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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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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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Lumley E, O'Cathain A, Drabble S, Pye C, Brian K, Metwally M. Managing ovarian hyperstimulation syndrome: A qualitative interview study with women and healthcare professionals. J Clin Nurs 2023; 32:6599-6610. [PMID: 37078453 DOI: 10.1111/jocn.16701] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 04/21/2023]
Abstract
AIM To explore the experiences of women who have had ovarian hyperstimulation syndrome, and healthcare professionals who care for them. BACKGROUND Ovarian hyperstimulation syndrome is a side effect of fertility treatment. Little research exists internationally that explores the experiences of women who have had this condition, or the healthcare professionals who manage it. DESIGN Qualitative study using semi-structured interviews. METHODS Eighteen interviews with women who had experienced ovarian hyperstimulation syndrome (n = 10) and healthcare professionals (n = 8) in six UK fertility centres. Framework analysis was used. This paper is reported following COREQ guidelines. RESULTS Women described a range of symptoms and severity, sometimes experiencing worrying physical health problems such as abdominal swelling and shortness of breath. The combination of the symptoms, and their management, on delaying future fertility treatment could cause emotional distress. Healthcare professionals at different centres described variation in practice, which generally involved 'active monitoring' until symptoms became severe, when women would be hospitalised. Women expressed feeling 'left in limbo' while waiting for symptoms to improve or worsen, and described a lack of control during this waiting period. Healthcare professionals felt they provided adequate information about ovarian hyperstimulation syndrome and its management. This, however, did not align with women's perceptions that information, including potential delays to their fertility treatment, was missing. There was similar mismatch between women's and healthcare professionals' views of decision-making about fertility treatment following ovarian hyperstimulation syndrome, including women's concerns about having to make rushed, unplanned decisions about their fertility treatment when they did not feel adequately informed to do so. CONCLUSION Ovarian hyperstimulation syndrome and its management can have a significant physical and emotional impact on women, and influence their fertility treatment. Improvements could be made to the information women receive about this condition, its management and its implications for wider fertility treatment. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses have the skills and knowledge to support women through the physical and emotional stresses of fertility treatment. Therefore, they are well placed to provide specialist information and support for OHSS and ensure women are fully informed about all aspects of the condition, including how its management might delay fertility treatment.
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Affiliation(s)
- Elizabeth Lumley
- Health and Care Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Alicia O'Cathain
- Health and Care Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Sarah Drabble
- Health and Care Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Clare Pye
- Jessops Wing, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Kate Brian
- PPI Representative for STOP-OHSS and Member of Fertility Network, London, UK
| | - Mostafa Metwally
- Jessops Wing, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
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Cao M, Liu Z, Lin Y, Luo Y, Li S, Huang Q, Liu H, Liu J. A Personalized Management Approach of OHSS: Development of a Multiphase Prediction Model and Smartphone-Based App. Front Endocrinol (Lausanne) 2022; 13:911225. [PMID: 35872996 PMCID: PMC9296830 DOI: 10.3389/fendo.2022.911225] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed to develop multiphase big-data-based prediction models of ovarian hyperstimulation syndrome (OHSS) and a smartphone app for risk calculation and patients' self-monitoring. METHODS Multiphase prediction models were developed from a retrospective cohort database of 21,566 women from January 2017 to December 2020 with controlled ovarian stimulation (COS). There were 17,445 women included in the final data analysis. Women were randomly assigned to either training cohort (n = 12,211) or validation cohort (n = 5,234). Their baseline clinical characteristics, COS-related characteristics, and embryo information were evaluated. The prediction models were divided into four phases: 1) prior to COS, 2) on the day of ovulation trigger, 3) after oocyte retrieval, and 4) prior to embryo transfer. The multiphase prediction models were built with stepwise regression and confirmed with LASSO regression. Internal validations were performed using the validation cohort and were assessed by discrimination and calibration, as well as clinical decision curves. A smartphone-based app "OHSS monitor" was constructed as part of the built-in app of the IVF-aid platform. The app had three modules, risk prediction module, symptom monitoring module, and treatment monitoring module. RESULTS The multiphase prediction models were developed with acceptable distinguishing ability to identify OHSS at-risk patients. The C-statistics of the first, second, third, and fourth phases in the training cohort were 0.628 (95% CI 0.598-0.658), 0.715 (95% CI 0.688-0.742), 0.792 (95% CI 0.770-0.815), and 0.814 (95% CI 0.793-0.834), respectively. The calibration plot showed the agreement of predictive and observed risks of OHSS, especially at the third- and fourth-phase prediction models in both training and validation cohorts. The net clinical benefits of the multiphase prediction models were also confirmed with a clinical decision curve. A smartphone-based app was constructed as a risk calculator based on the multiphase prediction models, and also as a self-monitoring tool for patients at risk. CONCLUSIONS We have built multiphase prediction models based on big data and constructed a user-friendly smartphone-based app for the personalized management of women at risk of moderate/severe OHSS. The multiphase prediction models and user-friendly app can be readily used in clinical practice for clinical decision-support and self-management of patients.
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Affiliation(s)
- Mingzhu Cao
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhi Liu
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanshan Lin
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yiqun Luo
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sichen Li
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qing Huang
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haiying Liu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Haiying Liu, ; Jianqiao Liu,
| | - Jianqiao Liu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Haiying Liu, ; Jianqiao Liu,
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Li D, Hu S, Meng X, Yu X. Changes in thyroid function during controlled ovarian hyperstimulation (COH) and its impact on assisted reproduction technology (ART) outcomes: a systematic review and meta-analysis. J Assist Reprod Genet 2021; 38:2227-2235. [PMID: 33928487 DOI: 10.1007/s10815-021-02206-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/29/2020] [Accepted: 04/20/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate the thyroid function changes during controlled ovarian hyperstimulation (COH) and ascertain its impact on reproductive outcomes. METHODS We conducted meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed to identify studies reported changes in thyroid parameters during COH. We analyzed thyroid-stimulating hormone (TSH) levels, free thyroxin (fT4) levels, changes in estrogens (E2), thyroxine-binding globulin (TBG), relative risks (RRs) of clinical pregnancy rate (CPR), live birth rate (LBR), and mean difference (MD) of TSH increment between the miscarriage group and ongoing pregnancy group. RESULTS This meta-analysis included fifteen individual studies (n = 1665 subjects). At the end of COH, the mean TSH (2.53 mIU/L; 95% CI, 2.19 to 2.88; I2 = 92.9%) exceeded the upper limit (2.5 mIU/L) and remained above the threshold until one month following embryo transfer (ET). Thyroxin decreased from baseline to the end of COH (-0.18 ng/l; 95% CI, -0.35 to 0.00; I2 = 92.2%). The CPR and LBR of patients with TSH exceeding the cutoff after COH were significantly lower than those of patients with TSH below the threshold (CPR: RR, 0.62; 95% CI, 0.47 to 0.82; I2 = 0.0% and LBR: RR, 0.64; 95% CI, 0.44 to 0.92; I2 = 0.0%). The MD of the increment in TSH levels between the miscarriage and ongoing pregnancy groups was 0.40 mIU/L (95% CI, 0.15 to 0.65; I2 = 0.0%). CONCLUSIONS This meta-analysis shows that TSH increases and fT4 decreases during COH. COH-induced thyroid disorder impairs reproductive outcomes.
