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Zhou J, Chen Y, Bai L, Zhou W, Yang H, Chen Y, Chen L, Lu R, Hu L, Wang S. Ovarian Hyperstimulation syndrome combined with hypothyroidism: a comprehensive review. J Ovarian Res 2024; 17:98. [PMID: 38725001 PMCID: PMC11084021 DOI: 10.1186/s13048-024-01406-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
Ovarian Hyperstimulation Syndrome (OHSS) is a systemic condition marked by the enlargement of the ovaries and heightened vascular permeability. And hypothyroidism (HT) emerges as a potential risk factor for OHSS occurrence. This review presented a comprehensive summary of pertinent case reports involving patients diagnosed with both HT and OHSS. Detailed exploration was conducted into their clinical presentations, diagnostic methodologies, and treatment modalities. Additionally, the review delved into potential interaction mechanisms between HT and OHSS, encompassing various aspects including hormone levels. Moreover, management strategies for mitigating the risk of OHSS in HT patients were thoroughly reviewed and the importance of monitoring thyroid function in those experiencing OHSS was emphasized. This review indicated that the association between HT and OHSS, underscoring its multifaceted complexity. It could accentuate the ongoing necessity for rigorous research and clinical refinement to deepen our comprehension of this association and to bolster diagnostic and therapeutic methodologies for optimal patient care. In conclusion, this review offered valuable insights for future research directions and clinical practices for patients afflicted with OHSS and HT.
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Affiliation(s)
- Jing Zhou
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Yu Chen
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Lijing Bai
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Wei Zhou
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Haiyan Yang
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Yang Chen
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Li Chen
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Renjie Lu
- Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
- Changzhou Institute for Advanced Study of Public Health, Nanjing Medical University, Nanjing, 210000, Jiangsu, China
| | - Lingmin Hu
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China.
| | - Shuxian Wang
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China.
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Santistevan L, Lonergan D, Eyvazzadeh AD. First case report of serous otitis media as a complication of severe ovarian hyperstimulation syndrome: Case report and literature review. Int J Gynaecol Obstet 2024; 164:843-847. [PMID: 37525483 DOI: 10.1002/ijgo.15022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/26/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023]
Abstract
Ovarian hyperstimulation syndrome (OHSS) may be a severe complication of controlled ovarian hyperstimulation during assisted reproductive technology. During OHSS, fluid shifts from the intravascular space to the third-space compartments as the result of an increase in capillary permeability. This can cause fluid accumulation in peritoneal as well as thoracic cavities. The patient presented with symptoms of severe OHSS (bilateral hydrothorax and pulmonary effusion), requiring bilateral ultrasound-guided paracentesis and bilateral thoracentesis during her Emergency Room visits and hospitalization. Due to distant effects from the increased capillary permeability, the patient presented fluid in the middle ear, which led to the development of serous otitis media 12 days after egg retrieval. This was resolved 2-3 weeks later after being treated with antihistamines and antibiotics given by her Ear, Nose, and Throat doctor. OHSS risk may be reduced by continuous monitoring of patients undergoing ovulation induction, using an appropriate gonadotropin dosage, and using additional agents known to decrease its risk. If OHSS still occurs, symptomatic treatment and a multidisciplinary team of professionals may be needed to prevent fluid build-up complications. In contrast to many published articles about OHSS and its complications, this is the first case report of a patient presenting serous otitis media as a complication of severe OHSS.
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Affiliation(s)
| | - Devin Lonergan
- San Ramon Regional Medical Center, San Ramon, California, USA
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Leal CRV, Zanolla K, Spritzer PM, Reis FM. Assisted Reproductive Technology in the Presence of Polycystic Ovary Syndrome: Current Evidence and Knowledge Gaps. Endocr Pract 2024; 30:64-69. [PMID: 37708997 DOI: 10.1016/j.eprac.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/02/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE In this narrative review, we discuss the current evidence as well as the knowledge gaps concerning assisted reproductive technology (ART) indications, protocols, and results in the presence of polycystic ovary syndrome (PCOS). METHODS An electronic literature search was performed for English-language publications in the last decade in databases such as PubMed, Medline, the Web of Sciences, Embase, and Scopus. RESULTS We found evidence that ovarian steroidogenesis and folliculogenesis are deeply altered by PCOS; however, the oocyte quality and pregnancy rates after ART are not affected. Patients with PCOS are more sensitive to the action of exogenous gonadotropins and more likely to develop ovarian hyperstimulation syndrome. This risk can be mitigated by the adoption of the gonadotropin-releasing hormone antagonist protocols for pituitary blockade and ovarian stimulation, along with frozen embryo transfer, without compromising the odds of achieving a live birth. Pregnancy complications, such as miscarriage, gestational diabetes, preeclampsia, and very preterm birth, are more frequent in the presence of PCOS, requiring more intense prenatal care. It remains uncertain whether weight reduction or insulin sensitizers used before ART are beneficial for the treatment outcomes. CONCLUSION Although PCOS is not a drawback for ART treatments, the patients need special care to avoid complications. More in-depth studies are needed to uncover the mechanisms of follicular growth, gamete maturation, and endometrial differentiation during ART procedures in the presence of PCOS.
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Affiliation(s)
- Caio R V Leal
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Karla Zanolla
- Department of Medicine, Universidade Federal de Lavras, Lavras, Brazil
| | - Poli Mara Spritzer
- Department of Physiology and Postgraduate Program in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Gynecological Endocrinology Unit, Endocrine Division, Hospital de Clínicas de Porto, Alegre, Porto Alegre, Brazil
| | - Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Qi Q, Xia Y, Luo J, Wang Y, Xie Q. Cocktail treatment by GnRH-antagonist, letrozole, and mifepristone for the prevention of ovarian hyperstimulation syndrome: a prospective randomized trial. Gynecol Endocrinol 2023; 39:2269281. [PMID: 37844908 DOI: 10.1080/09513590.2023.2269281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE This study is aimed to determine the efficacy of a cocktail style treatment by combining GnRH-antagonist, letrozole, and mifepristone on the prevention of ovarian hyperstimulation syndrome (OHSS) in high-risk women. METHODS This prospective, randomized controlled clinical trial was performed between January 2018 and December 2018. A total of 170 women who identified as high risk of OHSS during the ovarian hyperstimulation and underwent cryopreservation of whole embryos. On the day of oocyte retrieval, the combination group received 0.25 mg Cetrorelix for 3 d, 5 mg letrozole for 5 d, and 50 mg mifepristone for 3 d, the mifepristone group received 50 mg mifepristone for 3 d. A total of 156 cases were included in final analysis. All the frozen embryo transfer (FET) cycles were followed up until December 2021. RESULTS The combination group showed significantly decreased incidence of moderate and severe OHSS than mifepristone group (20.5% vs. 42.3%), with remarkably reduced serum estradiol level on hCG + 3 and + 5 d, decreased ovarian diameter, and shortened luteal phase. Oocyte retrieval number, levels of estradiol on hCG + 0 and VEGF, and ovarian diameter on hCG + 5 were associated with the severity of the symptoms. There was no significant difference in cumulative live birth rates (LBRs) between the combination and mifepristone group (74.4% vs. 76.9%). CONCLUSIONS The combination treatment effectively reduces the incidence of moderate/severe OHSS in high-risk women.
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Affiliation(s)
- Qianrong Qi
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Yi Xia
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Jin Luo
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Yaqin Wang
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Qingzhen Xie
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
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Gökçay Canpolat A, Aslan B, Şükür YE. A promising treatment for spontaneous ovarian hyperstimulation syndrome due to familial partial lipodystrophy: GnRH analogs combined with cyst aspiration. Hormones (Athens) 2023; 22:741-745. [PMID: 37491654 DOI: 10.1007/s42000-023-00469-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 07/14/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE To present a patient with familial partial lipodystrophy (FPLD) and polycystic ovary syndrome (PCOS) who was admitted with spontaneous ovarian hyperstimulation syndrome (OHSS)-like extremely enlarged ovaries, which was successfully treated using gonadotropin-releasing hormone analogs and abdominal cyst aspiration in combination. METHOD This is a descriptive case report of a single patient with FPLD and PCOS. RESULTS Clinical improvement was achieved 6 months after therapy besides progressive reduction in total testosterone and DHEAS. Furthermore, there was a significant improvement in hyperinsulinemia and hypertriglyceridemia. Additionally, reduction in the size of ovarian cysts, reduction in the size and number of localizations of acanthosis nigricans, reduction in scores of mFGS, and weight loss were also observed. CONCLUSION Although there are few reports in the literature describing the association between PCOS with FPLD, management of this novel spontaneous OHSS-like condition has not yet been clearly defined. In the case of extremely enlarged multicystic ovaries and severe hyperandrogenemia, GnRH analogs may be considered to prevent ovarian enlargement and reduce hyperandrogenemia, especially when other treatment options are inappropriate.
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Affiliation(s)
- Asena Gökçay Canpolat
- Department of Endocrinology and Metabolism, Ankara University School of Medicine, Ankara, Turkey.
| | - Batuhan Aslan
- Department of Obstetrics and Gynaecology, Ankara University School of Medicine, Ankara, Turkey
| | - Yavuz Emre Şükür
- Department of Obstetrics and Gynaecology, Ankara University School of Medicine, Ankara, Turkey
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Cheung CTD, Jayasekara M, Hussain M, Raman N. Synchronous bilateral ovarian torsion followed by recurrent unilateral torsion in a patient undergoing fertility treatment: A case report and literature review. Eur J Obstet Gynecol Reprod Biol 2023; 290:60-66. [PMID: 37734139 DOI: 10.1016/j.ejogrb.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Ovarian torsion (OT) is a gynaecological emergency and requires prompt recognition and treatment in order to prevent the loss of ovarian function. Patients who are undergoing fertility treatment are at an increased risk of developing OT. OBJECTIVE The diagnosis of OT in patients undergoing fertility treatment can be challenging as they often present with abdominal pain and other non-specific symptoms. We highlight the importance of early diagnosis of suspected torsion and performed a literature review on cases of bilateral OT to review its presentation, investigation, and subsequent management. CASE REPORT A 32-year-old nulliparous woman who was undergoing controlled ovarian stimulation presented with lower abdominal pain and was initially managed as ovarian hyperstimulation syndrome (OHSS). Her pain did not subside following conservative management and she proceeded to have a laparoscopy which demonstrated synchronous bilateral ovarian torsion (SBOT), both ovaries were detorted. Eight months later, she was preparing for her frozen embryo transfer (FET) cycle, patient again presented with significant right sided abdominal pain and was found to have a recurrent torsion of the right ovary which was again detorted successfully. CONCLUSIONS Clinicians should have a low-threshold to investigate and rule out OT in patients who present with lower abdominal pain, especially in those with additional risk factors for torsion. Patients with confirmed torsion can be successfully managed with detorsion of the ovaries. Further research is needed to determine the best management option for patients with recurrent torsion episodes.
