Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Assisted Reproduction and Genetics
Published in: Journal of Assisted Reproduction and Genetics 10/2017

01-10-2017 | Assisted Reproduction Technologies

What is the best predictor of severe ovarian hyperstimulation syndrome in IVF? A cohort study

Authors: Theoni B Tarlatzi, Christos A Venetis, Fabienne Devreker, Yvon Englert, Anne Delbaere

Published in: Journal of Assisted Reproduction and Genetics | Issue 10/2017

Login to get access

Abstract

Purpose

The purpose of the present study is to study what is the best predictor of severe ovarian hyperstimulation syndrome (OHSS) in IVF.

Methods

This is a retrospective analysis of all consecutive IVF/intracytoplasmic injection cycles performed during a 5-year period (2009–2014) in a single university fertility centre. All fresh IVF cycles where ovarian stimulation was performed with gonadotrophins and GnRH agonists or antagonists and triggering of final oocyte maturation was induced with the administration of urinary or recombinant hCG were analyzed (2982 patients undergoing 5493 cycles). Because some patients contributed more than one cycle, the analysis of the data was performed with the use of generalized estimating equation (GEE).

Results

Severe OHSS was diagnosed in 20 cycles (0.36%, 95% CI 0.20–0.52). The number of follicles ≥10 mm on the day of triggering final oocyte maturation represents the best predictor of severe OHSS in IVF cycles. The cutoff in the number of follicles ≥10 mm with the best capacity to discriminate between women that will and will not develop severe OHSS was ≥15.