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Affiliation(s)
- Danpei Li
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Sitao Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyu Meng
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuefeng Yu
- Branch of National Clinical Research Center for Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
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Du X, Zhang W, Wang X, Yu X, Li Z, Guan Y. Follicle-Stimulating Hormone-Secreting Pituitary Adenoma Inducing Spontaneous Ovarian Hyperstimulation Syndrome, Treatment Using In Vitro Fertilization and Embryo Transfer: A Case Report. Front Endocrinol (Lausanne) 2021; 12:621456. [PMID: 34248835 PMCID: PMC8264655 DOI: 10.3389/fendo.2021.621456] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/18/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To describe the management of a patient with a pituitary adenoma secreting follicle-stimulating hormone (FSH) associated with spontaneous ovarian hyperstimulation syndrome (sOHSS) who was treated with in vitro fertilization and embryo transfer (IVF-ET). METHODS We report a clinical case of a woman of reproductive age with menstrual irregularity, infertility and ovarian hyperstimulation due to recurrent pituitary adenoma secreting FSH, which persisted after transsphenoidal surgery.She underwent the diagnosis by magnetic resonance imaging (MRI) and laboratory tests,and finally she was treated with IVF-ET. RESULTS The patient was plagued by a recurrent pituitary adenoma for many years and tried various treatments. After complete transsphenoidal surgery, sOHSS decreased, as shown by a reduction in oestradiol levels and an improvement in the ultrasonography parameters; however, secondary amenorrhea occurred. Finally, pregnancy was achieved through IVF-ET and the symptoms of ovarian hyperstimulation were relieved. CONCLUSIONS IVF-ET was found to be effective for the treatment of recurrent pituitary adenoma, thus representing a therapeutic option that should be taken into consideration in such cases.
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Wei W, Liu LY, Chen L, Su MH, Hong XJ. Acupuncture for "poor ovarian response" of women to controlled ovarian hyperstimulation: A protocol for meta-analysis and systematic review. Medicine (Baltimore) 2020; 99:e22868. [PMID: 33126333 PMCID: PMC7598851 DOI: 10.1097/md.0000000000022868] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Poor ovarian response (POR) is a high-incidence disease of women, which cause in vitro fertilization failure. Various treatment options have been proposed for women with POR to improve their ovarian response, but with little effect. In recent years, there is a wide range of applications of acupuncture in the process of in vitro fertilization. The meta-analysis and systematic review are designed to analyze whether acupuncture is effective for patients with POR. METHODS The following databases will be searched from inception to March 2020: Electronic databases consist of MEDLINE, EMBASE, Allied and Complementary Medicine Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, the Chinese Scientific Journal Database, and Wanfang Database. Other literature resources will also be searched including clinical trial registries, key journals, and meeting records. The results of randomized controlled trials of acupuncture therapy on POR, which are published in Chinese or English, will be embedded. The primary outcome is the clinical pregnancy rate. Data identification, data selection, data extraction, and assessment of bias risk will be completed independently by 2 or more reviewers. STATA/IC 16 will be used to perform the meta-analysis. We will use the Grading of Recommendations Assessment, Development, and Evaluation system to evaluate the quality of our evidence. A systematic narrative synthesis will be provided if the quantitative analysis is not available. DISCUSSION This study will provide the first meta-analysis and systematic review to evaluate the efficacy of acupuncture in treating POR. This protocol provides details to guide this study. CONCLUSIONS From this review may benefit POR patients or clinical decision-makers. PROSPERO REGISTRATION NUMBER PROSPERO CRD42020169560.
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Rotshenker-Olshinka K, Badeghiesh A, Volodarsky-Perel A, Steiner N, Suarthana E, Dahan MH. Trends in ovarian hyperstimulation syndrome hospitalization rates in the USA: an ongoing concern. Reprod Biomed Online 2020; 41:357-360. [PMID: 32693992 DOI: 10.1016/j.rbmo.2020.06.004] [Citation(s) in RCA: 4] [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: 04/26/2020] [Revised: 05/23/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a serious, almost exclusively, iatrogenic complication of ovarian stimulation. Many techniques have been developed over the past 25 years to decrease OHSS risks, and most have been in common use for 15-20 years. In view of these techniques, it could be hypothesized that severe OHSS rates would decrease or almost disappear. According to the US National ART Surveillance System, rates did not change significantly between 2000 and 2009, at 106 OHSS cases per 10,000 IVF cycles annually. In the present study, OHSS-related hospital admissions were evaluated to establish whether a decline has occurred in OHSS admissions since the development of preventative strategies. A retrospective-population-based study was conducted using data from the Health-Care Cost and Utilization Project-Nationwide-Inpatient-Sample database between 2004 and 2014 inclusively. Between 2004 and 2008, admissions of OHSS decreased in absolute numbers and rates; however, these statistics plateaued, remaining stable between 2008 and 2014. Despite this, OHSS remains a concern and is clearly not a disease of the past. The financial burden of OHSS hospitalizations likely persists. Although techniques have resulted in a decrease in OHSS admissions since 2004, this change has plateaued, and therefore efforts to further reduce OHSS must continue.
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Affiliation(s)
- Keren Rotshenker-Olshinka
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal Quebec H3A 0G4, Canada; MUHC Reproductive Centre, McGill University, Montréal Quebec H2L 4S8, Canada.
| | - Ahmad Badeghiesh
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal Quebec H3A 0G4, Canada
| | - Alexander Volodarsky-Perel
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal Quebec H3A 0G4, Canada; MUHC Reproductive Centre, McGill University, Montréal Quebec H2L 4S8, Canada
| | - Naama Steiner
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal Quebec H3A 0G4, Canada; MUHC Reproductive Centre, McGill University, Montréal Quebec H2L 4S8, Canada
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal Quebec H3A 0G4, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal Quebec H3A 0G4, Canada; MUHC Reproductive Centre, McGill University, Montréal Quebec H2L 4S8, Canada
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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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Osakwe E, Meighan V, Cunningham K, Morrissey B. Point of Care Ultrasound in the Diagnosis and Management of Severe Ovarian Hyperstimulation Syndrome. Ir Med J 2020; 113:11. [PMID: 32298563] [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: 06/11/2023]
Abstract
Presentation A 32year old woman, presented with a 5-day history of non-productive cough, chest pain, shortness of breath andabdominal bloating. She had undergone Embryo Transfer Treatment 6 days previously. Diagnosis A point of care ultrasound (POCUS) exam was performed as part of her initial investigations which showed right pleuraleffusion, ascites and cystic ovaries. Treatment She received Oxygen, IV Fluids and Antibiotics and was referred to the Obstetricians. Discussion Point of care ultrasound (POCUS) aided the prompt diagnosis of ovarian hyperstimulation syndrome (OHSS) in thispatient, making it possible for her to receive appropriate resuscitation and referral and an excellent outcome despitethis being a case of severe ovarian hyperstimulation syndrome.