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Affiliation(s)
- Candice Tien-da Cheung
- Department of Obstetrics and Gynaecology, Southend University Hospital, Prittlewell Chase, Westcliff-on-sea, Southend-on-Sea, SS0 0RY, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, PE29 6NT England, UK.
| | - Matthew Jayasekara
- University of Cambridge School of Clinical Medicine, Box 111, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK.
| | - Munawar Hussain
- Department of Obstetrics and Gynaecology, Southend University Hospital, Prittlewell Chase, Westcliff-on-sea, Southend-on-Sea SS0 0RY, UK.
| | - Narayanaswamy Raman
- Department of Obstetrics and Gynaecology, Southend University Hospital, Prittlewell Chase, Westcliff-on-sea, Southend-on-Sea SS0 0RY, UK.
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Fan T, Ma L. Ovarian hyperstimulation syndrome with carotid artery dissection and cerebral infarction: a case report. BMC Womens Health 2023; 23:500. [PMID: 37726717 PMCID: PMC10510232 DOI: 10.1186/s12905-023-02644-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND AND PURPOSE Ovarian hyperstimulation syndrome (OHSS) is one of the most serious iatrogenic complications in assisted reproductive technology, which seem rarely associated with cerebrovascular diseases. We reported a patient diagnosed with OHSS combined with carotid artery dissection and massive cerebral infarction. CASE PRESENTATION We reported a unique case of a 31-year-old woman who experienced abdominal pain, blurred consciousness, and speech inability after 15-day continuous injection of human gonadotropin for infertility. Imaging examination showed hyperacute cerebral infarction in the left frontotemporal island parietal lobe and left internal carotid artery dissection. After therapeutic use of low-molecular-weight heparin calcium anticoagulation and other conventional cerebrovascular treatments, she eventually achieved a good prognosis. CONCLUSIONS OHSS seemd rarely associated with cerebrovascular diseases, such as infarction and carotid artery dissection. Encountering abdominal symptoms combined with neurologic symptoms, a detailed history and a thorough examination are essential. It is necessary to comprehensively analyze the pathogenesis and formulate individualized therapy according to the specific conditions of patients.
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Affiliation(s)
- Tianhua Fan
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Liansheng Ma
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
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Marin L, Ambrosini G, Nuzzi L, Buzzaccarini G, Esposito F, Capobianco G, Chiantera V, Laganà AS, Andrisani A. Intrahepatic cholestasis of pregnancy after ovarian hyperstimulation syndrome with wild-type ABCB4 gene: a peculiar case and literature review. BMC Womens Health 2023; 23:316. [PMID: 37330509 PMCID: PMC10276903 DOI: 10.1186/s12905-023-02471-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 06/12/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) in the first trimester occurring after ovarian hyperstimulation syndrome (OHSS) is a rare condition and few cases are reported in the literature. Hyperestrogenism may explain this problem in genetically predisposed women. The objective of this article is to report one of these rare cases and offer an overview of the other published cases. CASE PRESENTATION We report a case of severe OHSS followed by ICP in the first trimester. The patient was admitted to the intensive care unit and was treated according to the guidelines for the management of OHSS. Moreover, the patient also received ursodeoxycholic acid for ICP, which brought to an improvement of her clinical conditions. The pregnancy continued without other complications until the 36th week of gestation, when the patient developed ICP in the third trimester and underwent cesarean section for increased bile acid levels and cardiotocographic (CTG) pathologic alterations. The newborn was a healthy baby weighing 2500 gr. We also reviewed other case reports published by other authors about this clinical condition. We present what is, to our knowledge, the first case of ICP developed in the first trimester of pregnancy after OHSS in which genetic polymorphisms of ABCB4 (MDR3) have been investigated. CONCLUSIONS ICP in the first trimester might be induced by elevated serum estrogen levels after OHSS in genetically predisposed women. In these women, it might be useful to check for genetic polymorphisms to know if they have a predisposition for ICP recurrence in the third trimester of pregnancy.
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Affiliation(s)
- Loris Marin
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Guido Ambrosini
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Ludovica Nuzzi
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Giovanni Buzzaccarini
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Esposito
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Giampiero Capobianco
- Department of Surgical, Microsurgical and Medical Sciences, Gynecologic and Obstetric Clinic, University of Sassari, Sassari, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza Nicola Leotta 4, 90127, Palermo, Italy.
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Rajasekaran K, Malhotra N, Mahey R, Khadgawat R, Kalaivani M. Myoinositol versus metformin pretreatment in GnRH-antagonist cycle for women with PCOS undergoing IVF: a double-blinded randomized controlled study. Gynecol Endocrinol 2022; 38:140-147. [PMID: 34590929 DOI: 10.1080/09513590.2021.1981282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To study the effects of myoinositol (Myo) in comparison to metformin (Met), in reducing the risk of OHSS and improving ART outcome in PCOS women undergoing IVF. DESIGN Double-blinded randomized controlled trial (CTRI/2018/05/014196). SETTING ART Clinic, AIIMS, New Delhi patients: 102 infertile PCOS women undergoing IVF cycles were enrolled after evaluating for eligibility and allotted as 50 in group 1 (Myo) and 52 in group 2 (Met) after randomization. INTERVENTIONS Recruited patients received Myo 2 g twice daily (group 1) and Met 850 mg twice daily (group 2). Pre- and post-treatment clinical (menstrual pattern, BMI), hormonal profile (LH, FSH, testosterone, prolactin [PRL], and AMH), biochemical parameters (HOMA IR, fasting glucose, and insulin), ovarian with antral follicle count (AFC) and side effect profile were assessed. After 3 months of therapy, patients were recruited for IVF cycle by antagonist protocol was involving controlled ovarian stimulation, cycle monitoring, oocyte recovery, insemination of oocytes and follow up with fertilization, cleavage, transfer of good grade cleavage embryos, or blastocysts pregnancy outcomes and OHSS incidence and medications was continued until the day of OPU. MAIN OUTCOME MEASURES Primary outcome was OHSS and clinical pregnancy rate including spontaneous, IVF, and cumulative pregnancy rate including FET. Secondary outcome was ART outcomes and the change in biochemistry and hormonal profile between groups and inter group after medications at 12 weeks. RESULTS Incidence of OHSS (Myo 5 (10.0) (n = 50), Met 10 (20.0) (n = 50) p .07) was not statistically different between groups. Clinical pregnancy rate (Myo 18 (36.0) (n = 50), Met 9 (18.0) (n = 50) p .04) cumulative pregnancy rate including FET (Myo 16 (43.2) (n = 37) vs. Met 10) 22.7) (n = 44) p .05) and spontaneous conception (prior to IVF) Myo 13 (26.0) (n = 50), Met 6 (12.0) (n = 50) p .07) was significantly high in Myo group. No between group difference in ovarian stimulation outcomes including duration and dosage of gonadotropins, E2, P4 levels, number of follicles >14 mm on day of trigger. Number of oocytes retrieved and grade of maturity were similar between groups. Fertilization, cleavage and number of good grade embryos were significantly higher in Myo group. However, implantation rate and number of embryos for freezing were similar between groups. Myo had improvement in fasting insulin, HOMA, Sr.AMH, and SHBG suggesting decreased insulin resistance. CONCLUSIONS Myo is equally beneficial as Met in reducing the risk of OHSS and has better ART outcome in PCOS women undergoing antagonist cycles.
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Affiliation(s)
- Keerthana Rajasekaran
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Fartushna OY, Prokopiv MM, Palahuta HV, Bahrii RV, Hnepa YY, Fartushnyi YM, Selina OG. MULTIPLE ACUTE POSTERIOR CIRCULATION STROKE WITH LESIONS IN THE PONS AND BOTH HEMISPHERES OF THE CEREBELLUM ASSOCIATED WITH OVARIAN HYPERSTIMULATION SYNDROME: A CASE REPORT OF A WHITE EUROPEAN ADULT IN UKRAINE. Wiad Lek 2022; 75:2554-2557. [PMID: 36472298 DOI: 10.36740/wlek202210145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
We have presented a brief literature overview of the disease, supported by a clinical case of multiple acute posterior circulation strokes with lesions in the pons and both hemispheres of the cerebellum associated with ovarian hyperstimulation syndrome in a white young European adult in Ukraine. Specific features of posterior circulation stroke associated with ovarian hyperstimulation syndrome were determined, analyzed, and described. Complex posterior circulation cerebral infarction in the pons and both hemispheres of the cerebellum associated with ovarian hyperstimulation syndrome has not been reported before but has devastating consequences for both mother and fetus. Strokes in patients with OHSS must be timely prevented, promptly diagnosed, and treated to avoid high morbidity and mortality associated with it.
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Affiliation(s)
| | | | - Hanna V Palahuta
- STATE UNIVERSITY "UZHHOROD NATIONAL UNIVERSITY", UZHHOROD, UKRAINE
| | - Romana V Bahrii
- STATE UNIVERSITY "UZHHOROD NATIONAL UNIVERSITY", UZHHOROD, UKRAINE
| | - Yana Y Hnepa
- STATE UNIVERSITY "UZHHOROD NATIONAL UNIVERSITY", UZHHOROD, UKRAINE
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Hubka P, Študent V. Fluidothorax as an atypical symptom of late ovarian hyperstimulation syndrome. Ceska Gynekol 2022; 87:40-42. [PMID: 35240835 DOI: 10.48095/cccg202240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To present a case of isolated fluidothorax as a symptom of atypical late ovarian hyperstimulation syndrome. METHODS Review of available information and presentation of our case observed at the Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University and University Hospital Bulovka. GnRH antagonist protocol was used to stimulate the patient and fresh embryo transfer was performed. Sixteenth day after the oocyte retrieval the patient was examined due to dyspnoea and lab exam proved ovarian hyperstimulation syndrome. CONCLUSION Late ovarian hyperstimulation syndrome can lead to isolated fluidothorax in case of additional favourable conditions.
