The reasons for severe ovarian hyperstimulation syndrome in patients requiring hospitalisation

Czech version

Authors: L. Maršík; A. Ďurechová; M. Borovský; M. Petrenko; H. Urban
Authors‘ workplace: Univerzitné pracovisko reprodukčnej medicíny, I. gynekologicko-pôrodnícka klinika, LF UK a UN Bratislava, Slovenská republika
Published in: Prakt Gyn 2011; 15(3-4): 137-143
Category: Original Article

Overview

Objective:
Prevention and early management of ovarian hyperstimulation syndrome (OHSS) prevents a development of severe forms of the syndrome. Despite this, hospitals frequently admit patients with untreated OHSS following IVF. The aim of the study was to identify the reasons for a development of severe OHSS requiring hospitalization and to establish an effective communication with IVF centres, to protect high-risk patients in the future.

Materials and Methods:
We conducted an analysis of the last five-year clinical data (2006–2010) on patients with severe OHSS, ovary size exceeding 10 cm, ascites and at least laboratory signs of haemoconcentration and hypercoagulation treated at the 1^st Depatment of Obstetrics and Gynaecology of Commenius University in Bratislava. The data were obtained through an anamnesis, from the medical documentation and, where possible, by communication with an IVF centre.

Results:
Between 2006–2010, 17 patients were treated for severe OHSS. The stimulation was performed at 6 different IVF centres in 4 different countries (Slovakia, Czech Republic, Austria and Hungary). Complete information on the stimulation was obtained from the patients, from medical documentation and by consultation with the IVF centre in 9 patients. This information was obtained from the patient and the IVF centre only in 3 patients, no valid medical documentation was available. The information was provided by the patient only in 5 cases, there was no valid medical documentation and no possibility to consult the IVF centre. The most frequent reason for the development of OHSS was an administration of an inadequately high dose of gonadotropins with respect to patient age and risk factors (14 patients). The most frequent error of the cycle management was luteal supplementation performed via HCG (5 cases). OHSS prevention was performed in 7 patients only, the rest (10/17) were not considered to be in a high risk of OHSS. One patient was hospitalized twice for severe OHSS during the data collection period, her case report is included.

Conclusion:
The main reason for the development of endangering forms of OHSS was the breach of preventive steps in IVF centres. High responders were not provided with sufficient care. Inadequate cooperation by the patient, frequently declared by the IVF centres, was not proved as the reason for the development of OHSS.

Key words:
ovarian hyperstimulation syndrome (OHSS) – assisted reproduction (AR) – in vitro fertilisation (IVF) – controlled ovarian hyperstimulation (COH) – complications – hospitalization

Sources

1. Delvigne A, Rozenberg S. Preventive attitude of physicians to avoid OHSS in IVF patients. Hum Reprod 2001; 16(12): 2491–2495.

2. Maršík L, Ďurechová A. Ovariálny hyperstimulačný syndróm – manažment. Gynekol Prax 2004; 2(3): 179–183.

3. Hredzák R, Ostró A, Lazar I. Ovariálny hyperstimulačný syndróm. Lék Listy 2002; 8: 10.

4. Hudeček R, Ventruba P, Tsompsos KN et al. Incidence of malignancy occurance in patients treated for infertility with assisted reproduction techniques. Helen Jour Obstet Gynecol 2005; 4(5): 251–257.

5. Hudeček R, Ventruba P, Unzeitig V et al. Analysis of ovarian hyperstimulation syndrome development using data mining. Scripta Medica Brno 2005; 78: 329–340.

6. Bielik P, Bieliková S. Ovariálny hyperstimulačný syndróm pri spontánnej gravidite. Slov Lek 2009; 5–6: 110–112.

7. Golan A, Ron-El R, Herman A et al. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv 1989; 44(6): 430–440.

8. Navot D. Practicual Guidelines to Prevention and Management of Ovarian Hyperstimulation Syndrome. Serono Fertility Series 1997; 1: 59–69.

9. Rizk B. Ovarian hyperstimulation syndrome: epidemiology, pathophysiology, prevention and management. New York: Cambridge University Press 2006: 7–13, 119–126, 130–184.