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Affiliation(s)
- E Osakwe
- Emergency Department, Sligo University Hospital, The Mall, Sligo, Ireland
| | - V Meighan
- Emergency Department, Sligo University Hospital, The Mall, Sligo, Ireland
| | - K Cunningham
- Emergency Department, Sligo University Hospital, The Mall, Sligo, Ireland
| | - B Morrissey
- Emergency Department, Sligo University Hospital, The Mall, Sligo, Ireland
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Cao Y, Shi H, Ma Y, Ma L, Zhai J. Effect and Relationship of Seasons on the High Risk of Ovarian Hyperstimulation Syndrome After Oocyte Retrieval in Patients With Polycystic Ovary Syndrome. Front Endocrinol (Lausanne) 2020; 11:610828. [PMID: 33574799 PMCID: PMC7870698 DOI: 10.3389/fendo.2020.610828] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/07/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the effect of seasons on the incidence of high risk of ovarian hyperstimulation syndrome (OHSS) after in oocyte retrieval in patients with polycystic ovarian syndrome (PCOS) and to establish a nomogram to predict the risk of OHSS. DESIGN Single-center, retrospective study. SETTING University-affiliated reproductive medicine center. PATIENTS A total of 2,030 infertility patients with PCOS underwent the follicular phase long-acting long protocol IVF/ICSI in the reproductive medicine center from January 2017 to December 2019. INTERVENTIONS None. MAIN OUTCOME MEASURES Logistic regression analysis was used to analyze the factors associated with a high risk of OHSS. We established a nomogram to predict the risk of OHSS in infertility patients with PCOS after oocyte retrieval. RESULTS The incidence of patients at high risk of OHSS was significantly different from season-to-season and was especially higher in the summer and winter. Multivariate logistic analysis showed that gonadotropin dosage, number of retrieved oocytes, estradiol level, average bilateral ovarian diameter on the day human chorionic gonadotropin was administered, type of infertility, and average temperature were independent risk factors for OHSS after oocyte retrieval in PCOS patients. Based on the above independent risk factors, we constructed a prediction model for OHSS risk. To evaluate the efficiency of the prediction model, we calculated the C-index (0.849), area under the receiver operating characteristic curve (0.849), and internal validation C-index (0.846). Decision curve analysis suggested that the prediction model exhibited significant net benefits. CONCLUSIONS The incidence of PCOS patients at high risk for OHSS after oocyte retrieval fluctuated with seasonal temperature changes, and was significantly higher in extreme climates. The prediction model had favorable predictive performance and clinical application value.
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Affiliation(s)
- Yurong Cao
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Shi
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yue Ma
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linna Ma
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Zhai
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Jun Zhai,
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Abstract
To analyze the management of severe ovarian hyperstimulation syndrome based on aspects of its etiology and pathogenesis a systematic review of the literature was done. An evaluation of clinical trials, meta-analysis, case-reports and reviews assessing the management of different conditions related to ovarian hyperstimulation syndrome was made using the following data sources: MEDLINE Pubmed (from 1966 to July 2018) and the Cochrane Controlled Clinical Trials Register, Embase (up to July 2018). The role of intra-abdominal hypertension in the development of the severe forms of ovarian hyperstimulation syndrome and its complicated outcomes was assessed. The pathophysiology and clinic of intra-abdominal hypertension syndrome are almost identical to moderate and severe forms of ovarian hyperstimulation syndrome and associated organ dysfunction. The classic triad (respiratory disorders, reduction in venous return, and restriction of perfusion in internal organs) is present in severe ovarian hyperstimulation syndrome as well as in intra-abdominal hypertension syndrome. This review provides recommendations for the management of ovarian hyperstimulation syndrome and insight into the different medical complaints of this syndrome. The principles of therapy for intra-abdominal hypertension syndrome might be considered in the treatment of severe forms of ovarian hyperstimulation syndrome.
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Affiliation(s)
- Aleksei Petrovich Petrenko
- a Faculty of Medicine , Institut Clinic of Gynecology, Obstetrics and Neonatology, University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
- b Department of Anesthesiology , Y.Ya. Gordeev City Clinical Hospital №1 , Saratov , Russian Federation
| | - Camil Castelo-Branco
- a Faculty of Medicine , Institut Clinic of Gynecology, Obstetrics and Neonatology, University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | - Dmitrij Vasilevich Marshalov
- c Department of Obstetrics and Gynecology, Medical Faculty , V.I. Razumovsky Saratov State Medical University , Saratov , Russian Federation
| | - Igor Arkadevich Salov
- c Department of Obstetrics and Gynecology, Medical Faculty , V.I. Razumovsky Saratov State Medical University , Saratov , Russian Federation
| | - Efim Munevich Shifman
- d 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
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Song J, Sun Z. A borderline form of empty follicle syndrome treated with a double-trigger of gonadotropin-releasing hormone agonist and human chorionic gonadotropin: A case report. Medicine (Baltimore) 2019; 98:e16213. [PMID: 31277129 PMCID: PMC6635269 DOI: 10.1097/md.0000000000016213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 01/16/2023] Open
Abstract
RATIONALE The borderline form of empty follicle syndrome (EFS) is a phenomenon where only a few mature or immature oocytes are retrieved despite adequate response to controlled ovarian hyperstimulation (COH). It is a rare phenomenon with an unclear underlying mechanism, and there is currently no effective treatment. PATIENT CONCERNS The patient received 3 assisted reproductive technology cycles, and although her follicular development and estrogen levels were normal during COH, the outcome with respect to the oocytes obtained was unsatisfactory. DIAGNOSES Borderline form of EFS. INTERVENTIONS In the context of undergoing GnRH-antagonist protocol, we implemented a double-trigger with human chorionic gonadotropin (hCG) after 6 hours of gonadotropin-releasing hormone agonist (GnRH-a) administration. OUTCOMES Eleven oocytes were obtained (M I × 3, M II × 8), which underwent in vitro fertilization (IVF). After 18 hours, 7 oocytes showed normal fertilization, with 2 embryos formed 72 hours later (embryo rating, 6C II × 1, 9C II × 1); the embryos were then frozen. LESSONS Oocyte maturation and ovulation are time-dependent processes, and that different patients require different lengths/intervals of time for treatment. Therefore, the borderline form of EFS, in general, may be treatable, and our novel trigger method provides a new treatment option for such patients in the future.