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Gaughran J, Lyne T, Kopeika J, Hamilton J. Ovarian hyperstimulation syndrome: cardiac arrest with an unexpected outcome. BMJ Case Rep 2021; 14:e246780. [PMID: 34799395 PMCID: PMC8606776 DOI: 10.1136/bcr-2021-246780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/03/2022] Open
Abstract
We describe the acute deterioration of a 29-year-old undergoing in vitro fertilisation. Late-onset critical ovarian hyperstimulation syndrome triggered a massive pulmonary embolism and subsequent cardiac arrest. While the prognosis was deemed to be poor, the patient made a full recovery. The potential reasons for this are explored.
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Affiliation(s)
- Jonathan Gaughran
- Departement of Gynaecology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Tom Lyne
- School of Medical Education, King's College London, London, UK
| | - Julia Kopeika
- Assisted Conception Unit, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Judith Hamilton
- Departement of Gynaecology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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Li F, Chen Y, Niu A, He Y, Yan Y. Nomogram Model to Predict the Probability of Ovarian Hyperstimulation Syndrome in the Treatment of Patients With Polycystic Ovary Syndrome. Front Endocrinol (Lausanne) 2021; 12:619059. [PMID: 34421814 PMCID: PMC8377671 DOI: 10.3389/fendo.2021.619059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 07/07/2021] [Indexed: 11/21/2022] Open
Abstract
Objective The objective of this study was to explore the risk factors of ovarian hyperstimulation syndrome (OHSS) in patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and to establish a nomogram model evaluate the probability of OHSS in PCOS patients. Methods We retrospectively analyzed clinical data from 4,351 patients with PCOS receiving IVF/ICSI in our reproductive medical center. The clinical cases were randomly divided into a modeling group (3,231 cases) and a verification group (1,120 cases) according to a ratio of about 3:1. The independent risk factors correlation with the occurrence of OHSS was identified by logistic regression analysis. Based on the selected independent risk factors and correlated regression coefficients, we established a nomogram model to predict the probability of OHSS in PCOS patients, and the predictive accuracy of the model was measured using the area under the receiver operating curve (AUC). Results Univariate and multivariate logistic regression analyses showed that FSH (OR, 0.901; 95% CI, 0.847-0.958; P<0.001), AMH (OR, 1.259; 95% CI, 1.206-1.315; P<0.001), E2 value on the day of hCG injection (OR, 1.122; 95% CI, 1.021-1.253; P<0.001), total dosage of Gn used (OR, 1.010; 95% CI, 1.002-1.016; P=0.041), and follicle number on the day of hCG injection (OR, 0.134; 95% CI, 1.020-1.261; P=0.020) are the independent risk factors for OHSS in PCOS patients. The AUC of the modeling group is 0.827 (95% CI, 0.795-0.859), and the AUC of the verification group is 0.757 (95% CI, 0.733-0.782). Conclusion The newly established nomogram model has proven to be a novel tool that can effectively, easily, and intuitively predict the probability of OHSS in the patients with PCOS, by which the clinician can set up a better clinical management strategies for conducting a precise personal therapy.
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Affiliation(s)
- Fei Li
- Center for Reproductive Medicine, The First People’s Hospital of Shangqiu, Henan, China
- Center for Reproductive Medicine, The First Affiliated Hospital of Zheng Zhou University, Henan, China
| | - Ying Chen
- Center for Reproductive Medicine, The First People’s Hospital of Shangqiu, Henan, China
| | - Aiqin Niu
- Center for Reproductive Medicine, The First People’s Hospital of Shangqiu, Henan, China
| | - Yajing He
- Department of Pathology, The First People’s Hospital of Shangqiu, Henan, China
| | - Ying Yan
- Department of Molecular Biology, The First People’s Hospital of Shangqiu, Henan, China
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Wang N, Chen Z, Guo X, Cheng H, Wang P, Wang T, Wang L, Tash D, Ren P, Zhu B, Guan D, Zhang G, Zhao R. Sudden Death Due to Severe Ovarian Hyperstimulation Syndrome: An Autopsy-Centric Case Report. Am J Forensic Med Pathol 2021; 42:88-91. [PMID: 33186129 DOI: 10.1097/paf.0000000000000601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic disorder associated with controlled ovarian stimulation during assisted reproductive technology. Severe OHSS may impose serious complications, including pleural effusion, acute renal insufficiency, venous thrombosis, and even death, although lethal outcomes are rare in forensic practice. The reported incidence of severe OHSS ranges from 0.008% to 10%. Herein, we present the case of a 29-year-old woman who diagnosed with polycystic ovary syndrome and infertility chose to undergo assisted reproduction. She received leuprorelin acetate and follicle stimulating hormone prior to egg retrieval. Three days after the retrieval procedure, she developed abdominal pain and distension. Later that same day, she died unexpectedly. The subsequent autopsy revealed turbid effusions of pleural and peritoneal cavities, abnormal ovarian enlargement, and duskiness of multiple organ surfaces. Microscopic examination disclosed edema and hemorrhage in follicles of both ovaries, thrombosis within the myocardial matrix, and massive pulmonary edema. Routine toxicology screening was negative. The death was attributed to severe OHSS. This case provides a morphologic reference for clinical and forensic work. Autopsy findings in instances of severe OHSS provide valuable insight into the mechanisms and pathogenesis of this disease.
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Affiliation(s)
- Ning Wang
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Ziyuan Chen
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Xiangshen Guo
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Hao Cheng
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Pengfei Wang
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Tianqi Wang
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Linlin Wang
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Dilichati Tash
- Kizilsu Kirgiz Autonomous Prefecture Public Security Bureau, Xinjiang Uygur Autonomous Region, China
| | - Peng Ren
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Baoli Zhu
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Dawei Guan
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Guohua Zhang
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
| | - Rui Zhao
- From the Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, Liaoning Province
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Park JE, Park Y, Yuk JS. Incidence of and risk factors for thromboembolism during pregnancy and postpartum: A 10-year nationwide population-based study. Taiwan J Obstet Gynecol 2021; 60:103-110. [PMID: 33494981 DOI: 10.1016/j.tjog.2020.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Knowledge of the incidence of pregnancy-related thromboembolism and its risk factors is clinically important because thromboembolism is the leading cause of maternal death. However, there are insufficient large population-based studies on this topic. The purpose of this study was to estimate the incidence of and identify the risk factors for thromboembolism during pregnancy and puerperium. MATERIALS AND METHODS We analyzed data from 2007 to 2016 using the Health Insurance Review and Assessment Service (HIRA) database. Women who gave birth in the Republic of Korea were identified. Thromboembolism was defined as the simultaneous presence of both the diagnostic and test codes. Risk factors for thromboembolism were identified using logistic regression. RESULTS A total of 1,188 delivery episodes with thromboembolism were extracted from 4,243,393 delivery episodes. The incidence of thromboembolism was 0.28 per 1,000 deliveries, and it increased over the 10-year period. The incidence of antepartum thromboembolism was 0.1 per 1,000 deliveries (418 cases), and the incidence of postpartum thromboembolism was 0.18 per 1,000 deliveries (770 cases). Thromboembolism was associated with ovarian hyperstimulation syndrome, low socioeconomic status, multiple birth, cesarean birth, preeclampsia, postpartum hemorrhage, placenta previa, advanced maternal age, hyperemesis and primiparity. The factors associated with mortality from thromboembolism were cesarean birth and preterm premature rupture of membranes. CONCLUSION The incidence of pregnancy-related thromboembolism increased over the 10-year study period. Low socioeconomic status, ovarian hyperstimulation syndrome, cesarean delivery and premature rupture of membranes were high-risk factors. This study provides an important reference for thromboprophylaxis for pregnancy-related thromboembolism.
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Affiliation(s)
- Ji Eun Park
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Yongwhi Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Jin-Sung Yuk
- Department of Obstetrics and Gynecology, College of Medicine, Inje University, Sanggye Paik Hospital, Republic of Korea.
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Bai L, Pan H, Zhao Y, Chen Q, Xiang Y, Yang X, Zhu Y. The Exploration of Poor Ovarian Response-Related Risk Factors: A Potential Role of Growth Differentiation Factor 8 in Predicting Ovarian Response in IVF-ET Patient. Front Endocrinol (Lausanne) 2021; 12:708089. [PMID: 34630324 PMCID: PMC8499678 DOI: 10.3389/fendo.2021.708089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Controlled ovarian hyperstimulation (COH) is the most common therapeutic protocol to obtain a considerable number of oocytes in IVF-ET cycles. To date, the risk factors affecting COH outcomes remain elusive. Growth differentiation factor 8 (GDF-8), a member of transforming growth factor β (TGF-β) superfamily, has been long discerned as a crucial growth factor in folliculogenesis, and the aberrant expression of GDF-8 is closely correlated with the reproductive diseases. However, less is known about the level of GDF-8 in IVF-ET patients with different ovarian response. In the present study, the potential risk factors correlated with ovarian response were explored using logistic regression analysis methods. Meanwhile, the expression changes of GDF-8 and its responsible cellular receptors in various ovarian response patients were determined. Our results showed that several factors were intensely related to poor ovarian response (POR), including aging, obesity, endometriosis, surgery history, and IVF treatment, while irregular menstrual cycles and PCOS contribute to hyperovarian response (HOR). Furthermore, POR patients exhibited a decrease in numbers of MII oocytes and available embryos, thereby manifesting a lower clinical pregnancy rate. The levels of GDF-8, ALK5, and ACVR2B in POR patients were higher compared with those in control groups, whereas the expression level of ACVR2A decreased in poor ovarian response patients. In addition, clinical correlation analysis results showed that the concentration of GDF-8 was negatively correlated with LH and estradiol concentration and antral follicle count. Collectively, our observations provide a novel insight of ovarian response-associated risk factors, highlighting the potential role of GDF-8 levels in ovarian response during COH process.
