estradiol level greater than or equal to 3000 pg/mL were evaluated. The study was conducted on a total of 119 patients, 98 of whom have been treated by coasting or coasting with GnRH antagonist co-treatment strategies, while the remaining 21 women (control group) have not been managed with coasting treatment. The COH and IVF-ET outcomes in the 119 patients were compared based on the coasting treatment situation. RESULTS Among the women who received coasting treatment, the number of patients demonstrating E2 level decrement and also E2 level decrement rate after coasting were similar between patients with and without clinical pregnancy. Total gonadotropin dose, 2PN number, embryo number, and fertilization rate were significantly higher in the patients with a clinical pregnancy. CONCLUSION The coasting treatment is a clinically useful preventive strategy for OHSS avoidance. GnRH antagonist co-treatment decreases the duration of coasting although any detrimental or ameliorating impact of this effect on pregnancy rates have not been seen. The E2 level decrement or increment following coasting treatment seems not to be related to cycle outcomes.
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Affiliation(s)
- Ömer Hamid Yumuşak
- Zekai Tahir Burak Women’s Health Education and Research Hospital, Clinic of Reproductive Endocrinology, Ankara, Turkey
| | - Serkan Kahyaoğlu
- Zekai Tahir Burak Women’s Health Education and Research Hospital, Clinic of Reproductive Endocrinology, Ankara, Turkey
| | - Ayşe Seval Özgü Erdinç
- Zekai Tahir Burak Women’s Health Education and Research Hospital, Clinic of Reproductive Endocrinology, Ankara, Turkey
| | - Saynur Yılmaz
- Zübeyde Hanım Women’s Health Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Yaprak Engin Üstün
- Bozok University Faculty of Medicine, Department of Obstetrics and Gynecology, Yozgat, Turkey
| | - Nafiye Yılmaz
- Zekai Tahir Burak Women’s Health Education and Research Hospital, Clinic of Reproductive Endocrinology, Ankara, Turkey
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Xu CK, Tang SB. Alteration of endometrial receptivity in rats with ovarian hyperstimulation syndrome. J OBSTET GYNAECOL 2014; 34:146-52. [DOI: 10.3109/01443615.2013.832735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Assisted reproductive technologies (ART) encompass fertility treatments, which involve manipulations of both oocyte and sperm in vitro. This chapter provides a brief overview of ART, including indications for treatment, ovarian reserve testing, selection of controlled ovarian hyperstimulation (COH) protocols, laboratory techniques of ART including in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), embryo transfer techniques, and luteal phase support. This chapter also discusses potential complications of ART, namely ovarian hyperstimulation syndrome (OHSS) and multiple gestations, and the perinatal outcomes of ART.
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Datta AK, Zosmer A, Tozer A, Sabatini L, Davis C, Al-Shawaf T. Can the fall in serum FSH during coasting in IVF/ICSI predict clinical outcomes? Reprod Biomed Online 2012; 24:503-10. [DOI: 10.1016/j.rbmo.2012.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 02/06/2012] [Accepted: 02/07/2012] [Indexed: 11/29/2022]
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Al-Hussaini TK. OHSS-free IVF practice: Dream or reality. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2012. [DOI: 10.1016/j.mefs.2012.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Vitthala S, Bouaziz J, Tozer A, Zosmer A, Al-Shawaf T. Serum FSH Levels in Coasting Programmes on the hCG Day and Their Clinical Outcomes in IVF ± ICSI Cycles. Int J Endocrinol 2012; 2012:540681. [PMID: 22518127 PMCID: PMC3296177 DOI: 10.1155/2012/540681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/12/2011] [Accepted: 10/17/2011] [Indexed: 11/17/2022] Open
Abstract
Introduction. Coasting is the most commonly used strategy in prevention of severe OHSS. Serum FSH levels measurements during coasting may aid in optimizing the duration of coasting. Objective(s). To study live birth rates (LBRs), clinical pregnancy rates (CPRs), and optimal duration of coasting based on serum FSH levels on the hCG day. Materials and Methods. It is a retrospective study performed between 2005 and 2008 at Barts and The London Centre for Reproductive Medicine, NHS Trust, London, UK, on 349-coasted women undergoing controlled ovarian stimulation (COS) for IVF ± ICSI. The serum FSH level measurements on the hCG day during coasting programme were analysed to predict the LBR and CPR. Result(s). LBR and CPR were significantly higher when the FSH levels on the hCG day were >2.5 IU/L (LBR: 32.5%, P = 0.045 and CPR: 36.9%, P = 0.027) compared to FSH <2.5 IU/L. The optimal FSH cut-off level for LBR and CPR is 5.6 IU/L on the hCG day. The optimal cutoff for coasting is 4 days. Conclusion(s). Coasting may be continued as long as either serum FSH level is > 2.5 IU/L on the hCG day without compromising the LBR and CPR or to maximum of 4 days.
