Ovarian Hyperstimulation Syndrome

OHSS is a potentially serious iatrogenic complication of ovarian stimulation with gonadotropins. A controlled study comparing patients with and without polycystic ovaries undergoing IVF showed that 10.5% of the polycystic ovary patients developed moderate/severe OHSS compared with none of the controls (13). OHSS is characterized by increased vascular permeability and transudation of protein-rich fluid from the vascular space into the peritoneal cavity. The incidence of severe OHSS ranges between 0.6 and 1.9% but may occur as frequently as 6% in women with polycystic ovary/ PCOS (34-36). Severe OHSS is characterized by ascites, plural effusion, and electrolyte imbalances. While there is no successful strategy to completely predict and prevent this potentially life-threatening complication, patients are commonly identified when the serum E2 concentration is high (10,00015,000 pmol/L) and the number of ovarian follicles is greater than 20. Although follicular puncture

Ovarian Hyperstimulation Syndrome

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Fig. 3. Stromal blood flow in a normal ovary (A) and a polycystic ovary (B) increased in the polycystic ovary.

Note that ovarian blood flow is and aspiration of follicular fluid have been suggested to be protective against OHSS, it seems that follicular aspiration does not necessarily prevent OHSS.

The strategies to reduce the risk of OHSS include the following:

1. Starting stimulation with lower dose of FSH.

2. Close monitoring by ultrasound scans and serum E2 level measurements.

3. Coasting: When E2 levels exceed 10,000 pmol/L following gonadotropin injections, hCG can be withheld. Coasting does not seem to decrease pregnancy rates. In a series of 51 patients, Sher et al. (37) stopped further gonadotropin injections when E2 exceeded 22,000 pmol/L for 3-11 days and administered hCG when serum E2 levels decreased below 11,000 pmol/L; the pregnancy rate was 41%.

4. Withholding or decreasing the hCG dose for final follicular maturation, or in suitable cases substituting hCG with GnRH agonist (38).

5. Intravascular volume expanders, hydroxyethyl starch, or human albumin can be administered during and after oocyte retrieval; however, it is not always helpful in preventing OHSS (39).

6. Glucocorticoid use has been recommended, but it does not seem to have a significant effect in preventing OHSS (40).

7. Decreasing the number of embryos transferred or freezing all the embryos to be transferred in a later frozen embryo transfer cycle.

8. Metformin pretreatment and/or concomitant metformin use has been suggested for PCOS patients. A study showed that metformin pretreatment in coasted cycles may help to decrease the maximum E2 concentrations and the number of days of coasting (18). However, large prospective studies regarding OHSS risk with metformin pretreatment are not available yet.

None of the above-mentioned solutions avoids the risk of OHSS completely. The only reliable way to prevent OHSS is to avoid ovarian stimulation with FSH completely. In addition, other than severe OHSS risk, there are numerous disadvantages associated with gonadotropin stimulation, including high drug costs, the need for daily injections, frequent monitoring, and potential side effects, such as abdominal bloating, breast tenderness, mood swings, and nausea. IVM would avoid the risk of OHSS in women with polycystic ovary/PCOS who need IVF.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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