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Affiliation(s)
- Long Bai
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Women’s Reproductive Health Laboratory of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huihui Pan
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yinjun Zhao
- Institute of Genetics and Department of Genetics, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qingqing Chen
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yu Xiang
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohang Yang
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Women’s Reproductive Health Laboratory of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Institute of Genetics and Department of Genetics, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Yimin Zhu, ; Xiaohang Yang,
| | - Yimin Zhu
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Women’s Reproductive Health Laboratory of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Yimin Zhu, ; Xiaohang Yang,
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Wei L, Zhang Y, Song X. Strangulated internal hernia following severe ovarian hyperstimulation syndrome: a case report. Gynecol Endocrinol 2021; 37:93-96. [PMID: 33078979 DOI: 10.1080/09513590.2020.1812568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovarian stimulation. Herein, we report a rare case of strangulated internal hernia in a woman with severe OHSS following ovulation induction. A delay in the diagnosis and management of acute abdominal pain can lead to serious problems. The aim of this case report was to highlight the diagnostic difficulties of abdominal pain in women with OHSS, and emphasize the positive effects of imaging and a timely differential diagnosis in clinical practice.
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Affiliation(s)
- Likun Wei
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanfang Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xueru Song
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
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18
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Yee M, Skosnik K, Albertini E, Stork C. Mania Triggered by Gonadotropins in an Ovarian Hyperstimulation Protocol for Egg Harvesting: A Case Report. Psychosomatics 2020; 61:390-394. [PMID: 31928785 DOI: 10.1016/j.psym.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Michael Yee
- Department of Psychiatry, Mount Sinai Health System, New York, NY.
| | | | | | - Caitlin Stork
- Department of Psychiatry, Mount Sinai Health System, New York, NY; Department of Psychiatry, Manhattan Psychiatric Center, New York, NY
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19
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Fabregues F, Peñarrubia J. Assisted reproduction and thromboembolic risk in the COVID-19 pandemic. Reprod Biomed Online 2020; 41:361-364. [PMID: 32660814 PMCID: PMC7316047 DOI: 10.1016/j.rbmo.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/22/2022]
Abstract
The COVID-19 pandemic has significantly increased mortality in many countries, with the number of infected cases increasing exponentially worldwide. One of the main determining factors of the poor prognosis in these patients is the development of coagulopathy. Moreover, it is well known that assisted reproductive technology procedures confer a risk of thromboembolic complications. This commentary analyses specific aspects coexisting between the thrombotic risk described during virus infection and that reported in the context of assisted reproduction treatments. Based on known pathophysiological aspects of virus infection and of ovarian stimulation, there are common elements that deserve to be taken into account. In the present context, any risk of hyperstimulation should be avoided. Gonadotrophin-releasing hormone agonist triggering should be mandatory in high-responder patients and/or those with COVID-19 infection. In both cases, the cycle should be segmented. A proposal is made for the use of prophylactic low molecular weight heparin not only in those cases in which oocyte retrieval has been performed, but also in those in which cancellation has been decided. In addition, endometrial preparation for frozen-thawed embryo transfers should use the transdermal route in order to minimize the higher thrombotic risk associated with the oral route.
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Affiliation(s)
- Francesc Fabregues
- Hospital Clinic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Petrenko AP, Castelo Branco C, Marshalov DV, Salov IA, Kuligin AV, Shifman EM, Chauke SS. Alternative strategies for the management of ovarian hyperstimulation syndrome, the role of intra-abdominal hypertension control. Gynecol Endocrinol 2020; 36:197-203. [PMID: 31668111 DOI: 10.1080/09513590.2019.1683822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The aim of this study is to analyze the methods for reducing intra-abdominal pressure (IAP) in the management of the moderate and severe forms of ovarian hyperstimulation syndrome (OHSS). We carried out a systematic review of the literature. An evaluation of clinical trials, meta-analysis, case-reports, and reviews assessing the management of conditions associated with OHSS and intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS) was made using the following data sources: MEDLINE Pubmed (from 1966 to July 2019) and the Cochrane Controlled Clinical Trials Register, Embase (up to July 2019). The principles of treatment of IAH syndrome can be considered in the treatment of moderate and severe forms of OHSS. Medical treatment of patients with increased IAP in OHSS should be started early to prevent further organ dysfunction and avoid a transition to a more severe stage of IAH and ACS. Some of the new, non-surgical methods, such as continuous negative extra-abdominal pressure, are a promising option in specific groups of patients with OHSS. This review provides suggestions for the management of OHSS based on the principles of therapy for IAH syndrome. Further well-designed studies are needed to confirm these initial data.
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Affiliation(s)
- Aleksei Petrovich Petrenko
- Faculty of Medicine, Clinic Institute of Gynecology, Obstetrics and Neonatology, University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University Named after V. I. Razumovsky, Saratov, Russian Federation
- City Clinical Hospital №1 Named after Y.Ya. Gordeev, Saratov, Russian Federation
| | - Camil Castelo Branco
- Faculty of Medicine, Clinic Institute of Gynecology, Obstetrics and Neonatology, University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Dimitry Vasilevich Marshalov
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University Named after V. I. Razumovsky, Saratov, Russian Federation
- City Clinical Hospital №1 Named after Y.Ya. Gordeev, Saratov, Russian Federation
| | - Igor Arkadevich Salov
- City Clinical Hospital №1 Named after Y.Ya. Gordeev, Saratov, Russian Federation
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saratov State Medical University Named after V. I. Razumovsky, Saratov, Russian Federation
| | - Alexander Valerievich Kuligin
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University Named after V. I. Razumovsky, Saratov, Russian Federation
| | - Efim Munevich Shifman
- Department of Anesthesiology and Critical Care, State Budgetary Healthcare Institution of Moscow Region M.F. Vladimirskiy Moscow's Regional Research Clinical Institute, Moscow, Russian Federation
| | - Shane Shitsundzuxo Chauke
- Kananelo Community Health Centre, HIV/AIDS Clinic, Vredefort, South Africa
- Department of Surgery, Parys Hospital, Parys, South Africa
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Gelmi CAE, Frattini C, Birindelli A, Segalini E, Coniglio C, Gourgiotis S, Tugnoli G, Di Saverio S. "Falling down": a retroperitoneal catastropheC. G Chir 2019; 40:535-5380. [PMID: 32007116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Hemoperitoneum due to ruptured retroperitoneal varices is an extremely rare condition and a poor prognostic sign with a catastrophic and life-threatening situation. Early recognition affords appropriate management and urgent surgical intervention in order to favor the survival rate. In this case report we accurately describe the complex clinical course of a 56-year old woman with retroperitoneal varices, who few months earlier had a chest trauma with multiple left lower rib fractures and 10 years earlier she underwent to ovarian hyperstimulation for an ovulation induction. She was taken to the emergency room for a fainting episode with signs of a clear hemodinamic shock without a present history of trauma. The intricacy of this case was mostly due to the choice of the correct management, where the damage control resuscitation turned out to have an important role.
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22
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Sun Y, Chen C, Di T, Zhu Y, Zhu R, Chen S, Qian Y. Clinical characteristics of preterm ovarian hyperstimulation syndrome: seven cases from China and 14 cases from the literature. Gynecol Endocrinol 2019; 35:819-824. [PMID: 30957580 DOI: 10.1080/09513590.2019.1597345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Preterm ovarian hyperstimulation syndrome (POHS) is a rare condition with only a few reported cases. The objective of this study is to investigate the clinical characteristics of 21 POHS cases (seven from China and 14 from the literature). Suspected patients (n = 7) were referred for further confirmation and data on demographics, family history, clinical manifestations (edema developed in the vulva, the hypogastric site and the upper leg), serum and sonographic assessments (ovarian cyst/cysts, gonadotropins, and estradiol levels), the natural course of patients were documented. We did not observe substantial differences in clinical manifestations among POHS patients from China relative to that from the literature. Preterm female newborns developed edema in the vulva, the hypogastric site and the upper leg at 30-39+6 weeks of post-conception age (PCA) as the major clinical manifestations. The characteristic also included high gonadotropins and estradiol, and ovarian cysts. This condition can self-resolve. Clinical manifestations of POHS patients from China are similar to those from the literature. The pathognomonic signs of POHS include vulvar, hypogastric, and upper leg edema developed at 30-39+6 PCA along with high gonadotropins and E2 values and the presence of ovarian cysts in preterm female newborns and the syndrome can self-resolve.
