Current possibilities in the prevention and therapy of ovarian hyperstimulation syndrome


Authors: Hubka P. 1,2;  Višňová H. 2;  Sehnal B. 1;  Lincová M. 1;  Zikán M. 1
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a Nemocnice Na Bulovce, Praha 1;  IVF Cube SE, Praha 2
Published in: Ceska Gynekol 2021; 86(2): 124-127
Category:
doi: 10.48095/cccg2021124

Overview

Objective: To present current possibilities of the prevention and therapy of ovarian hyperstimulation syndrome (OHSS). Methods: Literature and guidelines were researched. Results: From the view of safety and prevention of OHSS, antagonistic protocol is suitable. Patients with syndrome of polycystic ovaries benefit from the use of metformin or letrozole that can be sufficient to induce ovulation. As a treatment of imminent OHSS, it is recommended to administer 0.5 mg of cabergoline per os daily as well as low molecular weight heparin subcutaneously in prophylactic dose and to maintain sufficient fluid intake. Diuretics are strongly discouraged to use. To maintain intravascular volume, drained ascites can be reintroduced. Conclusion: We present a review of current literature and recommendations.

Keywords:

assisted reproduction – In vitro fertilization – ovarian hyperstimulation syndrome – prevention – therapy


Sources

1. Kumar P, Sait SF, Sharma A et al. Ovarian hyperstimulation syndrome. J Hum Reprod Sci 2011; 4(2): 70–75. doi: 10.4103/ 0974-1208.86080.

2. Whelan JG 3rd, Vlahos NF. The ovarian hyperstimulation syndrome. Fertil Steril 2000; 73(5): 883–896. doi: 10.1016/ s0015-0282(00)00491-x.

3. Sansone P, Aurilio C, Pace MC et al. Intensive care treatment of ovarian hyperstimulation syndrome (OHSS). Ann N Y Acad Sci 2011; 1221: 109–118. doi: 10.1111/ j.1749-6632.2011.05983.x.

4. Binder H, Dittrich R, Einhaus F et al. Update on ovarian hyperstimulation syndrome: part 1 – incidence and pathogenesis. Int J Fertil Womens Med 2007; 52(1): 11–26.

5. Lyons CA, Wheeler CA, Frishman GN et al. Early and late presentation of the ovarian hyperstimulation syndrome: two distinct entities with different risk factors. Hum Reprod 1994; 9(5): 792–799. doi: 10.1093/ oxfordjournals.humrep.a138598.

6. Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil Steril 1992; 58(2): 249–261. doi: 10.1016/ s0015-0282(16)55188-7.

7. Abramov Y, Barak V, Nisman B et al. Vascular endothelial growth factor plasma levels cor­relate to the clinical picture in severe ovarian hyperstimulation syndrome. Fertil Steril 1997; 67(2): 261–265. doi: 10.1016/ S0015-0282(97)81908-5.

8. Rumpiková T, Štelcl M, Vencálek O et al. Faktory ovlivňující sérovou hladinu anti-Müllerian hormonu. Ceska Gynekol 2018; 83(5): 324–328.

9. Delvigne A, Rozenberg S. Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review. Hum Reprod Update 2002; 8(6): 559–577. doi: 10.1093/  humupd/ 8.6.559.

10. Al-Fozan H, Al-Khadouri M, Tan SL et al. A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation. Fertil Steril 2004; 82(6): 1561–1563. doi: 10.1016/ j.fertnstert.2004.04.070.

11. Franik S, Eltrop SM, Kremer JA et al. Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev 2018; 5(5): CD010287. doi: 10.1002/ 14651858.CD010287.pub3.

12. Tso LO, Costello MF, Albuquerque LE et al. Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2014; 2014(11): CD006105. doi: 10.1002/ 14651858.CD006105.pub.3.

13. Al-Inany HG, Abou-Setta AM, Aboulghar M. Gonadotrophin-releasing hormone antagonists for assisted conception: a Cochrane review. Reprod Biomed Online 2007; 14(5): 640–649. doi: 10.1016/ s1472-6483(10)61059-0.

14. European and Middle East Orgalutran Study. Comparable clinical outcome using the GnRH antagonist ganirelix or a long protocol of the GnRH agonist triptorelin for the prevention of premature LH surges in women undergoing ovarian stimulation. Hum Reprod 2001; 16(4): 644–651. doi: 10.1093/ humrep/ 16.4.644.

15. Lin H, Li Y, Li L et al. Is a GnRH antagonist protocol better in PCOS patients? A meta-analysis of RCTs. PLoS One 2014; 9(3): e91796. doi: 10.1371/ journal.pone.0091796.

16. Corbett S, Shmorgun D, Claman P et al. The prevention of ovarian hyperstimulation syndrome. J Obstet Gynaecol Can 2014; 36(11): 1024–1033. doi: 10.1016/ S1701-2163(15)30417-5.

17. Van Wely M, Westergaard LG, Bossuyt PM et al. Human menopausal gonadotropin versus recombinant follicle stimulation hormone for ovarian stimulation in assisted reproductive cycles. Cochrane Database Syst Rev 2003; 1: CD003973. doi: 10.1002/ 14651858.CD003973.

18. van der Linden M, Buckingham K, Farquhar C et al. Luteal phase support for assisted reproduction cycles. Cochrane Database Syst Rev 2011; 10: CD009154. doi: 10.1002/ 14651858.CD009154.pub.2.

19. Manno M, Tomei F, Marchesan E et al. Cabergoline: a safe, easy, cheap, and effective drug for prevention/ treatment of ovarian hyperstimulation syndrome? Eur J Obstet Gynecol Reprod Biol 2005; 122(1): 127–128. doi: 10.1016/ j.ejogrb.2005.01.009.

20. Tang H, Hunter T, Hu Y et al. Cabergoline for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev 2012; 2: CD008605. doi: 10.1002/ 14651858.CD008605.pub2.

21. Jee BC, Suh CS, Kim YB et al. Administration of intravenous albumin around the time of oocyte retrieval reduces pregnancy rate without preventing ovarian hyperstimulation syndrome: a systematic review and meta-analysis. Gynecol Obstet Invest 2010; 70(1): 47–54. doi: 10.1159/ 000286379.

22. Lattova V, Dostal J, Vodicka J et al. The risk of thromboembolism in relation to in vitro fertilization. Ceska Gynekol 2019; 84(3): 229–232.

23. Shmorgun D, Claman P, Joint Sogc-Cfas Clinical Practice Guidelines Committee. The dia­gnosis and management of ovarian hyper­stimulation syndrome. J Obstet Gynaecol Can 2011; 33(11): 1156–1162. doi: 10.1016/  S1701-2163(16)35085-X.

24. Maslovitz S, Jaffa A, Eytan O et al. Renal blood flow alteration after paracentesis in women with ovarian hyperstimulation. Obstet Gynecol 2004; 104(2): 321–326. doi: 10.1097/ 01.AOG.0000129956.97012.0d.

25. Koike T, Araki S, Minakami H et al. Clinical efficacy of peritoneovenous shunting for the treatment of severe ovarian hyperstimulation syndrome. Hum Reprod 2000; 15(1): 113–117. doi: 10.1093/ humrep/ 15.1.113.

26. Zhang Q, Xia L, Gao G. A new effective method in the treatment of severe ovarian hyper­stimulation syndrome. Iran J Reprod Med 2012; 10(6): 589–594

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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