10. Maršík L, Ďurechová A, Války J et al. Komplexná ambulantná liečba pacientok s ovariálnym hyperstimulačným syndrómom. Slov Gynek Pôrod 2009; 16: 18–21.

11. Hredzák R, Toporcerová S, Ostró A et al. Možnosti predikcie reakcie ovárií na stimuláciu v programe IVF. Slov Gynek Pôrod 2003; 10(1): 34–35.

12. Oyesanya OA, Parsons JH, Collins WP et al. Total ovarian volume before human chorionic gonadotrophin administration for ovulation induction may predict the hyperstimulation syndrome. Hum Reprod 1995; 10(12): 3211–3212.

13. Lass A. UK Timing of hCG Group. Monitoring of in vitro fertilization-embryo transfer cycles by ultrasound versus by ultrasound and hormonal levels: a prospective, multicenter, randomized study. Fertil Steril 2003; 80(1): 80–85.

14. Chen ChD, Wu MY, Yang JH et al. Intravenous albumin does not prevent the development of severe ovarian hyperstimulation syndrome. Fertil Steril 1997; 68(2): 287–291.

15. Imoedemhe DA. Prevention of ovarian hyperstimulation syndrome. Reproductive medicine in the twenty-first century. London: Parthenon Publishing Group 2002: 306–321.

16. Tarlatzis BC, Grimbizis G. Treatment of OHSS: Management of the Patient. Serono Fertility Series 1997; 1: 71–82.

17. Busso C, Fernández-Sánchez M, García-Velasco JA et al. The non-ergot derived dopamine agonist quinagolide in prevention of early ovarian hyperstimulation syndrome in IVF patients: a randomized, double-blind, placebo-controlled trial. Hum Reprod 2010; 25(4): 995–1004.

18. Alvarez C, Alonso-Muriel I, García G et al. Implantation is apparently unaffected by the dopamine agonist Cabergoline when administered to prevent ovarian hyperstimulation syndrome in women undergoing assisted reproduction treatment: a pilot study. Hum Reprod 2007; 22(12): 3210–3214.

19. de Mouzon J, Goossens V, Bhattacharya Set al. Assisted reproductive technology in Europe, 2008: results generated from European registers by ESHRE. Hum Reprod 2011; 26: i84.

20. Malý Z. OHSS – řešitelná komplikace. Zborník abstraktov: XVIII. kongres Slovenskej gynekologicko-pôrodníckej spoločnosti 2011: 34–35.

21. Buckett WM, Chian RC, Holzer H et al. Obstetric outcomes and congenital abnormalities after in vitro maturation, in vitro fertilization, and intracytoplasmic sperm injection. Obstet Gynecol 2007; 110(4): 885–891.

22. Nardo LG, Yates AP, Roberts SA et al. The relationship between AMH, androgens, insulin resistance and basal ovarian follicular status in non-obese subfertile women with and without PCOS. Hum Reprod 2009; 24(11): 2917–2923.

23. La Marca A, Broekmans FJ, Volpe A et al. Anti-Mullerian hormone (AMH): what do we still need to know? Hum Reprod 2009; 24(9): 2264–2275.

24. Ferraretti AP, Gianaroli L, Diotallevi L et al. Dopamine treatment for severe hyperstimulation syndrome. Hum Reprod 1992; 7(2): 180–183.

25. Ben-Ami I, Chuderland D, Kaplan-Kraicer R et al. Novel treatment for ovarian hyperstimulation syndrome (OHSS) using pigment epithelium derived factor (PEDF). Hum Reprod 2011; 26: i37–i38.

26. Ventruba P, Mrázek M, Žáková J et al. Etická a legislativní pravidla asistované reprodukce – Surveillance 1998–2010. Prakt Gyn 2010; 14 (Suppl 1): 159.

27. Korbeľ M, Féderová L, Nižňanská Z et al. Reprodukčné straty v Slovenskej republike v rokoch 2007–2009. Prakt Gyn 2010; 14 (Suppl 1): 160.