Top

Journal of Ovarian Research

Published in:

Open Access 01-12-2015 | Research

Can steroidal ovarian suppression during the luteal phase after oocyte retrieval reduce the risk of severe OHSS?

Authors: Ya-Qin Wang, Jin Luo, Wang-Min Xu, Qin-Zhen Xie, Wen-Jie Yan, Geng-Xiang Wu, Jin Yang

Published in: Journal of Ovarian Research | Issue 1/2015

Abstract

Background

Ovarian stimulation in IVF cycle results in luteal supraphysiological steroid concentrations especially for high response patients. The aim of this study was to evaluate the efficacy of ovarian steroid hormone suppression in luteal phase after oocyte retrieval for preventing severe ovarian hyperstimulation syndrome (OHSS) in high-risk patients with embryo cryopreservation.

Methods

281 patients with high risk of OHSS were enrolled in this study among 4735 infertile women undergoing their first IVF treatment. The subjects were allocated into treatment and control group. The treatment group (n = 161) received letrozole (n = 43), mifepristone (n = 51), cetrotide (n = 39) and three-drug combinations (n = 28) during the luteal phase after oocyte retrieval, respectively. The control group (n = 120) received no medicine. Fertilization rate, good embryo rate, serum steroid concentration, clinical outcome, and incidence of severe OHSS were compared between the two groups.

Results

On days 2, 5 and 8 after oocyte retrieval, serum estradiol levels in the letrozole and three-drug combination therapy group were significantly lower than in the other three groups at the same time (P < 0.001, respectively). There were no significantly difference of serum luteinizing hormone concentration on days 2, 5 and 8 and progesterone concentration on day 8 after oocyte retreival among the five groups (P > 0.05, respectively). Compared with the control group, the incidence of severe OHSS, the paracentesis rate, the duration of hospitalization and the days of luteal phase in each subgroup of treatment groups was not significantly decreased (P > 0.05, respectively).

Conclusions

Our findings indicate that steroidal ovarian suppression in luteal phase after oocyte retrieval seems to be unable to prevent severe OHSS in high-risk patients with embryo cryopreservation.

Aboulghar MA, Mansour RT. Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures. Hum Reprod Update. 2003;9:275–89.CrossRefPubMed

Kamath MS, Joshi A, Kamath AM, Aleyamma T. Management of severe ovarian hyperstimulation syndrome with thawed plasma. J Hum Reprod Sci. 2013;6:82–5.PubMedCentralCrossRefPubMed

Egbase PE. Severe OHSS: how many cases are preventable? Hum Reprod. 2000;15:8–10.CrossRefPubMed

Papanikolaou EG, Pozzobon C, Kolibianakis EM, Camus M, Tournaye H, Fatemi HM, et al. Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles. Fertil Steril. 2006;85:112–20.CrossRefPubMed

Yilmaz N, Uygur D, Ozgu E, Batioglu S. Does coasting, a procedure to avoid ovarian hyperstimulation syndrome, affect assisted reproduction cycle outcome? Fertil Steril. 2010;94:189–93.CrossRefPubMed

Delvigne A, Rozenberg S. A qualitative systematic review of coasting, a procedure to avoid ovarian hyperstimulation syndrome in IVF patients. Hum Reprod Update. 2002;8:291–6.CrossRefPubMed

Nardo LG, Cheema P, Gelbaya TA, Horne G, Fitzgerald CT, Pease EH, et al. The optimal length of ‘coasting protocol’ in women at risk of ovarian hyperstimulation syndrome undergoing in vitro fertilization. Hum Fertil (Camb). 2006;9:175–80.CrossRef

Fatemi HM, Popovic-Todorovic B, Donoso P, Papanikolaou E, Smitz J, Devroey P. Luteal phase oestradiol suppression by letrozole: a pilot study in oocyte donors. Reprod Biomed Online. 2008;17:307–11.CrossRefPubMed

Garcia-Velasco JA, Quea G, Piró M, Mayoral M, Ruiz M, Toribio M, et al. Letrozole administration during the luteal phase after ovarian stimulation impacts corpus luteum function: a randomized, placebo-controlled trial. Fertil Steril. 2009;92:222–5.CrossRefPubMed

10.

Ujioka T, Matsuura K, Kawano T, Okamura H. Role of progesterone in capillary permeability in hyperstimulated rats. Hum Reprod. 1997;12:1629–34.CrossRefPubMed

11.