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Affiliation(s)
- Srisailesh Vitthala
- Kamineni Fertility Centre, Kamineni Hospitals, King Koti, Hyderabad 500001, India
- *Srisailesh Vitthala:
| | - Jerome Bouaziz
- Services of Gynecology and Obstetrics-Reproduction, The Bow Hospital, Chu de Nice, Route Saint Anton, 06200 Nice, France
| | - Amanda Tozer
- Centre for Reproductive Medicine-Barts and The London NHS Trust, London EC 1A 7BE, UK
| | - Ariel Zosmer
- Centre for Reproductive Medicine-Barts and The London NHS Trust, London EC 1A 7BE, UK
| | - Talha Al-Shawaf
- Centre for Reproductive Medicine-Barts and The London NHS Trust, London EC 1A 7BE, UK
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Kumar P, Sait SF, Sharma A, Kumar M. Ovarian hyperstimulation syndrome. J Hum Reprod Sci 2011; 4:70-5. [PMID: 22065820 PMCID: PMC3205536 DOI: 10.4103/0974-1208.86080] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 06/01/2011] [Accepted: 06/04/2011] [Indexed: 11/04/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology. The syndrome is characterized by cystic enlargement of the ovaries and a fluid shift from the intravascular to the third space due to increased capillary permeability and ovarian neoangiogenesis. Its occurrence is dependent on the administration of human chorionic gonadotrophin (hCG). β-hCG and its analogs, estrogen, estradiol, prolactin, histamine and prostaglandins have all been implicated in OHSS but now it is increasingly better understood that the vasoactivesubstances such as interleukins, tumor necrosis factor-α, endothelin-1, and vascular endothelial growth factor (VEGF) secreted by the ovaries have been implicated in increasing vascular permeability. Enlargement of the ovaries causes abdominal pain, nausea and vomiting. Leakage of fluid from follicles, increased capillary permeability leading to third spacing (due to the release of vasoactive substances), or frank rupture of follicles can all cause ascites. Due to leakage of fluid through the impaired blood vessels both within and outside the ovary there is massive fluid-shift from the intra-vescular bed to the third compartment results in intravascular hypovolemia with concomitant development of edema, ascites, hydrothorax and/or hydropericardium. Low-dose gonadotrophin protocols have been implemented to reduce the risks of fertility treatment in polycystic ovary syndrome patients. Prophylactic albumin administration may interrupt the development of OHSS by increasing the plasma oncotic pressure and binding mediators of ovarian origin. OHSS is significantly lower in an antagonist protocol than in an agonist protocol. Cabergoline inhibits partially the VEGF receptor 2 phosphorylation levels and associated vascular permeability without affecting luteal angiogenesis reduces the 'early' (within the first 9 days after hCG) onset of OHSS. To prevent thrombosis, subcutaneous heparin 5000-7500 U/d is begun on the first day of admission. These patients need a hospital ward where the clinical picture is well understood and the personnel have expertise in its treatment and follow-up. Admission to an intensive care unit is necessary when critical OHSS develops.
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Affiliation(s)
- Pratap Kumar
- Departments of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Mohamed AM, Chouliaras S, Jones CJ, Nardo LG. Live birth rate in fresh and frozen embryo transfer cycles in women with endometriosis. Eur J Obstet Gynecol Reprod Biol 2011; 156:177-80. [DOI: 10.1016/j.ejogrb.2011.01.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 12/22/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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Sansone P, Aurilio C, Pace MC, Esposito R, Passavanti MB, Pota V, Pace L, Pezzullo MG, Bulletti C, Palagiano A. Intensive care treatment of ovarian hyperstimulation syndrome (OHSS). Ann N Y Acad Sci 2011; 1221:109-18. [DOI: 10.1111/j.1749-6632.2011.05983.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tsoumpou I, Mohamed AM, Tower C, Roberts SA, Nardo LG. Failed IVF cycles and the risk of subsequent preeclampsia or fetal growth restriction: a case-control exploratory study. Fertil Steril 2011; 95:973-8. [DOI: 10.1016/j.fertnstert.2010.07.1053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 07/08/2010] [Accepted: 07/09/2010] [Indexed: 11/26/2022]
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The effect of duration of coasting and estradiol drop on the outcome of assisted reproduction: 13 years of experience in 1,068 coasted cycles to prevent ovarian hyperstimulation. Fertil Steril 2010; 94:1757-63. [DOI: 10.1016/j.fertnstert.2009.09.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 09/27/2009] [Accepted: 09/29/2009] [Indexed: 11/22/2022]
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Nastri CO, Ferriani RA, Rocha IA, Martins WP. Ovarian hyperstimulation syndrome: pathophysiology and prevention. J Assist Reprod Genet 2010; 27:121-8. [PMID: 20140640 DOI: 10.1007/s10815-010-9387-6] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 01/11/2010] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To review and discuss the pathophysiology and prevention strategies for ovarian hyperstimulation syndrome (OHSS), which is a condition that may occur in up to 20% of the high risk women submitted to assisted reproductive technology cycles. METHODS The English language literature on these topics were reviewed through PubMed and discussed with emphasis on recent data. RESULTS The role of estradiol, luteinizing hormone, human chorionic gonadotropin (hCG), inflammatory mediators, the renin-angiotensin system and vascular endothelial growth factor is discussed in the pathophysiology of OHSS. In addition we consider the prevention strategies, including coasting, administration of albumin, renin-angiotensin system blockage, dopamine agonist administration, non-steroidal anti-inflammatory administration, GnRH antagonist protocols, reducing hCG dosage, replacement of hCG and in vitro maturation of oocytes (IVM). CONCLUSIONS Among the many prevention strategies that have been discussed, the current evidence points to the replacement of hCG by GnRH agonists in antagonist cycles and the performance of IVM procedures as the safest approaches.