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Affiliation(s)
- Jingyan Song
- Shandong University of Traditional Chinese Medicine
- Reproductive and Genetic Center of Integrated Traditional and Western Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhengao Sun
- Shandong University of Traditional Chinese Medicine
- Reproductive and Genetic Center of Integrated Traditional and Western Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Irani M, Robles A, Gunnala V, Chung P, Rosenwaks Z. Unilateral pleural effusion as the sole clinical presentation of severe ovarian hyperstimulation syndrome: a systematic review. Gynecol Endocrinol 2018; 34:92-99. [PMID: 29063807 DOI: 10.1080/09513590.2017.1390738] [Citation(s) in RCA: 6] [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: 10/18/2022] Open
Abstract
The pathophysiology of isolated pleural effusion in ovarian hyperstimulation syndrome (OHSS) is not well defined. The objective of the current review is to delineate the pathophysiology, risk factors, preventive measures, and therapeutic options of isolated pleural effusion in severe OHSS. Major databases were searched until June 2016. Studies evaluating women who presented with pleural effusion as the sole extra-ovarian manifestation of severe OHSS were included. Data were extracted from 24 articles encompassing 30 reported cases. Values were expressed as mean ± SEM. Patients were young (31.5 ± 0.8 years old) and 29.1% of them were diagnosed with polycystic ovary syndrome. All the patients received human chorionic gonadotropin to trigger oocyte maturation. Estradiol level was 3110 ± 330 pg/mL on the day of the ovulatory trigger. Dyspnea was the presenting symptom in 86.6% of the patients. Pleural effusion was predominantly on the right side (80%). Ninety percent of the patients underwent thoracentesis (4332 ± 769 mL): 66.7% exudate and 33.3% transudate. Fluid initially accumulates in the peritoneal cavity then enters the pleural space due to the pressure gradient through the thoracic duct and diaphragmatic defects, which are more common on the right side. The risk factors, prevention, and management, which are also discussed in this review, are similar to those of severe OHSS.
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Affiliation(s)
- Mohamad Irani
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
| | - Alex Robles
- b Department of Obstetrics and Gynecology , Weill Cornell Medicine , New York , NY , USA
| | - Vinay Gunnala
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
| | - Pak Chung
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
| | - Zev Rosenwaks
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
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Bhavsar PN, Padwal NJ, Bhide M, Ghagare SP, Joshi AR, Karnik ND. Life-threatening Medical Complications Due to Ovarian Hyperstimulation Syndrome: A Hidden Etiology. J Assoc Physicians India 2017; 65:87-91. [PMID: 29322719] [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
Ovarian hyperstimulation syndrome is usually an iatrogenic complication in women taking ovulation induction medications during assisted reproduction. We hereby report the case of a 25 years old female who presented with hypertension, polyserositis with tense ascites and large cystic ovaries. She developed sigmoid and transverse sinus thrombosis. She had undergone a clandestine ovulation induction therapy as a commercial ovum donor. She fitted in severe category of ovarian hyperstimulation syndrome.
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Affiliation(s)
| | | | | | | | - Anagha R Joshi
- Professor, Department of Radiology, LTM Medical College and LTMG Hospital, Mumbai, Maharashtra
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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
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) in assisted reproductive technology (ART) cycles is a treatment-induced disease that has an estimated prevalence of 20% to 33% in its mild form and 3% to 8% in its moderate or severe form. These numbers might even be higher for high-risk women such as those with polycystic ovaries or a high oocyte yield from ovum pickup. OBJECTIVES The objective of this overview is to identify and summarise all evidence from Cochrane systematic reviews on interventions for prevention or treatment of moderate, severe and overall OHSS in couples with subfertility who are undergoing ART cycles. METHODS Published Cochrane systematic reviews reporting on moderate, severe or overall OHSS as an outcome in ART cycles were eligible for inclusion in this overview. We also identified Cochrane submitted protocols and title registrations for future inclusion in the overview. The evidence is current to 12 December 2016. We identified reviews, protocols and titles by searching the Cochrane Gynaecology and Fertility Group Database of Systematic Reviews and Archie (the Cochrane information management system) in July 2016 on the effectiveness of interventions for outcomes of moderate, severe and overall OHSS. We undertook in duplicate selection of systematic reviews, data extraction and quality assessment. We used the AMSTAR (Assessing the Methodological Quality of Systematic Reviews) tool to assess the quality of included reviews, and we used GRADE methods to assess the quality of the evidence for each outcome. We summarised the characteristics of included reviews in the text and in additional tables. MAIN RESULTS We included a total of 27 reviews in this overview. The reviews were generally of high quality according to AMSTAR ratings, and included studies provided evidence that ranged from very low to high in quality. Ten reviews had not been updated in the past three years. Seven reviews described interventions that provided a beneficial effect in reducing OHSS rates, and we categorised one additional review as 'promising'. Of the effective interventions, all except one had no detrimental effect on pregnancy outcomes. Evidence of at least moderate quality indicates that clinicians should consider the following interventions in ART cycles to reduce OHSS rates.• Metformin treatment before and during an ART cycle for women with PCOS (moderate-quality evidence).• Gonadotrophin-releasing hormone (GnRH) antagonist protocol in ART cycles (moderate-quality evidence).• GnRH agonist (GnRHa) trigger in donor oocyte or 'freeze-all' programmes (moderate-quality evidence). Evidence of low or very low quality suggests that clinicians should consider the following interventions in ART cycles to reduce OHSS rates.• Clomiphene citrate for controlled ovarian stimulation in ART cycles (low-quality evidence).• Cabergoline around the time of human chorionic gonadotrophin (hCG) administration or oocyte pickup in ART cycles (low-quality evidence).• Intravenous fluids (plasma expanders) around the time of hCG administration or oocyte pickup in ART cycles (very low-quality evidence).• Progesterone for luteal phase support in ART cycles (low-quality evidence).• Coasting (withholding gonadotrophins) - a promising intervention that needs to be researched further for reduction of OHSS.On the basis of this overview, we must conclude that evidence is currently insufficient to support the widespread practice of embryo cryopreservation. AUTHORS' CONCLUSIONS Currently, 27 reviews in the Cochrane Library were conducted to report on or to try to report on OHSS in ART cycles. We identified four review protocols but no new registered titles that can potentially be included in this overview in the future. This overview provides the most up-to-date evidence on prevention of OHSS in ART cycles from all currently published Cochrane reviews on ART. Clinicians can use the evidence summarised in this overview to choose the best treatment regimen for individual patients - a regimen that not only reduces the chance of developing OHSS but does not compromise other outcomes such as pregnancy or live birth rate. Review results, however, are limited by the lack of recent primary studies or updated reviews. Furthermore, this overview can be used by policymakers in developing local and regional protocols or guidelines and can reveal knowledge gaps for future research.
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Affiliation(s)
- Selma Mourad
- Radboud University Medical CentreNijmegenNetherlands
| | - Julie Brown
- The University of AucklandLiggins InstitutePark RdGraftonAucklandNew Zealand1142
| | - Cindy Farquhar
- University of AucklandDepartment of Obstetrics and GynaecologyFMHS Park RoadGraftonAucklandNew Zealand1003
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Yang F, Hu H, He PZ, Zhang M, Qian Y, Li Y. Severe ovarian hyperstimulation syndrome in a naturally conceived singleton pregnancy after ovulation induction: a case report. CLIN EXP OBSTET GYN 2017; 44:292-295. [PMID: 29746043] [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: 06/08/2023]
Abstract
OBJECTIVE To present a case of severe ovarian hyperstimulation syndrome (OHSS) in a naturally conceived singleton pregnancy after ovulation induction. CASE A 31-year-old woman with polycystic ovarian syndrome (PCOS) underwent ovulation induction therapy. Six days later, she was admitted to the present hospital with the symptoms of OHSS. Ultrasonography confirmed the single live intrauterine pregnancy, as well as enlarged multicystic ovaries and marked ascites that required abdominal paracentesis. The woman was treated with intravenous infusion, exogenous colloid supplementation, essentiale liver treatment, rocephin anti-infective therapy for skin lymphangitis of left lower limb, and drainage of the ascites. She recovered by day 45 of admission. CONCLUSION Severe OHSS may develop in women with PCOS who undergo ovulation induction therapy. Serious complications may develop rapidly and therefore OHSS must be treated urgently and with multidisciplinary management.