Ishikawa K, Ohba T, Tanaka N, Iqbal M, Okamura Y, Okamura H. Organ-specific production control of vascular endothelial growth factor in ovarian hyperstimulation syndrome-model rats. Endocr J. 2003;50:515–25.CrossRefPubMed

12.

Coccia ME, Comparetto C, Bracco GL, Scarselli G. GnRH antagonists. Eur J Obstet Gynecol Reprod Biol. 2004;115 Suppl 1:S44–56.CrossRefPubMed

13.

Pundir J, Sunkara SK, El-Toukhy T, Khalaf Y. Meta-analysis of GnRH antagonist protocols: do they reduce the risk of OHSS in PCOS? Reprod Biomed Online. 2012;24(1):6–22.CrossRefPubMed

14.

Griesinger G, Diedrich K, Tarlatzis BC, Kolibianakis EM. GnRH-antagonists in ovarian stimulation for IVF in patients with poor response to gonadotrophins, polycystic ovary syndrome, and risk of ovarian hyperstimulation: a meta-analysis. Reprod Biomed Online. 2006;13:628–38.CrossRefPubMed

15.

Bonilla-Musoles FM, Raga F, Castillo JC, Sanz M, Dolz M, Osborne N. High doses of GnRH antagonists are efficient in the management of severe ovarian hyperstimulation syndrome. Clin Exp Obstet Gynecol. 2009;36:78–81.PubMed

16.

Lainas TG, Sfontouris IA, Zorzovilis IZ, Petsas GK, Lainas GT, Kolibianakis EM. Management of severe early ovarian hyperstimulation syndrome by re-initiation of GnRH antagonist. Reprod Biomed Online. 2007;15:408–12.CrossRefPubMed

17.

Lainas GT, Kolibianakis EM, Sfontouris IA, Zorzovilis IZ, Petsas GK, Tarlatzi TB, et al. Outpatient management of severe early OHSS by administration of GnRH antagonist in the luteal phase: an observational cohort study. Reprod Biol Endocrinol. 2012;10:69.PubMedCentralCrossRefPubMed

18.

Lainas GT, Kolibianakis EM, Sfontouris IA, Zorzovilis IZ, Petsas GK, Lainas TG, et al. Pregnancy and neonatal outcomes following luteal GnRH antagonist administration in patients with severe early OHSS. Hum Reprod. 2013;28:1929–42.CrossRefPubMed

19.

Lainas GT, Kolibianakis EM, Sfontouris IA, Zorzovilis IZ, Petsas GK, Lainas TG, et al. Serum vascular endothelial growth factor levels following luteal gonadotrophin- releasing hormone antagonist administration in women with severe early ovarian hyperstimulation syndrome. BJOG. 2014;121:848–55.CrossRefPubMed

20.

Golan A, Ron-el R, Herman A, Soffer Y, Weinraub Z, Caspi E. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv. 1989;44:430–40.CrossRefPubMed

21.

Delvigne A. Symposium: Update on prediction and management of OHSS. Epidemiology of OHSS. Reprod Biomed Online. 2009;19:8–13.CrossRefPubMed

22.

Fatemi HM. The luteal phase after 3 decades of IVF: what do we know? Reprod Biomed Online. 2009;19(4):4331.PubMed

23.

Fauser BC, Devroey P. Reproductive biology and IVF: ovarian stimulation and luteal phase consequences. Trends Endocrinol Metab. 2003;14:236–42.CrossRefPubMed

24.

Tavaniotou A, Bourgain C, Albano C, Platteau P, Smitz J, Devroey P. Endometrial integrin expression in the early luteal phase in natural and stimulated cycles for in vitro fertilization. Eur J Obstet Gynecol Reprod Biol. 2003;108:67–71.CrossRefPubMed

25.

Enskog A, Henriksson M, Unander M, Nilsson L, Brännström M. Prospective study of the clinical and laboratory parameters of patients in whom ovarian hyperstimulation syndrome developed during controlled ovarian hyperstimulation for in vitro fertilization. Fertil Steril. 1999;71:808–14.CrossRefPubMed

26.

Aboulghar M. Prediction of ovarian hyperstimulation syndrome (OHSS). Estradiol level has an important role in the prediction of OHSS. Hum Reprod. 2003;18:1140–1.CrossRefPubMed

27.

Whelan JG, Vlahos NF. The ovarian hyperstimulation syndrome. Fertil Steril. 2000;73:883–96.CrossRefPubMed

28.