Conclusion

The presence of more than 15 follicles ≥10 mm on the day of triggering final oocyte maturation represents the best predictor of severe OHSS in IVF cycles.
Literature
1.
Kupka MS, Ferraretti AP, de Mouzon J, Erb K, D’Hooghe T, Castilla JA, et al. Assisted reproductive technology in Europe, 2010: results generated from European registers by ESHRE†. Hum Reprod. 2014;29:2099–113.CrossRefPubMed
2.
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. 2005;85:112–20.CrossRef
3.
Smitz J, Camus M, Devroey P, Erard P, Wisanto A, Van Steirteghem AC. Incidence of severe ovarian hyperstimulation syndrome after GnRH agonist/HMG superovulation for in-vitro fertilization. Hum Reprod. 1990;5:933–7.CrossRefPubMed
4.
Tarlatzis BC, Griesinger G, Leader A, Rombauts L, Ijzerman-Boon PC, BMJL M. Comparative incidence of ovarian hyperstimulation syndrome following ovarian stimulation with corifollitropin alfa or recombinant FSH. Reprod BioMed Online. 2012;24:410–9.CrossRefPubMed
5.
Aboulghar MA, Mansour RT. Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures. Hum Reprod Update. 2003;9:275–89.CrossRefPubMed
6.
Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil Steril. 1992;58:249–61.CrossRefPubMed
7.
Delbaere A, Smits G, Vassart G, Costagliola S. Genetic predictors of ovarian hyperstimulation syndrome in women undergoing in vitro fertilization. Nat Clin Pract Endocrinol Metab. 2006;2:590–1.CrossRefPubMed
8.
Daelemans C, Smits G, de Maertelaer V, Costagliola S, Englert Y, Vassart G, et al. Prediction of severity of symptoms in iatrogenic ovarian hyperstimulation syndrome by follicle-stimulating hormone receptor Ser680Asn polymorphism. J Clin Endocrinol Metab. 2004;89:6310–5.CrossRefPubMed
9.
Delbaere A, Smits G, De Leener A, Costagliola S, Vassart G. Understanding ovarian hyperstimulation syndrome. Endocrine. 2005;26:285–90.CrossRefPubMed
10.
Aboulghar MA, Mansour RT, Serour GI. Pathophysiology of ovarian hyperstimulation syndrome. Fertil Steril. 1992;58:449–51.CrossRefPubMed
11.
Delbaere A, Bergmann PJ, Gervy-Decoster C, Staroukine M, Englert Y. Angiotensin II immunoreactivity is elevated in ascites during severe ovarian hyperstimulation syndrome: implications for pathophysiology and clinical management. Fertil Steril. 1994;62:731–7.CrossRefPubMed
12.
Delbaere A, Bergmann PJ, Gervy-Decoster C, Camus M, de Maertelaer V, Englert Y. Prorenin and active renin concentrations in plasma and ascites during severe ovarian hyperstimulation syndrome. Hum Reprod. 1997;12:236–40.CrossRefPubMed
13.
Delbaere A, Smits G, Olatunbosun O, Pierson R, Vassart G, Costagliola S. New insights into the pathophysiology of ovarian hyperstimulation syndrome. What makes the difference between spontaneous and iatrogenic syndrome? Hum Reprod. 2004;19:486–9.CrossRefPubMedPubMedCentral
14.
Evbuomwan I. The role of osmoregulation in the pathophysiology and management of severe ovarian hyperstimulation syndrome. Hum Fertil (Camb). 2013;16:162–7.CrossRef
15.
Lyons CA, Wheeler CA, Frishman GN, Hackett RJ, Seifer DB, Haning RV. Early and late presentation of the ovarian hyperstimulation syndrome: two distinct entities with different risk factors. Hum Reprod. 1994;9:792–9.CrossRefPubMed
16.
Mathur RS, Akande AV, Keay SD, Hunt LP, Jenkins JM. Distinction between early and late ovarian hyperstimulation syndrome. Fertil Steril. 2000;73:901–7.CrossRefPubMed
17.
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
18.
Morris RS, Paulson RJ, Sauer MV, Lobo RA. Predictive value of serum oestradiol concentrations and oocyte number in severe ovarian hyperstimulation syndrome. Hum Reprod. 1995;10:811–4.CrossRefPubMed
19.
Balen AH, Braat D, West C, Patel A, Jacobs HS. Cumulative conception and live birth rates after the treatment of anovulatory infertility: safety and efficacy of ovulation induction in 200 patients. Hum Reprod. 1994;
20.
D’Angelo A, Brown J, Amso NN. Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2011;:CD002811.
21.
Kashyap S, Parker K, Cedars MI, Rosenwaks Z. Ovarian hyperstimulation syndrome prevention strategies: reducing the human chorionic gonadotropin trigger dose. Semin Reprod Med. 2010;28:475–85.CrossRefPubMed
22.
Wada I, Matson PL, Horne G, Buck P, Lieberman BA. Is continuation of a gonadotrophin-releasing hormone agonist (GnRHa) necessary for women at risk of developing the ovarian hyperstimulation syndrome? Hum Reprod. 1992;7:1090–3.CrossRefPubMed
23.
Salat-Baroux J, Alvarez S, Antoine JM, Cornet D. Treatment of hyperstimulation during in-vitro fertilization. Hum Reprod. Oxford University Press; 1990.
24.
Venetis CA, Kolibianakis EM, Toulis KA, Goulis DG, Papadimas I, Tarlatzis BC. Intravenous albumin administration for the prevention of severe ovarian hyperstimulation syndrome: a systematic review and metaanalysis. Fertil. Steril. 2011;95:188–96–196.e1–3.CrossRefPubMed
25.
Graf MA, Fischer R, Naether OG, Baukloh V, Tafel J, Nückel M. Reduced incidence of ovarian hyperstimulation syndrome by prophylactic infusion of hydroxyaethyl starch solution in an in-vitro fertilization programme. Hum Reprod. 1997;12:2599–602.CrossRefPubMed
26.
Tang H, Hunter T, Hu Y, Zhai S-D, Sheng X, Hart RJ. Cabergoline for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2012;2:CD008605–5.
27.
Humaidan P, Papanikolaou EG, Tarlatzis BC. GnRHa to trigger final oocyte maturation: a time to reconsider. Hum Reprod. 2009;24:2389–94.CrossRefPubMed
28.
Fauser BC, de Jong D, Olivennes F, Wramsby H, Tay C, Itskovitz-Eldor J, et al. Endocrine profiles after triggering of final oocyte maturation with GnRH agonist after cotreatment with the GnRH antagonist ganirelix during ovarian hyperstimulation for in vitro fertilization. J Clin Endocrinol Metab. 2002;87:709–15.CrossRefPubMed
29.