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Ding L, Li M, Yan L, Tang R, Chen ZJ. Effect of cervical conization on pregnancy outcome of in-vitro fertilization/intracytoplasmic sperm injection treatment: a retrospective cohort study. CLIN EXP OBSTET GYN 2016; 43:546-549. [PMID: 29734546] [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: 06/08/2023]
Abstract
AIMS To investigate the effect of cervical conization on the outcome of in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. Materials andMethods: The authors performed a retrospective, database-searched cohort study based on patients undergoing controlled ovarian hyperstimulation and IVF/ICSI between 2009 and 2013 in the present hospital. Cervical intraepithelial neoplasia (CIN) or cervical cancer was carefully confirmed by transvaginal ultrasound, hysteroscopy, and biopsy. High-quality case-control study with strict inclusion criteria was conducted. The authors analyzed basic characters and main IVF/ICSI outcomes between both groups. RESULTS The authors included 48 patients with a history of cervical conization who underwent IVF/ICSI and control group without cervical conization. No significant differences were found in IVF/ICSI outcomes between both groups. No obvious evidence was found indicating that cervical stenosis could impact IVF operation. CONCLUSIONS The present results suggest that cervical conization does not affect IVF/ICSI outcomes. Patients can receive cervical conization before undertaking assisted reproductive technology.
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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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Carter R, Petrie K, Sadighi A, Skene H. Ovarian hyperstimulation syndrome on the acute medical unit: a problem-based review. Acute Med 2015; 14:21-27. [PMID: 25745646] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Ovarian Hyperstimulation Syndrome (OHSS) is a spectrum of clinical features typically resulting from assisted conception techniques. With 2.35% of all live births in the UK resulting from in-vitro fertilisation (IVF), OHSS is on the rise. Moreover, there has been an increase in the presentation of its complications to GP surgeries and unscheduled acute care services nationwide. This review will discuss signs and symptoms of the increasingly common and potentially fatal complications of OHSS, namely pleural effusion, ascites and thromboembolic events. With such propensity toward critical, life-threatening events it is not only prudent to recognise the population at risk, but also to be aware of the signs, symptoms and complications to expedite treatment and ensure optimum outcome.
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Affiliation(s)
- R Carter
- Chelsea & Westminster Hospital, 369 Fulham Road, London
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22
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Kulikov AV, Shifman EM, Portnov IG. [Intensive therapy of ovarian hyperstimulation syndrome (clinical guidelines)]. Anesteziol Reanimatol 2015; 60:73-76. [PMID: 26027232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Hong YL, Tan Y, Yin YY, Zou YJ, Guo YH, Nie XW. [Effect of electro-acupuncture on clinical outcomes and ovarian hyperstimulation syndrome in in vitro fertilization and embryo transplantation]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2014; 34:1292-1296. [PMID: 25566616] [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
OBJECTIVE To observe the effect of electro-acupuncture (EA) on clinical outcomes and the occurrence of ovarian hyperstimulation syndrome (OHSS) in in vitro fertilization and embryo transplantation. METHODS Totally 109 patients who routinely received in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) at Reproductive Center were assigned to the control group (56 cases) and the EA group (53 cases) according to even and odd-numbered date. Patients in the control group received controlled ovarian hyperstimulation (COH) referring to GnRH-a long protocol. On the basis of COH, those in the EA group received EA from the day of Gn injection to the day of embryo transfer. Estradiol (E2), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), and angiotensin (AT) II were measured in all patients on the day of hCG injection, the day of ovum pick up (OPU), and the day of embryo transfer (ET), respectively. The oocyte retrieval rate, good quality embryo rate, clinical pregnancy rate, the abortion rate, and the occurrence of OHSS were compared between the two groups. RESULTS Compared with the control group, serum E2 levels on the day of OPU and the day of ET were significantly lower in the EA group (P < 0.05). On the day of OPU levels of VEGF and IL-6 also significantly decreased (P < 0.05). Serum levels of VEGF and IL-6 reached the highest line on the day of hCG in the two groups, and then showed a decreasing trend. Compared with the control group at the same time point, serum levels of VEGF and IL-6 obviously decreased on on the day of OPU, hCG, and ET (P < 0.05). The occurrence of OHSS and the canceling rate of transplant cycle were significantly lower in the EA group than in the control group (P < 0.05). CONCLUSIONS EA, as an adjunctive therapy, could reduce the occurrence of OHSS in IVF. Besides, it did not decrease good embryo rates and pregnancy rates in IVF-ET, which might be associated with lowering local vascular permeability of ovaries.
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Affiliation(s)
- Yan-Li Hong
- Department of Gynecology, Nanjing University of Chinese Medicine, China
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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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Haas J, Yinon Y, Meridor K, Orvieto R. Pregnancy outcome in severe OHSS patients following ascitic/plerural fluid drainage. J Ovarian Res 2014; 7:56. [PMID: 24872846 PMCID: PMC4036081 DOI: 10.1186/1757-2215-7-56] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 05/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various inflammatory cytokines have been implicated in the pathophysiology of severe ovarian hyperstimulation syndrome, as well as, various pregnancy complications, including preterm labor, pregnancy induced hypertension/preeclampsia and intra-uterine growth restriction. We aim to determine whether severe OHSS, complicated by third space fluid accumulation necessitating drainage, is associated with increased risk of late obstetrics complications. METHODS We assessed the obstetrics and neonatal outcome measures of 16 patients admitted to our gynecology ward during a 6-year period, with severe OHSS complicated by third space fluid accumulation necessitating drainage. RESULTS Patients delivered at 37.3 ± 5.9weeks, with a mean birth weight of 3062 ± 757 gr. There was no single case of gestational diabetes, hypertensive diseases of pregnancy, nor placental abruption. Two (12.5%) patients had preterm delivery: one at 23 weeks' gestation and one at 28 weeks' gestation following preterm premature rupture of membrane. Another patient experienced an unexplained antepartum fetal death at 27 weeks' gestation. CONCLUSIONS Severe OHSS, complicated by third space fluid sequestration necessitating drainage, is not associated with adverse late pregnancy outcome, except probably for preterm labor. Following resolution of the OHSS, pregnancies should be regarded as any pregnancy resulting from IVF treatment, with special attention to prevent preterm labor.
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Affiliation(s)
- Jigal Haas
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Yinon
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katya Meridor
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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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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Sahin L, Yavuzcan A. Recurrent spontaneous ovarian hyperstimulation in a virgin girl. Ginekol Pol 2013; 84:647-649. [PMID: 24032279] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) develops due to the release of vasoactive mediators induced by excessively luteinized and enlarged ovaries. Most OHSS cases are iatrogenic subsequent to ovulation induction. We report the first case of recurrent OHSS developed during normal menstral cycle in a virgin girl, diagnosed with ultrasonography and magnetic resonance imaging.