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Affiliation(s)
- Yuanyuan Sun
- a Department of Pediatrics, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Cuie Chen
- b Department of Pediatrics, Yiwu Maternity and Children Health Care Hospital , Jinhua , China
| | - Tianwei Di
- c Department of Pediatrics, Zhejiang University School of Medicine Children's Hospital , Hangzhou , China
| | - Yanke Zhu
- a Department of Pediatrics, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Ronghe Zhu
- a Department of Pediatrics, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Shujun Chen
- b Department of Pediatrics, Yiwu Maternity and Children Health Care Hospital , Jinhua , China
| | - Yan Qian
- a Department of Pediatrics, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
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23
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Selter J, Wen T, Palmerola KL, Friedman AM, Williams Z, Forman EJ. Life-threatening complications among women with severe ovarian hyperstimulation syndrome. Am J Obstet Gynecol 2019; 220:575.e1-575.e11. [PMID: 30742828 DOI: 10.1016/j.ajog.2019.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/28/2018] [Accepted: 02/03/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ovarian hyperstimulation syndrome is a potentially life-threatening clinical condition. OBJECTIVE The objective of this study was to evaluate risk factors for life-threatening complications for patients with severe ovarian hyperstimulation syndrome in a United States nationwide sample. MATERIALS AND METHODS Ovarian hyperstimulation syndrome admissions from 2002 to 2011 from the Nationwide Inpatient Sample were included in this study. The association between patient and hospital factors and life-threatening complications (deep vein thrombosis/pulmonary embolism, acute respiratory distress syndrome, acute renal failure, intubation), nonroutine discharge (discharge to skilled nursing facility, transfer hospital), prolonged length of stay, and total hospital charges were analyzed. Survey-adjusted multivariable logistic regression analyses were performed for these outcomes, controlling for risk factors, with adjusted odds ratios with 95% confidence intervals as the measures of effect. RESULTS A total of 11,562 patients were hospitalized with severe ovarian hyperstimulation syndrome from 2002 to 2011. The majority were white (55.7%), with private insurance (87.7%), aged 25-39 years (84.6%), and hospitalized in an urban location (95%). In all, 19.3% of patients had medical comorbidities including hypertension, diabetes, obesity, hypothyroidism, and anemia. Life-threatening complications occurred in 4.4% of patients (deep vein thrombosis/pulmonary embolism, 2.2%; acute renal failure; acute respiratory distress syndrome, 0.9%; intubation, 0.5%). Patients ≥40 years old (odds ratio, 4.02; 95% confidence interval, 1.37, 11.76), those with comorbidities (odds ratio, 2.29; 95% confidence interval, 1.46, 3.57), and African American patients (odds ratio, 2.15; 95% confidence interval, 1.25, 3.70) were more likely to develop life-threatening conditions. Patients with medical comorbidities (odds ratio, 0.39; 95% confidence interval, 0.24, 0.63) were also less likely to be routinely discharged from the hospital. Adjusting for patient and hospital demographics, patients with comorbidities were more likely to develop deep vein thrombosis/pulmonary embolism (adjusted odds ratio, 2.44; 95% confidence interval, 1.28, 4.65) and acute renal failure (adjusted odds ratio, 2.26; 95% confidence interval, 1.21, 4.23). Patients who developed life-threatening complications had longer hospital length of stay (adjusted odds ratio, 3.72; 95% confidence interval, 2.28, 6.07) and higher hospital costs (adjusted odds ratio, 5.20; 95% confidence interval, 3.22,8.39). CONCLUSION Patients with common medical comorbidities are at higher risk for life-threatening complications in the setting of severe ovarian hyperstimulation syndrome. Furthermore, these complications are associated with high hospital costs and hospital burden. Given the increasing number of in vitro fertilization patients with medical comorbidities, closer monitoring of at-risk patients may be indicated. As assisted reproductive technology practice changes in recent years with strategies designed to reduce ovarian hyperstimulation syndrome risk, future studies are needed to assess the impact of these changes on hospitalization and complication risk.
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Affiliation(s)
- Jessica Selter
- Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY.
| | - Timothy Wen
- Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Katherine L Palmerola
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Columbia University Medical Center, New York, NY
| | - Alexander M Friedman
- Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Zev Williams
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Columbia University Medical Center, New York, NY
| | - Eric J Forman
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Columbia University Medical Center, New York, NY
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Lattová V, Dostál J, Vodička J, Procházka M. The risk of thromboembolism in relation to in vitro fertilization. Ceska Gynekol 2019; 84:229-232. [PMID: 31324115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Summary of available literature concerning recommendation of antithrombotic prophylaxis in the infertility treatment by in vitro fertilization (IVF) and in pregnancies after IVF. DESIGN Review article. SETTINGS Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc; Institute of Medical Genetics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc. METHODS Analysis of literary sources and databases Medline, Web of Science, Scholar Google, 2010-2018. CONCLUSION The incidence of thromboembolism in the first trimester of pregnancy after IVF is 0.2% e. g. 10-times higher compared to normal pregnant population. Pregnancies after IVF are complicated in 6-7% by ovarian hyperstimulation syndrome (OHSS), they then have the risk of venous thromboembolism (VTE) 1.7% in the first trimester, what is 100-times higher as compared to the general population. Women after IVF without OHSS have a 5-times higher risk of VTE compared to the general population. To lower the risk of thromboembolism during treatment, use of low dose gonadotrophin (mild) stimulation protocols, prioritization of antagonistic stimulation protocols, avoidance of OHSS using GnRH agonists instead of hCG, cryo embryotransfer in natural cycles, reduction of incidence of multiple pregnancy by single embryo transfer, use of prophylactic and therapeutic low molecular weight heparin (LMWH) is recommended. These strategies can reduce the risk of thromboembolism. The LMWH application is suitable in pregnant women in the first trimester of pregnancy after IVF where OHSS was present.
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Nassr AA, Shamshirsaz AA, Sanz Cortes M, Gibbons WE, Belfort MA, Espinoza J. Unusual course of hyperreactio luteinalis in twin pregnancy complicated by twin-twin transfusion syndrome. Ultrasound Obstet Gynecol 2018; 52:677-678. [PMID: 29363826 DOI: 10.1002/uog.19010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/06/2018] [Accepted: 01/17/2018] [Indexed: 06/07/2023]
Affiliation(s)
- A A Nassr
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
- Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt
| | - A A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - M Sanz Cortes
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - W E Gibbons
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - J Espinoza
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Wormer KC, Jangda AA, El Sayed FA, Stewart KI, Mumford SL, Segars JH. Is thromboprophylaxis cost effective in ovarian hyperstimulation syndrome: A systematic review and cost analysis. Eur J Obstet Gynecol Reprod Biol 2018; 224:117-124. [PMID: 29602141 PMCID: PMC5973799 DOI: 10.1016/j.ejogrb.2018.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/13/2018] [Accepted: 03/17/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND The majority of serious thromboembolic events occurring in assisted reproductive technologies (ART) are in women with ovarian hyperstimulation syndrome (OHSS). OBJECTIVES The purpose of this study was to present a thorough review and cost analysis regarding the use of venous thromboembolism (VTE) prophylaxis in OHSS to inform clinical management. DATA SOURCES Databases used were Pubmed and Embase, in addition to checking reference lists of retrieved articles (inception to November 2017). METHODS The systematic search strategy identified 365 titles and abstracts. Articles included in the qualitative synthesis had identified venous thrombosis incidence rates or ratios. A separate search for the cost model was conducted recognizing all associated complications of VTE. The decision tree was modeled to best fit the patient population and a sensitivity analysis was performed over a range of variables. RESULTS The cost of VTE event per OHSS patient not on prophylaxis was €5940 (range €3405 to €38,727), versus €4134 (€2705 to €23,192) per event per patient on prophylaxis, amounting to a saving of (€19 to €23,192) per VTE per patient. Sensitivity analysis found VTE prophyaxis to be cost effective if the incidence of VTE in the OHSS population was greater than 2.79%. Prophylactic therapy was cost effective through 16 weeks of treatment. LIMITATIONS OHSS is infrequent and hence, the incidence of VTE in patients with OHSS is low; therefore, the data used to inform the incidence of VTE in OHSS in the model carry some uncertainty. Further, low molecular weight heparin (LMWH) has side effects therefore individualization of care must be considered. CONCLUSIONS With the increasing incidence of infertility and requirement for ART, thromboembolism in OHSS poses a major health threat for patients. VTE prophylaxis using enoxaparin was cost effective in patients with severe OHSS over a wide range of costs and incidences. Prophylaxis was also cost effective through the completion of the first trimester of pregnancy.
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Affiliation(s)
| | | | - Farah A El Sayed
- Faculty of Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - Katherine I Stewart
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, United States
| | - Sunni L Mumford
- Epidemiology Branch, Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd, Bethesda, MD, 20892, United States
| | - James H Segars
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, United States.
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Di Micco P, D'Uva M, Romano M, Di Marco B, Niglio A. Stroke due to left carotid thrombosis in moderate ovarian hyperstimulation syndrome. Thromb Haemost 2017; 90:957-60. [PMID: 14597994 DOI: 10.1160/th03-03-0137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Pierpaolo Di Micco
- Second University of Naples, Department of Internal Medicine, via San Giacomo dei Capri 69, Naples, 80131, Italy.
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Bedarida GV, Hoffmann U, Tatò F. Jugular vein thrombosis with severe local and systemic inflammation in a woman with ovarian hyperstimulation syndrome. Thromb Haemost 2017; 95:1035-7. [PMID: 16732386 DOI: 10.1160/th05-12-0794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Gabriella V Bedarida
- Division of Vascular Medicine, Medizinische Poliklinik, Ludwig-Maximilians University, Pettenkoferstrasse 8a, D-80336 Munich, Germany
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Lee SH, Park JW, Han M, Bae JW, Cho YJ. Internal jugular vein thrombosis with OHSS. J Clin Ultrasound 2017; 45:450-452. [PMID: 27861970 DOI: 10.1002/jcu.22423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/23/2016] [Accepted: 09/30/2016] [Indexed: 06/06/2023]
Abstract
Ovarian hyperstimulation syndrome (OHSS) includes ovarian enlargement and ascites. It is usually mild but can be, rarely, fatal. Deep vein thrombosis (DVT) is among the potentially fatal complications of OHSS. During pregnancy, DVT is more common in the lower extremities than in the upper part of the body, but OHSS-related DVT occurs more frequently in the upper part. Internal jugular vein thrombosis is considered rare, and duplex ultrasound is the appropriate examination for its diagnosis. We present a rare case of internal jugular vein thrombosis following OHSS. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:450-452, 2017.
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Affiliation(s)
- Seung Hyun Lee
- Department of Obstetrics and Gynecology, Dong-A University, College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea
| | - Jung-Woo Park
- Department of Obstetrics and Gynecology, Dong-A University, College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea
| | - Myoungseok Han
- Department of Obstetrics and Gynecology, Dong-A University, College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea
| | - Jong Woon Bae
- Department of Obstetrics and Gynecology, Dong-A University, College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea
| | - Yeon Jean Cho
- Department of Obstetrics and Gynecology, Dong-A University, College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea
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Pereira N, Lekovich JP, Kligman I, Rosenwaks Z. Severe ovarian hyperstimulation syndrome after combined GnRH-agonist and low-dose human chorionic gonadotropin trigger in a patient with a single kidney. Gynecol Endocrinol 2017; 33:593-597. [PMID: 28440686 DOI: 10.1080/09513590.2017.1318372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) following gonadotropin-releasing hormone agonist (GnRH-a) trigger is rare. Here, we report a case of severe OHSS after combined GnRH-a and low-dose human chorionic gonadotropin (hCG) trigger in a patient with a single kidney. The patient is a 32-year-old women with a two-year history of infertility. The patient's history was significant for a single kidney, that is, she had donated a kidney to a family member three years ago. The patient underwent controlled ovarian stimulation (COS) for in vitro fertilization (IVF) and received a combined 2 mg GnRH-a and 1500 IU hCG ovulatory trigger. Estradiol (E2) levels on the day of and after the trigger were 3800 pg/mL and 4001 pg/mL, respectively. Four days after the trigger, the patient began experiencing nausea, abdominal distention and dyspnea, and her blood testing revealed hemoconcentration (hemoglobin: 16.9 g/dL; hematocrit: 51.0%) and an elevated creatinine level (1.16 mg/dL). Fresh embryo transfer was deferred. The patient was admitted to the hospital for fluid monitoring and prophylactic anticoagulation. Following inpatient management, her hemoglobin, hematocrit and creatinine levels normalized. The current report highlights that the systemic effects of OHSS can be accentuated in patients with preexisting renal disease or a single kidney.