Abbara A, Jayasena CN, Christopoulos G, Narayanaswamy S, Izzi-Engbeaya C, Nijher GMK, et al. Efficacy of kisspeptin-54 to trigger oocyte maturation in women at high risk of ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF) therapy. J Clin Endocrinol Metab. 2015;100:3322–31.CrossRefPubMedPubMedCentral
30.
Griesinger G, Schultz L, Bauer T, Broessner A. Ovarian hyperstimulation syndrome prevention by gonadotropin-releasing hormone agonist triggering of final oocyte maturation in a gonadotropin-releasing hormone antagonist protocol in combination with a “freeze-all” strategy: a prospective multicentric study. Fertil. Steril. 2011.
31.
Fatemi HM, Popovic-Todorovic B, Humaidan P, Kol S, Banker M, Devroey P, et al. Severe ovarian hyperstimulation syndrome after gonadotropin-releasing hormone (GnRH) agonist trigger and “freeze-all” approach in GnRH antagonist protocol. Fertil Steril. 2014;101:1008–11.CrossRefPubMed
32.
Gurbuz AS, Gode F, Ozcimen N, Isik AZ. Gonadotrophin-releasing hormone agonist trigger and freeze-all strategy does not prevent severe ovarian hyperstimulation syndrome: a report of three cases. Reprod BioMed Online. 2014;29:541–4.CrossRefPubMed
33.
Ling LP, Phoon JWL, Lau MSK, Chan JKY, Viardot-Foucault V, Tan TY, et al. GnRH agonist trigger and ovarian hyperstimulation syndrome: relook at ‘freeze-all strategy’. Reprod BioMed Online. 2014;29:392–4.CrossRefPubMed
34.
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
35.
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
36.
Chen CD, Wu MY, Chao KH, Chen SU, Ho HN, Yang YS. Serum estradiol level and oocyte number in predicting severe ovarian hyperstimulation syndrome. J Formos Med Assoc. 1997;96:829–34.PubMed
37.
D’Angelo A, Davies R, Salah E, Nix BA, Amso NN. Value of the serum estradiol level for preventing ovarian hyperstimulation syndrome: a retrospective case control study. Fertil Steril. 2004;81:332–6.CrossRefPubMed
38.
Steward RG, Lan L, Shah AA, Yeh JS, Price TM, Goldfarb JM, et al. Oocyte number as a predictor for ovarian hyperstimulation syndrome and live birth: an analysis of 256,381 in vitro fertilization cycles. Fertil Steril. 2014;101:967–73.CrossRefPubMed
39.
Golan A, Ron-El R, Herman A. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv. 1989.
40.
41.
Blankstein J, Shalev J, Saadon T, Kukia EE, Rabinovici J, Pariente C, et al. Ovarian hyperstimulation syndrome: prediction by number and size of preovulatory ovarian follicles. Fertil Steril. 1987;47:597–602.CrossRefPubMed
42.
Delvigne A, Vandromme J, Barlow P, Lejeune B, Leroy F. Are there predictive criteria of complicated ovarian hyperstimulation in IVF? Hum Reprod. 1991;6:959–62.CrossRefPubMed
43.
Fiedler K, Ezcurra D. Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment. Reprod Biol Endocrinol. 2012;10:32-2.CrossRef
44.
Navot D, Relou A, Birkenfeld A, Rabinowitz R, Brzezinski A, Margalioth EJ. Risk factors and prognostic variables in the ovarian hyperstimulation syndrome. Am J Obstet Gynecol. 1988;159:210–5.CrossRefPubMed
45.
Ocal P, Sahmay S, Cetin M, Irez T, Guralp O, Cepni I. Serum anti-Müllerian hormone and antral follicle count as predictive markers of OHSS in ART cycles. J Assist Reprod Genet. 2011;28:1197–203.CrossRefPubMedPubMedCentral
46.
Bódis J, Török A, Tinneberg HR. LH/FSH ratio as a predictor of ovarian hyperstimulation syndrome. Hum Reprod. 1997;12:869–70.CrossRefPubMed
47.
Danninger B, Brunner M, Obruca A, Feichtinger W. Prediction of ovarian hyperstimulation syndrome by ultrasound volumetric assessment [corrected] of baseline ovarian volume prior to stimulation. Hum Reprod. 1996;11:1597–9.CrossRefPubMed
48.
Gustafson O, Carlström K, Nylund L. Androstenedione as a predictor of ovarian hyperstimulation syndrome. Hum Reprod. 1992;7:918–21.CrossRefPubMed
49.
Lee T-H, Liu C-H, Huang C-C, Wu Y-L, Shih Y-T, Ho H-N, et al. Serum anti-Müllerian hormone and estradiol levels as predictors of ovarian hyperstimulation syndrome in assisted reproduction technology cycles. Hum Reprod. 2008;23:160–7.CrossRefPubMed
50.
Aramwit P, Pruksananonda K, Kasettratat N, Jammeechai K. Risk factors for ovarian hyperstimulation syndrome in Thai patients using gonadotropins for in vitro fertilization. Am J Health Syst Pharm. 2008;65:1148–53.CrossRefPubMed
51.
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
Metadata
Title
What is the best predictor of severe ovarian hyperstimulation syndrome in IVF? A cohort study
Authors
Theoni B Tarlatzi
Christos A Venetis
Fabienne Devreker
Yvon Englert
Anne Delbaere
Publication date
01-10-2017
Publisher
Springer US
Published in
Journal of Assisted Reproduction and Genetics / Issue 10/2017
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI
https://doi.org/10.1007/s10815-017-0990-7

Other articles of this Issue 10/2017

Journal of Assisted Reproduction and Genetics 10/2017 Go to the issue

Genetics

Detection of candidate nectin gene mutations in infertile men with severe teratospermia

Assisted Reproduction Technologies

Replacing single frozen-thawed euploid embryos in a natural cycle in ovulatory women may increase live birth rates compared to medicated cycles in anovulatory women

Assisted Reproduction Technologies

Initial maternal serum human chorionic gonadotropin levels in pregnancies achieved after assisted reproductive technology are higher after preimplantation genetic screening and after frozen embryo transfer: a retrospective cohort

Assisted Reproduction Technologies

Low first-trimester PAPP-A in IVF (fresh and frozen-thawed) pregnancies, likely due to a biological cause

Reproductive Physiology and Disease

Serum microRNAs in male subfertility—biomarkers and a potential pathogenetic link to metabolic syndrome

Commentary

Using stem cell oxygen physiology to optimize blastocyst culture while minimizing hypoxic stress