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Affiliation(s)
- Levent Sahin
- Department of Obstetrics and Gynecology, Anadolu Hospital, Antalya, Turkey
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Lima M, Sousa M, Oliveira C, Silva J, Teixeira Da Silva J, Cunha M, Viana P, Barros A. [Ovarian hyperstimulation syndrome: experience of a reproductive medicine center 2005-2011]. ACTA MEDICA PORT 2013; 26:24-32. [PMID: 23697354] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 01/23/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Ovarian Hyperstimulation Syndrome is a complication of controlled ovarian hyperstimulation during cycles of Assisted Medical Reproduction. The objective of this work was to analyze those cycles to achieve a better knowledge of this pathology, namely risk factors and strategies for prevention and treatment of Ovarian Hyperstimulation Syndrome. MATERIALS AND METHODS Retrospective analysis of 4870 ART cycles (2005 - 2011), with moderate (27) and severe (24) Ovarian Hyperstimulation Syndrome. Data was analyzed for patients' characteristics, stimulation protocol, embryologic and clinical outcomes, and treatment performed. RESULTS In Ovarian Hyperstimulation Syndrome groups the mean ages and the doses of rFSH + HMG were lower, and the serum E2 levels, doses of HCG, number of oocytes retrieved as well as the rates of blastocyst, biochemical and clinical pregnancy, implantation, newborns, very preterm birth and newborns with low and very low weight were significantly higher. Patients with severe Ovarian Hyperstimulation Syndrome were hospitalized and received only support measures with no complications. DISCUSSION Ovarian Hyperstimulation Syndrome is associated with conditions that can bring risk to the fetus, namely prematurity and low birth weight, so the pregnancy should be carefully monitored in these cases. CONCLUSIONS Young age is a risk factor for Ovarian Hyperstimulation Syndrome and high serum E2 levels may predict a higher risk too and thus should induce the adoption of prevention strategies.
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Affiliation(s)
- Mariana Lima
- Departamento de Microscopia, Laboratório de Biologia Celular, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
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Di Carlo C, Savoia F, Ferrara C, Tommaselli GA, Bifulco G, Nappi C. Case report: a most peculiar family with spontaneous, recurrent ovarian hyperstimulation syndrome. Gynecol Endocrinol 2012; 28:649-51. [PMID: 22313155 DOI: 10.3109/09513590.2011.650763] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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
Ovarian hyperstimulation syndrome (OHSS) mostly occurs as a complication of induction of ovulation. However, rarely, it may occur spontaneously at the beginning of a natural pregnancy and in the absence of any assisted reproductive treatment. Spontaneous OHSS has been reported in pregnant women affected by hypothyroidism, polycystic ovary syndrome, gonadotropin-producing pituitary adenoma, but also in normal pregnancies. The aetiology of this condition is still unclear. We hereby report on a case of spontaneous, familial, recurrent OHSS in a 26-year-old primipara whose first-degree cousin, paternal grandmother and a number of other members of her father's family had suffered from a similar condition. This case seems to support the concept of a genetic predisposition for spontaneous OHSS thereby suggesting the need for preventive and therapeutic strategies.
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Affiliation(s)
- Costantino Di Carlo
- Department of Obstetrics and Gynecology, University of Naples Federico II, Naples, Italy.
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Diness M, Nilas L. [Course of mole pregnancy complicated by ovarian hyperstimulation syndrome]. Ugeskr Laeger 2012; 174:1465-1467. [PMID: 22640792] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is usually an iatrogenic condition caused by ovulation induction. Spontaneous OHSS is rare. We present a case of OHSS after dilatation and curettage of a triploid partial mole. In the case symptoms of OHSS developed after the abortion when serum human chorionic gonadotropin values were declining. Noticeable was also an affected androgen metabolism and a high level of cancer antigen-125. It is important to be aware of the OHSS diagnosis in order to avoid unnecessary surgery due to suspected ovarian malignancy. The treatment of OHSS is supportive with intravenous fluid and thrombosis prophylaxis.
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Affiliation(s)
- Marie Diness
- Gynækologisk/Obstetrisk Afdeling, Hvidovre Hospital, Kettegård Allé 30, Hvidovre.
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Federación Mexicana de Colegios de Obstetricia y Ginecología. [Prevention, early diagnosis and treatment of ovarian hyperstimulation syndrome]. Ginecol Obstet Mex 2011; 79:732-8. [PMID: 22168121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Gómez R, Ferrero H, Delgado-Rosas F, Gaytan M, Morales C, Zimmermann RC, Simón C, Gaytan F, Pellicer A. Evidences for the existence of a low dopaminergic tone in polycystic ovarian syndrome: implications for OHSS development and treatment. J Clin Endocrinol Metab 2011; 96:2484-92. [PMID: 21646367 DOI: 10.1210/jc.2011-0075] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [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: 02/04/2023]
Abstract
CONTEXT The dopamine/dopamine receptor 2 (D2/Drd2) pathway modulates vascular endothelial growth factor (VEGF)-dependent vascular permeability and angiogenesis in the ovary. Deregulation of the VEGF/VEGF receptor (VEGFR)-2 pathway leading to increased risk of ovarian hyperstimulation syndrome has been described in the ovary of patients suffering from polycystic ovarian syndrome (PCOS). OBJECTIVE The objective of the study was to ascertain whether deregulation of the VEGF/VEGFR-2 might a least be partially due to abnormalities of the D2/Drd2 pathway in PCOS women. DESIGN Dated, archived ovaries from PCOs and control group patients as well as human chorionic gonadotropin-stimulated luteinized granulosa cells form PCOS and non-PCOS oocyte patients were used. SETTING The study was conducted at a private research center. PATIENTS OR OTHER PARTICIPANTS PCOS and nonpolycystic ovarian patients and oocyte patients participated in the study. INTERVENTION(S) Human ovarian sections were stained against the Drd2 antibody. Human chorionic gonadotropin-stimulated luteinized granulosa cells (LGC) were cultured in the presence/absence and the Drd2 agonist cabergoline. MAIN OUTCOME MEASURE(S) Drd2 and vascularized stained area in the theca layer of antral (< 8 mm) and luteinized follicles was quantified. VEGF, D2, and its related metabolites were measured in the supernatant of cultured LGC by ELISA and HPLC, respectively. VEGFR-2 and Drd2 expressed by LGC was quantified through an In-Cell ELISA. RESULTS Decreased Drd2 expression and increased vascularization in the theca layer of antral and luteinized follicles of PCOS ovaries was observed. A lower dopamine production and reduced efficacy of cabergoline in inhibiting VEGF secretion was uncovered in LGC from PCOS. CONCLUSIONS Decreased dopaminergic tone as well as deregulated Drd2 signaling might explain higher VEGF and vascularization leading to increased ovarian hyperstimulation syndrome risk in PCOS.