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Affiliation(s)
- Nigel Pereira
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College , New York , NY , USA
| | - Jovana P Lekovich
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College , New York , NY , USA
| | - Isaac Kligman
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College , New York , NY , USA
| | - Zev Rosenwaks
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College , New York , NY , USA
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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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Abstract
Ovarian hyperstimulation syndrome is a rare, but potentially life-threatening iatrogenic disorder arising from ovulation induction or ovarian hyperstimulation for assisted reproduction techniques. We report a case of a 26-year-old multiparous woman, an anonymous egg donor, who died a few hours after undergoing a procedure to donate eggs at an in vitro fertilization clinic. Her husband alleged that medical negligence had led to her death. The autopsy confirmed death due to ovarian hyperstimulation syndrome. We know of no previous descriptions of fatal ovarian hyperstimulation syndrome in an anonymous egg donor in medico-legal literature.
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Affiliation(s)
- Shashank Pooniya
- Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - C Behera
- Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A R Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - D N Bhardwaj
- Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tabin Millo
- Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India
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Affiliation(s)
- D M Raw
- Department of Clinical Radiology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S1O 2JF, UK.
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Gaude G, Chaudhury A. Symptomatic Unilateral Pleural Effusion Secondary due to Ovarian Hyperstimulation Syndrome. Indian J Chest Dis Allied Sci 2016; 58:199-201. [PMID: 30152657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Isolated pleural effusion is a rare presentation of ovarian hyperstimulation syndrome following ovulation induction therapy. We hereby report the case of a 24-year-old female who presented with unilateral moderate pleural effusion following ovulation induction therapy. Therapeutic thoracentesis was performed to relieve the breathlessness in this case.
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Yefet E, Weiss A. [IS ANTI-THROMBOTIC PROPHYLAXIS WARRANTED IN FERTILITY AND IN-VITRO FERTILIZATION TREATMENTS?]. Harefuah 2016; 155:398-402. [PMID: 28514122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Assisted reproductive technology (ART) treatments are potential risk factors for thromboembolism (TE) due to excessive estrogen levels. Recently, several studies have shed new light on this matter. AIMS To review the literature to assess the risk for TE during ART and to establish guidelines regarding thrombophylaxis. METHODS A search was conducted of PubMed, Medline, Cochrane and clinicaltrials.gov. The search terms were fertility, assisted reproductive technology, IVF, thromboembolism, thrombosis and anticoagulation. Case reports and reviews were excluded. RESULTS Three cohort studies and one cross-sectional study were included; one examined the effect of ART on TE risk after cycles not resulting in pregnancy. The others evaluated TE risk if pregnancy was achieved. The rate of TE for 75,141 cycles not resulting in pregnancy was not higher than controls in the general population. The three studies which compared TE risk when pregnancies were achieved found that ART increased the risk for TE primarily during the first trimester. If ovarian hyperstimulation syndrome (OHSS) was present the risk increased further. The risk for TE after frozen embryo replacement cycles was not increased. CONCLUSIONS ART posed a risk factor for TE during pregnancy, but not during ovarian stimulation or in cycles not resulting in pregnancy. Thrombophylaxis is not indicated for all women undergoing ART. Women with OHSS should be given thrombophylaxis during the acute episode and throughout the first trimester. Caution is advised for patients with combined risk factors and treatment should be individualized. Guidelines for thromboprophylaxis are provided.
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Affiliation(s)
- Enav Yefet
- Obstetrics and Gynecology Department, Ha'Emek Medical Center, Afula, Israel
| | - Amir Weiss
- Obstetrics and Gynecology Department, Ha'Emek Medical Center, Afula, Israel
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Affiliation(s)
- N Srivali
- From the Department of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA
| | - C Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - W Cheungpasitporn
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - P Ungprasert
- Department of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - S M Caples
- Department of Rheumatology, Mayo Clinic, Rochester, MN, USA
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Gaggero CR, Bogliolo S, Sala P, Molinari C, Motzo M, Fulcheri E, Anserini P, De Biasio P. Diginyc partial hydatidiform mole with increased fetal nuchal translucency and ovarian hyperstimulation syndrome. CLIN EXP OBSTET GYN 2016; 43:467-469. [PMID: 27328519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE OF INVESTIGATION Hydatidiform mole (HM) is an abnormal pregnancy characterized by proliferation of cytotrophoblast and syncytiotrophoblast and vesicular swelling of placental villi. The fetus or embryo can be absent or abnormal. HMs can be complete or partial. CASE REPORT A case of diginyc partial HM at 12 weeks of gestational age was referred to the present center of prenatal diagnosis. The patient showed ovarian hyperstimulation syndrome. At ultrasonography, increased fetal nuchal translucency (NT) with fetal anomaly was evident, without sonographic signs of placental mole. Pregnancy was terminated with legal abortion. RESULTS Partial HM (PHM) was suspected by ultrasonographic fetal markers with ovarian hyperstimulation syndrome, but the diagnosis was performed only with fluorescent in situ hybridization. In particular fetal NT appeared increased also in diginyc mole. CONCLUSION In order to improve the detection rate of PHM, routine histological examinations may be associated to fluorescent in situ hybridization in all cases of fetal anomalies.
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Danolić D, Kasum M, Puljiz M, Alvir I, Tomica D, Mamić I, Čehić E, Bolanča I. THE RISK OF HYPERCOAGULABILITY IN OVARIAN HYPERSTIMULATION SYNDROME. Acta Clin Croat 2015; 54:186-192. [PMID: 26415315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a rare and potentially life-threatening complication of infertility treatment occurring during either the luteal phase or early pregnancy. An increasing number of thromboembolic complications associated with the increased use of assisted reproductive techniques have been reported in the literature. Identification of the risk factors is crucial for prevention of thromboembolic events in OHSS patients. Alterations in the hemostatic system cause hypercoagulability in women affected by severe OHSS. Coexistence of inherited hypercoagulable conditions increases the risk of thromboembolism. The role of clinical parameters that can help predict development of thrombosis is controversial. Patients with a personal or family history of thrombosis undergoing infertility treatment should be considered for thrombophilia screening, while routine examination of inherited thrombophilic mutations is not indicated in infertile patients. Antithrombotic primary prevention is not indicated in healthy women undergoing assisted reproductive procedures or in women with thrombophilia. Anticoagulant therapy is indicted if there is clinical evidence of thrombosis or laboratory evidence of hypercoagulability. In this review, the risks of hypercoagulability in the OHSS are discussed.
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Di Carlo C, Savoia F, Fabozzi A, Gargano V, Nappi C. A case of ovarian torsion in a patient carrier of a FSH receptor gene mutation previously affected by spontaneous ovarian hyperstimulation syndrome. Gynecol Endocrinol 2015; 31:105-8. [PMID: 25495063 DOI: 10.3109/09513590.2014.987229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We here report a case of ovarian torsion in a patient with an history of two previous episodes of spontaneous ovarian hyperstimulation syndrome during her two pregnancies. A mutation of follicle-stimulating hormone receptor (FSHr) gene was identified in this patient and in other members of the family. Two years after her successful second pregnancy, the patient showed signs of severe thyroiditis during administration of oral contraceptive, with suppressed TSH and increased thyreoglobulin, in the absence of any abnormalities of the auto-antibodies. In few days, she developed severe pelvic pain and ultrasonographic evidence of increased ovarian volume. She underwent laparoscopy with unilateral adnexectomy for ovarian ischemic necrosis due to adnexal torsion. Our experience suggests that patients' carrier of a mutation of FSHr gene are at risk of ovarian pathologies also when non-pregnant and in the presence of low TSH levels. Further investigations are needed for an appropriate knowledge of typical and atypical manifestations of spontaneous ovarian hyperstimulation syndrome.
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Affiliation(s)
- C Di Carlo
- Dipartimento di Neuroscienze e Scienze della Riproduzione, Università degli Studi di Napoli Federico II , Naples , Italy and
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Rehman A, Ul-Ain Baloch N, Awais M. Severe ovarian hyperstimulation syndrome complicated by Stenotrophomonas maltophilia peritonitis: a case report and literature review. Intern Med 2015; 54:1149-52. [PMID: 25948367 DOI: 10.2169/internalmedicine.54.3564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic disorder resulting from ovulation induction. Although the occurrence of this disorder is rare, it can be potentially life-threatening in its most severe forms. We herein present the case of a young nulliparous woman who presented with features of abdominal compartment syndrome and was subsequently diagnosed with severe OHSS. All physicians, in particular critical care doctors, must be aware of this rare, but potentially life-threatening iatrogenic disorder.