Cole PA, Robinson CH. Mechanism and inhibition of cytochrome P-450 aromatase. J Med Chem. 1990;33:2933–42.CrossRefPubMed

29.

Winer EP, Hudis C, Burstein HJ, Chlebowski RT, Ingle JN, Edge SB, et al. American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for women with hormone receptor-positive breast cancer: status report 2002. J Clin Oncol. 2002;20:3317–27.CrossRefPubMed

30.

Garcia-Velasco JA, Moreno L, Pacheco A, Guillén A, Duque L, Requena A, et al. The aromatase inhibitor letrozole increases the concentration of intraovarian androgens and improves in vitro fertilization outcome in low responder patients: a pilot study. Fertil Steril. 2005;84:82–7.CrossRefPubMed

31.

Mitwally MF, Casper RF. Aromatase inhibition reduces the dose of gonadotropin required for controlled ovarian hyperstimulation. J Soc Gynecol Investig. 2004;11:406–15.CrossRefPubMed

32.

Yuen BH, McComb P, Sy L, Lewis J, Cannon W. Plasma prolactin, human chorionic gonadotropin, estradiol, testosterone, and progesterone in the ovarian hyperstimulation syndrome. Am J Obstet Gynecol. 1979;133:316–20.PubMed

33.

Spitz LM, Croxatto HB, Lähteenmäki P, Heikinheimo O, Bardin CW. Effect of mifepriston on inhibition of ovulation and induction of luteolysis. Hum Reprod. 1994;9 suppl 1:1069–76.CrossRef

34.

Gnoth C, Halbe E, Freundl G. Persistent ascites after ovarian hyperstimula-tion syndrome and administration of mifepristone (RU 486) for the termination of pregnancy. Arch Gynecol Obstet. 2003;268:65–8.PubMed

35.

Yung Y, Maman E, Ophir L, Rubinstein N, Barzilay E, Yerushalmi GM, et al. Progesterone antagonist, RU486, represses LHCGR expression and LH/hCG signaling in cultured luteinized human mural granulosa cells. Gynecol Endocrinol. 2014;30:42–7.CrossRefPubMed

36.

Devoto L, Vega M, Kohen P, Castro A, Castro O, Christenson LK, et al. Endocrine and paracrine-autocrine regulation of the human corpus luteum during the mid-luteal phase. J Reprod Fertil Suppl. 2000;55:13–20.PubMed

37.

Casper RF, Yen SS. Induction of luteolysis in the human with a long-acting analog of luteinizing hormone-releasing factor. Science. 1979;205:408–10.CrossRefPubMed

38.

Mais V, Kazer RR, Cetel NS, Rivier J, Vale W, Yen SS. The dependency of folliculogenesis and corpus luteum function on pulsatile gonadotropin secretion in cycling women using a gonadotropin-releasing hormone antagonist as a probe. J Clin Endocrinol Metab. 1986;62:1250–5.CrossRefPubMed

39.

Ortmann O, Weiss JM, Diedrich K. Embryo implantation and GnRH antagonists: ovarian actions of GnRH antagonists. Hum Reprod. 2001;16:608–11.CrossRefPubMed

Title: Can steroidal ovarian suppression during the luteal phase after oocyte retrieval reduce the risk of severe OHSS?
Authors: Ya-Qin Wang
Jin Luo
Wang-Min Xu
Qin-Zhen Xie
Wen-Jie Yan
Geng-Xiang Wu
Jin Yang
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Journal of Ovarian Research / Issue 1/2015
Electronic ISSN: 1757-2215
DOI: https://doi.org/10.1186/s13048-015-0190-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Can steroidal ovarian suppression during the luteal phase after oocyte retrieval reduce the risk of severe OHSS?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Oocyte zona pellucida dysmorphology is associated with diminished in-vitro fertilization success

Ovarian mucinous adenocarcinoma with functioning stroma in postmenopausal women: aromatase and SF-1 expressions

Risk prediction model for epithelial ovarian cancer using molecular markers and clinical characteristics

Expression of the beta-2 adrenergic receptor (ADRB-2) in human and monkey ovarian follicles: a marker of growing follicles?

A method to investigate the anti-metabolic activity of anti-cancer agents on ovarian cancer cells cultured in a 96-well high throughput format

Regulatory T lymphocytes and transforming growth factor beta in epithelial ovarian tumors-prognostic significance