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Affiliation(s)
- Raúl Gómez
- Fundacion IVI, Institituto Universitario IVI/Fundación Investigación Clinico de Valencia (INCLIVA), 46015 Valencia, Spain
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Rajesh H, Lee WY, Fook-Chong S, Yu SL. Ovarian hyperstimulation syndrome: an analysis of patient characteristics in the Asian population. Singapore Med J 2011; 52:168-174. [PMID: 21451925] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION We aimed to identify the variables associated with ovarian hyperstimulation in Asian patients and compare them with western standards. METHODS This is a retrospective case record analysis of 79 patients with ovarian hyperstimulation at a tertiary restructured hospital. RESULTS Gonadotropin doses resulting in hyperstimulation did not vary between long and antagonist cycles in women less than 35 years with polycystic ovaries (PCO). Mean oestradiol levels at hyperstimulation were not different between PCO and non-PCO patients in a long cycle. Hyperstimulation was mostly due to higher starting doses. Total follicle counts of more than 20 on Day 5-7 after stimulation may be predictive of subsequent hyperstimulation. Hyperstimulation tended to be more severe in lean PCO patients, and prophylactic albumin helped to reduce its severity. CONCLUSION Gonadotropin doses at stimulation should start at 150 iu or less in women below 35 years of age, with a step up of 37.5 iu, as necessary. Transfer should be abandoned in the presence of high oestradiol levels (more than 5,000 pg/ml), when the total number of intermediate and large follicle count exceeds 30 on the day of oocyte retrieval, or when more than 19 eggs are retrieved. Variables in the Asian population appear to be similar to those in the western population.
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Affiliation(s)
- H Rajesh
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Road, Singapore 169608.
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Kasum M, Oresković S. Treatment of ovarian hyperstimulation syndrome: new insights. Acta Clin Croat 2010; 49:421-427. [PMID: 21830453] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Ovarian hyperstimulation syndrome is the most serious iatrogenic complication resulting from ovarian stimulation. Currently there is no clear evidence of absolute efficacy for most of standard preventive and curative methods. Recent studies indicate that human chorionic gonadotropin increases vascular endothelial growth factor, vascular endothelial cadherin and vascular permeability via endothelial adherence junctions. Vascular endothelial growth factor plays a pivotal role in the pathophysiology of the condition and therefore vascular endothelial factor antagonism has been suggested for the prevention of the syndrome. Since vascular endothelial growth factor is also a physiological regulator of folliculogenesis, progesterone secretion and endometrial angiogenesis, its complete inactivation by specific blockers could produce undesirable effects interfering with early pregnancy development and therefore they cannot be used clinically. Recently, low doses of dopamine agonists (cabergoline) have been shown to counteract vascular endothelial growth factor induced vascular hyperpermeability, reducing the incidence of the syndrome by prophylactic treatment without compromising pregnancy outcome. The absence of undesirable side effects could make cabergoline an effective and safe etiologic approach for the prevention and treatment of the syndrome. A novel approach has suggested that metformin may also be helpful in the syndrome prevention in women with or without polycystic ovary disease.
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Affiliation(s)
- Miro Kasum
- University Department of Obstetrics and Gynecology, Human Reproduction Unit, School of Medicine, University of Zagreb, Zagreb, Croatia.
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35
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Pedroviejo Sáez V. [On the article "Severe ovarian hyperstimulation syndrome after exogenous administration of human chorionic gonadotropin]. Rev Esp Anestesiol Reanim 2010; 57:392-393. [PMID: 20645497 DOI: 10.1016/s0034-9356(10)70259-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Curiel Balsera E, Prieto Palomino MÁ, Muñoz Bono J, Banderas Bravo E. [Severe ovarian hyperstimulation syndrome]. Med Clin (Barc) 2010; 137:184-5. [PMID: 20338599 DOI: 10.1016/j.medcli.2010.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 02/02/2010] [Accepted: 02/04/2010] [Indexed: 11/27/2022]
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Tal Y, Haber G, Cohen MJ, Phillips M, Revel A, Varon D, Ben-Yehuda A. Superior vena cava syndrome and ovarian hyperstimulation syndrome. Isr Med Assoc J 2009; 11:503-504. [PMID: 19891241] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Yuval Tal
- Department of Internal Medicine C, Hadassah Medical Center and Hebrew University Medical School, Jerusalem, Israel
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Jayaprakasan K, Herbert M, Moody E, Stewart JA, Murdoch AP. Estimating the risks of ovarian hyperstimulation syndrome (OHSS): implications for egg donation for research. HUM FERTIL 2009; 10:183-7. [PMID: 17786651 DOI: 10.1080/14647270601021743] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aims to provide an estimate of women's risk of ovarian hyperstimulation syndrome (OHSS) when undergoing superovulation to donate eggs for research. This is an essential prerequisite for appropriate informed consent. In the absence of sufficiently large numbers of egg donors to assess the risk, comparative data was obtained from women undergoing the same superovulation protocol for in vitro fertilization (IVF) treatment. In this prospective study 339 women, who developed >/=20 follicles after superovulation in their first treatment cycle (total number of treatment cycles during the same period - 2417), were intensively monitored on five occasions, between human chorionic gonadotrophin and pregnancy test, according to our routine clinical protocol. Hospital admission was needed for 49 (14.5%) women, 13 (3.8%) needed intravenous fluids and 9 (2.7%) needed paracentesis. The admission rates were similar in pregnant and non-pregnant women (13.5% vs. 15%); the need for intravenous fluids and paracentesis were 3.2% vs. 2.3% and 6.3% vs. 2.3%, respectively. The peak increase in haematocrit occurred on Day 4 after hCG, and the mean day of hospital admission was Day 5. If an egg donor develops <20 follicles, she can be reassured that the risk of OHSS is very small (<0.1%). If >/=20 follicles develop, her risk of hospital admission due to OHSS is <15%. The absence of pregnancy in egg donors does not eliminate the risk of OHSS. Given the timescale of development of the haematological and biochemical abnormalities, egg donors who develop >/=20 follicles should be actively monitored for the first week after egg collection.
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Affiliation(s)
- K Jayaprakasan
- Newcastle Fertility Centre at Life, International Centre for Life, Newcastle upon Tyne, UK.
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Chervenak FA, McCullough LB. Preventive ethics and subsequent care of patients self-administering ovarian stimulation for the management of infertility. J Clin Ethics 2009; 20:239-240. [PMID: 19845195] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Frank A Chervenak
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, USA.
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Azcona B, Campo G, Zabaleta J. [Ovarian hyperstimulation syndrome]. An Sist Sanit Navar 2009; 32 Suppl 1:19-27. [PMID: 19552009 DOI: 10.23938/assn.0183] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Experience with ovulation induction treatment and understanding of the physiopathology of ovarian hyperstimulation syndrome (OHS), the risk factors and the clinical characteristics are of key importance for preventing and managing OHS. Light manifestations ofOHS are fairly common, occurring in up to a third of the cycles with superovulation induced by exogenous gonadotropins. A worsening of the symptoms of OHS can still normally be managed in out-patient form, but frequent monitoring and evaluation are essential. Serious disease resulting from OHS is much less common, but can involve risk to life. Hospitalisation might be necessary in some cases.