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Affiliation(s)
- Carolina O Nastri
- Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (DGO-HC-FMRP-USP), Avenida dos Bandeirantes 3900, 8 masculine andar, Ribeirão Preto, São Paulo, Brazil, CEP 14049-900
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Devroey P, Fauser BCJM, Diedrich K. Approaches to improve the diagnosis and management of infertility. Hum Reprod Update 2009; 15:391-408. [PMID: 19380415 PMCID: PMC2691653 DOI: 10.1093/humupd/dmp012] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 02/19/2009] [Accepted: 03/18/2009] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 26-27 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts. METHODS Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge. RESULTS It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches. CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.
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Affiliation(s)
- P Devroey
- Center of Reproductive Medicine, Free University Brussels, Laarbeeklaan 101, Brussels 1090, Belgium.
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Yilmaz N, Uygur D, Ozgu E, Batioglu S. Does coasting, a procedure to avoid ovarian hyperstimulation syndrome, affect assisted reproduction cycle outcome? Fertil Steril 2009; 94:189-93. [PMID: 19376515 DOI: 10.1016/j.fertnstert.2009.02.090] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 02/08/2009] [Accepted: 02/27/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effects of coasting (withdrawing gonadotropin administration) on IVF outcome. DESIGN Retrospective study. SETTING Department of Infertility of Zekai Tahir Burak Women's Health Research and Education Hospital. PATIENT(S) Ninety-four patients in whom coasting was applied (group 1). One control group consisted of 22 patients in whom coasting was not applied despite E(2) > 3000 pg/mL (group 2). A control group consisted of 111 normally responsive patients with peak E(2) < 3000 pg/mL level (group 3). INTERVENTION(S) When E(2) levels were greater than 3000 pg/mL in the presence of at least 20 follicles, each measuring >or=10 mm in diameter with >or=20% of them of diameter >or=15 mm, recombinant FSH administration was discontinued while GnRH agonist was maintained. MAIN OUTCOME MEASURE(S) Hormonal characteristics, IVF outcome, OHSS in coasted and noncoasted groups. RESULT(S) There was no statistically significant difference between number of total oocytes retrieved, metaphase II oocytes, and fertilization rates among the group 1 vs. group 2. However, the implantation rates and pregnancy rates were significantly higher in group 1 compared with group 2. Group 1 had more total oocytes retrieved and metaphase II oocytes compared with group 3. However, there was no significant difference in implantation and pregnancy rates between groups 1 and 3. CONCLUSION(S) Coasting does not adversely affect assisted reproductive technology outcome and can be applied safely to high responder patients in ICSI.
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Affiliation(s)
- Nafiye Yilmaz
- Department of Infertility, Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey.
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Robinson S, Pemberton P, Laing I, Nardo LG. Low grade inflammation, as evidenced by basal high sensitivity CRP, is not correlated to outcome measures in IVF. J Assist Reprod Genet 2008; 25:383-8. [PMID: 18810632 DOI: 10.1007/s10815-008-9253-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To assess the relationship between low-grade inflammation, measured as basal high sensitivity (hs)-CRP, and IVF outcome. METHODS We recruited a total of 220 women undergoing infertility work up prior to IVF. Patients were selected for a BMI < 30 kg/m(2) with an upper age limit of 40 years. Serum hs-CRP levels were measured on day 3 of a spontaneous menstrual cycle preceding ovarian stimulation. A sensitive two-site ELISA was used for analysis. Dose of gonadotrophins required, follicles days 8 and 10, number of oocytes collected, number of oocytes fertilised and pregnancy outcome were recorded. RESULTS Median hs-CRP was 1.08 mg/L (0.43-3.00 mg/L). The hs-CRP was significantly related to BMI (r = 0.386, P < .001) but not to age and smoking habit. There were no significant relationships between basal hs-CRP and any of the measured IVF outcomes. CONCLUSIONS These findings demonstrate that serum hs-CRP concentration is not a predictive marker of cycle or pregnancy outcome in women undergoing IVF treatment.
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Affiliation(s)
- Sarah Robinson
- Department of Clinical Biochemistry, Manchester Royal Infirmary, Manchester, UK
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