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Affiliation(s)
- Abdul Rehman
- Department of Biological & Biomedical Sciences, Aga Khan University, Pakistan
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Barlascini C, Piroddi MG, Perazzo A, Senarega R, Santo M, Nicolini A. Non-invasive ventilation for the treatment of acute respiratory failure following ovarian hyperstimulation syndrome: report of two cases and a brief review of the literature. Pneumologia 2015; 64:30-34. [PMID: 26506672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The ovarian hyperstimulation syndrome (OHSS) is a serious but rarely fatal complication of medical interventions that seek to induce fertility; it is typically encountered in women who undergo controlled ovarian hyperstimulation, but there are very rare patients who have genetic defects who present with OHSS. In recent years, its pathogenesis has been elucidated; this knowledge will decrease the frequency of this syndrome. Clinical signs may include any or all of the following: rapid weight gain, ascites, oliguria, hemoconcentration, leukocytosis, along with intravascular hypovolemia, hyponatremia, and hyperkalemia. If the patient is not diagnosed early, ascites, pleural and more rarely pericardial effusions, severe respiratory failure and ARDS, hypercoagulability with tromboembolism and multiple organ system failure can occur. Due to the increased use of therapeutic strategies for infertility (particularly those using human chorionic gonadotropin), the systemic, particularly the pulmonary, complications of this syndrome must be identified early to allow appropriate diagnosis and management. We describe two cases of women with extremely severe OHSS presenting bilateral pleural effusions, and severe respiratory failure (paO2/FiO2 < 200) treated with non-invasive ventilation (NIV). The severe form of OHSS varies between 0.5% and 5%, depending on the population studied: intensive care may be required for management of tromboembolic complications, renal failure and severe respiratory failure. The diagnosis of severe OHSS was made, largely based on bedside ultrasonography showing increased ovarian size, mild ascites and bilateral pleural effusions. Owing to severe respiratory failure the patients were admitted to Respiratory Intermediate Care. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and in more severe cases assisted ventilation. There are only a few studies in English that describe severe respiratory failure treated with non-invasive ventilation, but all of them have had good outcomes.
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42
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Xu GF, Zhang JY, Pan HT, Tian S, Liu ME, Yu TT, Li JY, Ying WW, Yao WM, Lin XH, Lv Y, Su WW, Ye XQ, Zhang FH, Pan JX, Liu Y, Zhou CL, Zhang D, Liu XM, Zhu YM, Sheng JZ, Huang HF. Cardiovascular dysfunction in offspring of ovarian-hyperstimulated women and effects of estradiol and progesterone: a retrospective cohort study and proteomics analysis. J Clin Endocrinol Metab 2014; 99:E2494-503. [PMID: 25268391 DOI: 10.1210/jc.2014-2349] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The cardiovascular dysfunction in children born with assisted reproductive technologies has been of great concern. However, the association of ovarian hyperstimulation syndrome (OHSS), a complication of assisted reproductive technologies, with worse cardiovascular functions and underlying mechanism remains unknown. OBJECTIVES The objective of the study was to assess the cardiovascular functions of children born to mothers with OHSS and investigate the underlying regulator(s). DESIGN AND SETTING This was a retrospective cohort recruited in a university hospital. PARTICIPANTS AND METHODS We assessed the cardiovascular functions by Doppler echography in 42 children born to OHSS women, 34 children of mothers with non-OHSS in vitro fertilization, and 48 spontaneously conceived (SC) children (mean age ∼ 4.5 y). Groups were matched for gestational age at delivery and birth weight. An isobaric tag for relative and absolute quantitation-labeled proteomics analysis was performed with another set of umbilical arteries from OHSS and SC pregnancies (n = 3 for both groups). RESULTS Children of OHSS mothers showed a significantly decreased mitral ratio of early to late mitral peak velocities, reduced systolic and diastolic diameters of common carotid arteries, and impaired flow-mediated dilation compared with non-OHSS in vitro fertilization and SC children. Intima-media thickness and arterial stiffness indices were similar in the three groups. In the proteomics study, 1640 proteins were identified from OHSS and SC umbilical arteries, and 40 differentially expressed proteins were selected for further analysis. Estradiol and progesterone were identified as activated upstream regulators. CONCLUSIONS Children born to ovarian-hyperstimulated women displayed cardiovascular dysfunctions. The underlying mechanisms may involve the effects of supraphysiological estradiol and progesterone levels.
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Affiliation(s)
- Gu-Feng Xu
- Key Laboratory of Reproductive Genetics (G.-F.X., S.T., M.-E.L., T.-T.Y., J.-Y.L., X.-H.L., J.-X.P., Y.L., C.-L.Z., D.Z., X.-M.L., H.-F.H.) and Bio-X Institutes (J.-Y.Z., H.-F.H.), Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Department of Pathology and Pathophysiology (H.-T.P., J.-Z.S.), School of Medicine, and Departments of Reproductive Endocrinology (G.-F.X., S.T., M.-E.L., T.-T.Y., J.-Y.L., X.-H.L., Y.L., W.-W.S., X.-Q.Y., F.-H.Z., J.-X.P., Y.L., C.-L.Z., D.Z.,, Y.-M.Z.) and Ultrasound (W.-W.Y., W.-M.Y.), Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China; and International Peace Maternal and Child Health Hospital (J.-Y.Z., H.-F.H.), Shanghai Jiao Tong University, School of Medicine, Shanghai 200030, China
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Kilpatrick CR, Ratts VS, Simckes E, McGill JB. Severe ovarian hyperstimulation syndrome in patients with autoimmune disorders: a report of two cases. J Reprod Med 2014; 59:591-595. [PMID: 25552133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) following ovulation induction is common and varies in severity from mild to severe. Severe OHSS can be life threatening and requires hospitalization and procedures to reduce the extracellular fluid accumulation. Ovulation induction regimen and patient characteristics such as young age and low body weight have been identified as risk factors for OHSS, and follicle count >20 may be predictive of increased risk for moderate to severe OHSS. Whether any other patient factors are important in this risk equation is unknown. CASES We report on 2 patients with type 1 diabetes mellitus (T1DM) and other autoimmune diseases who experienced a total of 4 episodes of OHSS, 2 of which were severe. CONCLUSION T1DM, with or without other concomitant autoimmune diseases, may increase the risk for severe OHSS. Awareness of the interaction of preexisting conditions and risk for vascular leak disorders is needed for comprehensive counseling prior to embarking on ovarian stimulation. Preventive measures may be important considerations in this population.
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Affiliation(s)
- C Rachel Kilpatrick
- Department of Endocrinology, Washington Regional Medical Center, Fayetteville, Arkansas, USA
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Nouri K, Tempfer CB, Lenart C, Windischbauer L, Walch K, Promberger R, Ott J. Predictive factors for recovery time in patients suffering from severe OHSS. Reprod Biol Endocrinol 2014; 12:59. [PMID: 24996451 PMCID: PMC4096731 DOI: 10.1186/1477-7827-12-59] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 07/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate predictive factors for recovery time from severe ovarian hyperstimulation syndrome (OHSS). METHODS In a retrospective cohort study, 201 women who were hospitalized for severe OHSS were included. Patients with recurrent OHSS were excluded. All the patients received standardized treatment including intravenous hydration, plasma volume expansion, human albumin, furosemid, subcutaneous heparin, and paracentesis if necessary. The main outcome parameter was recovery time from OHSS. Recovery was defined if a morning hematocrit <40%, rebalance of electrolytes, and serum creatinine <1 mg/dL were reached during the standardized therapy and the patient had not suffered from abdominal pain and discomfort at least for one day without any OHSS-specific infusions or medications. RESULTS Pregnant patients (n=80, 39.8%) revealed a longer median duration until recovery than non-pregnant patients (n=121, 60.2%; 10 days, IQR 7-13, vs. 8 days, IQR 6-10, respectively; p=0.001). In a generalized linear model, presence of polycystic ovary syndrome before controlled ovarian hyperstimulation (beta=0.3342 +/- 0.1335, p=0.012) and use of hCG for ovulation induction (beta=0.222 +/- 0.1389, p=0.048) were associated with a longer recovery time in pregnant patients. In non-pregnant patients, none of the tested factors was associated with recovery time. CONCLUSIONS Pregnant patients with severe OHSS needed a significantly longer recovery time than non-pregnant patients. In pregnant patients, presence of polycystic ovary syndrome and ovulation induction with hCG were associated with longer recovery times.
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Affiliation(s)
- Kazem Nouri
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Clemens B Tempfer
- Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany
| | - Christian Lenart
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Lisa Windischbauer
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Katharina Walch
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Regina Promberger
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Altuntas N, Turkyilmaz C, Yuce O, Kulali F, Hirfanoglu IM, Onal E, Ergenekon E, Koç E, Bideci A, Atalay Y. Preterm ovarian hyperstimulation syndrome presented with vaginal bleeding: a case report. J Pediatr Endocrinol Metab 2014; 27:355-8. [PMID: 24114896 DOI: 10.1515/jpem-2013-0166] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 07/22/2013] [Indexed: 11/15/2022]
Abstract
Preterm ovarian hyperstimulation syndrome (POHS) is an uncommon disorder characterized by prematurity, hypogastric and upper leg swelling of various intensities, high serum estradiol and gonadotropin levels, and ovarian follicular cyst/cysts. In this paper, we present the first case of POHS presenting with vaginal bleeding. A female infant was born via spontaneous vaginal delivery at 25 weeks of gestation with a birth weight of 610 g. At 36 weeks of post-conception age, she developed breast enlargement, swelling of the clitoral hood, labia major and minor, hypogastrium and upper legs. Several weeks later, vaginal bleeding started and lasted 3 days. The vaginal bleeding continued to occur at monthly intervals. The elevated levels of gonadotropins and estrogens, vulvar swelling and cysts in both ovaries confirmed the diagnosis of preterm ovarian hyperstimulation syndrome.
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Sukul SPP, Pekelharing JE, van Hooff MHA, van der Weiden RMF, van Asten JCMBAM. [Thrombosis in ovarian hyperstimulation syndrome]. Ned Tijdschr Geneeskd 2014; 158:A7108. [PMID: 24867481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Ovarian hyperstimulation syndrome is a rare complication of IVF treatment. In severe ovarian hyperstimulation syndrome there is an increased risk of thrombo-embolic events. Venous thrombotic complications tend to occur several weeks after the resolution of ovarian hyperstimulation syndrome. Predominant sites of venous thrombosis in OHSS are the upper extremities. CASE DESCRIPTION A 34-year old woman presented to the emergency department with complaints about a painful swelling in the neck and a bluish discoloration of the right arm. She had been admitted to the hospital six weeks before, because of shortness of breath from pleural effusion due to ovarian hyperstimulation syndrome. The diagnosis of jugular vein and subclavian vein thrombosis was made. She was treated with therapeutic doses of low-molecular-weight heparin. CONCLUSION Venous thrombosis is a rare but serious complication of ovarian hyperstimulation syndrome. For patients who require admission because of severe ovarian hyperstimulation syndrome, thromboprophylaxis should be continued several weeks after discharge.