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Affiliation(s)
- B Azcona
- Servicio de Obstetricia y Ginecología, Hospital Virgen del CaminoIrunlarrea, 431008 Pamplona, Spain.
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Awonuga AO, Schenone MH, Abdallah ME, Yelian FD, Diamond MP, Puscheck EE. Non-adherence to instructions to cancel a cycle in a patient overstimulated with gonadotropins in a planned intrauterine insemination cycle. J Clin Ethics 2009; 20:235-238. [PMID: 19845194] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Awoniyi Olumide Awonuga
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA.
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Ozgun MT, Batukan C, Oner G, Uludag S, Aygen EM, Sahin Y. Removal of ascites up to 7.5 liters on one occasion and 45 liters in total may be safe in patients with severe ovarian hyperstimulation syndrome. Gynecol Endocrinol 2008; 24:656-8. [PMID: 19031224 DOI: 10.1080/09513590802342882] [Citation(s) in RCA: 8] [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: 10/21/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a serious and potentially lethal complication of ovulation induction. We report herein a case with OHSS treated by serial vaginal paracentesis. A 31-year-old patient was hospitalized due to severe OHSS after in vitro fertilization (IVF)-embryo transfer. Transvaginal drainage was performed with a standard 17-gauge IVF needle connected to a vacuum pump through a drainage set in nine courses. We removed 45 liters of ascitic fluid in total and 7.5 liters of ascitic fluid in one course, leading to improvement of the patient's condition and laboratory parameters. In conclusion, removal of ascites up to 7.5 liters on one occasion and 45 liters in total by serial vaginal paracentesis may be performed in patients with severe OHSS.
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Affiliation(s)
- Mahmut T Ozgun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
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Ceyhan ST, Goktolga U, Karasahin E, Alanbay I, Duru NK. Continuous vaginal and bilateral thoracic fluid drainage for management of severe ovarian hyperstimulation syndrome. Gynecol Endocrinol 2008; 24:505-7. [PMID: 18958770 DOI: 10.1080/09513590802303017] [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: 10/21/2022] Open
Abstract
Severe ovarian hyperstimulation syndrome (OHSS) is a serious and potentially fatal complication of ovarian stimulation. A 29-year-old nulligravid patient with anovulatory infertility was treated with in vitro fertilization. Six days after embryo transfer, the patient presented with complaint of abdominal bloating, nausea, vomiting and shortness of breath. Severe late-onset OHSS, with massive ascites and pleural effusion, was diagnosed. Posterior colpotomy was performed under general anesthesia, a Foley catheter was inserted into the posterior cul-de-sac, and bilateral chest drainage tubes were left for continuous drainage. In total, 13.2 liters of ascites and 6.1 liters of pleural fluid were drained in 8 days. Continuous drainage of ascites and pleural effusion improved the patient's comfort without need for repeated transvaginal and thoracic aspirations.
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Affiliation(s)
- Seyit Temel Ceyhan
- Department of Obstetrics and Gynaecology, Division of Reproductive Endocrinology and Infertility, Gulhane Military Medical Academy and Medical School, Ankara, Turkey.
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Qazi A, Ahmed AN, Qazi MP, Usman F, Ahmad A. Ischaemic stroke with ovarian hyperstimulation syndrome. J PAK MED ASSOC 2008; 58:411-413. [PMID: 18988418] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a rare and serious complication of hormonal treatment for induction of ovulation. Haemoconcentration owing to the large fluid shift from the intravascular to the peritoneal cavity resulting in increased blood viscosity that can lead to arterial and venous occlusion. Thromboembolic stroke, cerebral venous thrombosis and systemic arteriovenous thrombosis have been reported in OHSS. We report a case of a 30-year-old female who had undergone a successful in vitro fertilization and presented in the emergency department with sudden onset of left hemiplegia. Her CT scan showed a full thickness right- MCA territory infarct. The patient was treated with oral aspirin, intra venous plasma expanders and Mannitol. Her repeat MRI showed haemorrhagic conversion of infarct. She made a good recovery and was independent in activities of daily living when seen for follow up after six months.
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Affiliation(s)
- Amna Qazi
- Department of Medicine, Shifa International Hospital and College of Medicine, H-8/4, Islamabad, Pakistan
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Korneeva IE, Veriaeva NA, Gel'fand BR, Churadze BT. [Ovarian overstimulation syndrome: problem of intensive care]. Anesteziol Reanimatol 2007:59-63. [PMID: 18326263] [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: 05/26/2023]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication, the basis for which is a hyperergic uncontrolled ovarian response to gonadotropins in the ovulation stimulation cycles and assisted procreation programs. The clinical picture of OHSS is characterized by a broad spectrum of clinical and laboratory manifestations: increased vascular permeability resulting in the excess release of liquid into the third space and its storage with the development of hypovolemia, hemoconcentration, oliguria, hypoproteinemia, electrolyte imbalance, polyserositis; in severe cases, acute renal failure, thromboembolic events, and adult respiratory distress syndrome develop. The goal of treatment is to prevent the development of multiply organ dysfunctions. Its leading methods are infusion therapy with colloid-crystalloid solutions and anticoagulant therapy. Whether diuretics and other drugs are administered is under consideration. Indications for laparocentesis and peritoneal transudate evacuation are discussed. Complications requiring surgery are identified.
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Hahn B. Ovarian hyperstimulation syndrome. J Emerg Med 2007; 33:191-2. [PMID: 17692773 DOI: 10.1016/j.jemermed.2006.12.032] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 11/23/2006] [Accepted: 12/04/2006] [Indexed: 05/16/2023]
Affiliation(s)
- Barry Hahn
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York, USA
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Shifman EM, Pogodin OK, Gumeniuk EG, Pogodin OO. [Intensive care for ovarian hyperstimulation syndrome]. Anesteziol Reanimatol 2007:77-81. [PMID: 17929495] [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: 05/25/2023]
Abstract
The paper reviews the current data available in the literature on the pathophysiology, clinical presentation, and treatment of the ovarian hyperstimulation syndrome (OHSS). Today due to the intensive development of high assisted reproductive techniques (ART) using the current superovulation stimulation, the risk of OHSS grows steadily. The clinical symptoms of OHSS appear in the luteal phase of a cycle and in early pregnancy when most females have just left the in vitro fertilization centers. In this connection, physicians of many specialties, including obstetricians, gynecologists, and intensivists should know the clinical manifestations of this syndrome and can correctly render a medical aid. Disputable issues of inpatient therapy for OHSS and the specific features of infusion management and intensive care are discussed.
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Lamm R, Nadel ES, Brown DFM. Abdominal pain and ascites. J Emerg Med 2007; 33:65-70. [PMID: 17630078 DOI: 10.1016/j.jemermed.2007.03.050] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 03/29/2007] [Indexed: 05/16/2023]
Affiliation(s)
- Ruth Lamm
- Division of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Practice Committee of the American Society for Reproductive Medicine. Ovarian hyperstimulation syndrome. Fertil Steril 2006; 86:S178-83. [PMID: 17055817 DOI: 10.1016/j.fertnstert.2006.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2003] [Revised: 07/14/2003] [Accepted: 07/14/2003] [Indexed: 11/22/2022]
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