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Marshalov DV, Salov IA, Shifman EM, Petrenko AP, Saliukov RR, Batsunova MO. [Role of intra-abdominal hypertension in the development and outcome of ovarian hyperstimulation syndrome]. Anesteziol Reanimatol 2013:41-46. [PMID: 24749264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the role of intraabdominal hypertension in the development and outcome of ovarian hyperstimulation syndrome. MATERIAL AND METHODS 60 patients with varying degrees of ovarian hyperstimulation syndrome (OHSS) due to ongoing pregnancy were involved in the study. Intraabdominal pressure (IAP) was measured in the bladder. Performance of abdominal perfusion pressure, filtration gradient, extensibility and compliance of the anterior abdominal wall were evaluated. A size of the ovaries, chorionic condition and ascites were determined by ultrasonic method. Relation of pregnancy outcome and IAP was analyzed. RESULTS The mean value of IAP in patients with light form of ovarian hyperstimulation syndrome was 7.05 +/- 1.76 mm Hg, 13.65 +/- 1.92 mm Hg in patients with moderate form, and 20.60 +/- 2.52 mm Hg in patients with severe form of OHSS. The leading factors in the development and progression of intraabdominal hypertension (IAH) are the volume of the ovaries, ascites, and extensibility of the abdominal wall. The comparison of pregnancy outcome and severity of IAP revealed a strong positive correlation--r = 0.726, p < 0.001. CONCLUSION Evaluation of the severity of intra-abdominal hypertension in patients with ovarian hyperstimulation syndrome with considering the clinical data and results of laboratory and instrumental studies allow clarifying the severity of condition and predict the potential complications and pregnancy outcomes.
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Di Carlo C, Savoia F, Gargano V, Sparice S, Bifulco G, Nappi C. Successful pregnancy complicated by spontaneous, familial, recurrent ovarian hyperstimulation syndrome: report of two cases. Gynecol Endocrinol 2013; 29:897-900. [PMID: 23952048 DOI: 10.3109/09513590.2013.825713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We here report two cases of spontaneous, familial, recurrent ovarian hyperstimulation syndrome ended in a successful pregnancy. First case was a 26-year-old woman, gravida 3 para 0 and two previous terminations of pregnancy due to spontaneous ovarian hyperstimulation syndrome (OHSS). During her pregnancy, patient was treated with IV fluid therapy, albumin and thromboembolic prophylaxis and required pleural and peritoneal drainage. She was referred to the hospital twice, at 8 and 28 weeks'. At 32 weeks due to worsening of clinical condition, decision was made for a caesarean section. A live, healthy preterm baby of 1950 g was delivered. Second case was a 27-year-old woman, gravida 2 para 0 with one previous termination of pregnancy due to spontaneous OHSS. During her pregnancy patient was treated with IV fluid therapy, albumin, and thromboembolic prophylaxis. She did not require any pleural or peritoneal drainage. She was referred to the hospital twice, at 8 and 30 weeks. At 37 weeks of gestation, due to worsening of clinical condition decision for a caesarean section was made. A live, healthy term baby of 2700 g was delivered. Our experience seems to confirm that management of spontaneous OHSS during pregnancy should be conservative and treatment tailored to severity of symptoms.
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Affiliation(s)
- Costantino Di Carlo
- Department of Obstetrics and Gynecology, University of Naples Federico II, Via S. Pansini 5, Naples, Italy.
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Magri F, Capelli V, Gaiti M, Brambilla E, Montesion L, Rotondi M, Spinillo A, Nappi RE, Chiovato L. Impaired outcome of controlled ovarian hyperstimulation in women with thyroid autoimmune disease. Thyroid 2013; 23:1312-8. [PMID: 23556516 DOI: 10.1089/thy.2013.0022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Controlled ovarian hyperstimulation (COH) is a crucial step of assisted reproductive technology (ART). Thyroid dysfunction and autoimmune thyroid disease (ATD) may negatively affect the outcome of ART, but the underlying mechanisms are still poorly understood. Our aim was to evaluate the respective role of ATD and thyroid function, as assessed by serum thyrotropin (TSH), on the early outcome of COH. METHODS In total, 262 (202 ATD-negative and 60 ATD-positive) euthyroid subfertile women underwent ART. Before COH, serum follicle-stimulating hormone (FSH), luteinizing hormone, and estradiol (E2) were measured at cycle day 3, and progesterone at cycle day 21. At oocyte pickup and at embryo transfer, we evaluated the performance of recombinant FSH (r-FSH), as assessed by serum E2 concentration/total administered r-FSH units (E2/r-FSH) ratio and by oocyte quality. RESULTS At both oocyte pickup and embryo transfer, the performance of r-FSH was significantly poorer in ATD-positive than in ATD-negative women. In the ATD-positive group, women with a TSH <2.5 mIU/L displayed a higher serum E2 concentration at oocyte pickup, a higher E2/r-FSH ratio, and a greater number of mature metaphase II oocytes than women with a TSH >2.5 mIU/L. When ATD-positive women were divided into quartiles according to their serum TSH level, both the ovarian response to r-FSH and the number of mature metaphase II oocytes significantly increased from the lowest to the highest quartiles of serum TSH concentration. CONCLUSIONS ATD has a negative effect on the early outcome of COH, but this negative influence may be avoided with adequate levothyroxine therapy aimed at keeping TSH <2.5 mU/L. Thyroid antibodies and serum TSH should be checked in any woman undergoing ART.
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MESH Headings
- Adult
- Cohort Studies
- Ectogenesis/drug effects
- Embryo Transfer
- Female
- Fertility Agents, Female/pharmacology
- Fertility Agents, Female/therapeutic use
- Follicle Stimulating Hormone, Human/pharmacology
- Follicle Stimulating Hormone, Human/therapeutic use
- Hormone Replacement Therapy
- Humans
- Infertility, Female/complications
- Infertility, Female/therapy
- Italy/epidemiology
- Ovarian Hyperstimulation Syndrome/blood
- Ovarian Hyperstimulation Syndrome/complications
- Ovarian Hyperstimulation Syndrome/immunology
- Ovarian Hyperstimulation Syndrome/prevention & control
- Ovary/drug effects
- Ovary/immunology
- Ovulation/drug effects
- Ovulation Induction/adverse effects
- Pregnancy
- Pregnancy Rate
- Recombinant Proteins/pharmacology
- Recombinant Proteins/therapeutic use
- Retrospective Studies
- Sperm Injections, Intracytoplasmic
- Thyroid Gland/drug effects
- Thyroid Gland/immunology
- Thyroid Gland/physiopathology
- Thyroiditis, Autoimmune/complications
- Thyroiditis, Autoimmune/drug therapy
- Thyroiditis, Autoimmune/immunology
- Thyroiditis, Autoimmune/physiopathology
- Thyrotropin/blood
- Thyroxine/therapeutic use
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Affiliation(s)
- Flavia Magri
- 1 Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia , Pavia, Italy
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Hatzipetros I, Gocze PM, Cziraky K, Kovacs K, Kalman E, Farkas B. Assessment of cells in the ascitic fluid of women with ovarian hyperstimulation syndrome: the clinical implications for subsequent ovarian malignancy. Reprod Biol Endocrinol 2013; 11:91. [PMID: 24028152 PMCID: PMC3847118 DOI: 10.1186/1477-7827-11-91] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/11/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although some studies have reported a potential connection between ovulation induction therapy (OIT) and malignant ovarian diseases, the results have been inconclusive. In the present study, we sought to determine whether women undergoing OIT at our in vitro fertilization (IVF) clinic, especially those with severe ovarian hyperstimulation syndrome (OHSS) and suspicious cytologic findings, were at risk for developing malignant ovarian tumours after treatment. METHODS Patients who underwent OIT at our IVF clinic were enrolled in this study and assessed for any evidence of malignant ovarian tumours. Patients who developed severe OHSS as a result of OIT were treated with a culdocentesis. Cells from the ascitic fluid were cytologically scored for abnormality and malignancy. Peripheral blood samples were obtained from patients with severe OHSS to determine serum levels of the tumour markers (CA-125 and HE4) that were used to calculate the Risk for Ovarian Malignancy Algorithm (ROMA) index. RESULTS Follow-up data were available for 1,353 of the 1,587 patients (85%) who underwent OIT at our IVF clinic between January 2006 and December 2012. Twenty-three patients (1.4%) were hospitalized with OHSS. Culdocentesis was performed 16 times in nine patients with severe OHSS (age range, 23-34 years; mean, 27.1 years). Although cytological examination of the ascitic cells of these patients suggested malignant ovarian neoplasia, over the course of the observation period, the ovarian volume gradually decreased and became normal. Subsequent cytological and histological examinations failed to find evidence of any malignant tumours in these nine patients. None of the 1,353 participants who underwent OIT developed any malignant ovarian tumours during the study period. Moreover, none of the 462 patients who were in our ovarian tumour registry were also participants in the IVF program. CONCLUSIONS The presence of atypical cells in the ascitic fluid of women with severe OHSS does not likely indicate malignancy; therefore, radical surgical intervention is not justified. The risk of malignancy is minimal shortly after OIT. At our centre, OIT has not been associated with any cases of ovarian tumour.
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Affiliation(s)
- Ioannis Hatzipetros
- Department of Obstetrics and Gynaecology, University of Pecs, Clinical Centre, Edesanyak Str. 17, 7624 Pecs, Hungary
| | - Peter M Gocze
- Department of Obstetrics and Gynaecology, University of Pecs, Clinical Centre, Edesanyak Str. 17, 7624 Pecs, Hungary
| | | | - Kalman Kovacs
- Department of Obstetrics and Gynaecology, University of Pecs, Clinical Centre, Edesanyak Str. 17, 7624 Pecs, Hungary
| | - Endre Kalman
- Department of Pathology, University of Pecs, Pecs, Hungary
| | - Balint Farkas
- Department of Obstetrics and Gynaecology, University of Pecs, Clinical Centre, Edesanyak Str. 17, 7624 Pecs, Hungary
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