Advertisement

Journal of Assisted Reproduction and Genetics

, Volume 34, Issue 10, pp 1341–1351 | Cite as

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

  • Theoni B Tarlatzi
  • Christos A Venetis
  • Fabienne Devreker
  • Yvon Englert
  • Anne Delbaere
Assisted Reproduction Technologies

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.

Keywords

OHSS IVF Prediction Prevention Number of follicles 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board (P2014/210).

For this type of study, formal consent is not required.

References

  1. 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.CrossRefPubMedGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 5.
    Aboulghar MA, Mansour RT. Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures. Hum Reprod Update. 2003;9:275–89.CrossRefPubMedGoogle Scholar
  6. 6.
    Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil Steril. 1992;58:249–61.CrossRefPubMedGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefPubMedGoogle Scholar
  9. 9.
    Delbaere A, Smits G, De Leener A, Costagliola S, Vassart G. Understanding ovarian hyperstimulation syndrome. Endocrine. 2005;26:285–90.CrossRefPubMedGoogle Scholar
  10. 10.
    Aboulghar MA, Mansour RT, Serour GI. Pathophysiology of ovarian hyperstimulation syndrome. Fertil Steril. 1992;58:449–51.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Evbuomwan I. The role of osmoregulation in the pathophysiology and management of severe ovarian hyperstimulation syndrome. Hum Fertil (Camb). 2013;16:162–7.CrossRefGoogle Scholar
  15. 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.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefPubMedGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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;Google Scholar
  20. 20.
    D’Angelo A, Brown J, Amso NN. Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2011;:CD002811.Google Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 23.
    Salat-Baroux J, Alvarez S, Antoine JM, Cornet D. Treatment of hyperstimulation during in-vitro fertilization. Hum Reprod. Oxford University Press; 1990.Google Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 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.Google Scholar
  27. 27.
    Humaidan P, Papanikolaou EG, Tarlatzis BC. GnRHa to trigger final oocyte maturation: a time to reconsider. Hum Reprod. 2009;24:2389–94.CrossRefPubMedGoogle Scholar
  28. 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.CrossRefPubMedGoogle Scholar
  29. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 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.Google Scholar
  31. 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.CrossRefPubMedGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar
  33. 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.CrossRefPubMedGoogle Scholar
  34. 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.CrossRefPubMedGoogle Scholar
  35. 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.CrossRefPubMedGoogle Scholar
  36. 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.PubMedGoogle Scholar
  37. 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.CrossRefPubMedGoogle Scholar
  38. 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.CrossRefPubMedGoogle Scholar
  39. 39.
    Golan A, Ron-El R, Herman A. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv. 1989.Google Scholar
  40. 40.
    Youden WJ. Index for rating diagnostic tests. Cancer. 1949;3:32–5.CrossRefGoogle Scholar
  41. 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.CrossRefPubMedGoogle Scholar
  42. 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.CrossRefPubMedGoogle Scholar
  43. 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.CrossRefGoogle Scholar
  44. 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.CrossRefPubMedGoogle Scholar
  45. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Bódis J, Török A, Tinneberg HR. LH/FSH ratio as a predictor of ovarian hyperstimulation syndrome. Hum Reprod. 1997;12:869–70.CrossRefPubMedGoogle Scholar
  47. 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.CrossRefPubMedGoogle Scholar
  48. 48.
    Gustafson O, Carlström K, Nylund L. Androstenedione as a predictor of ovarian hyperstimulation syndrome. Hum Reprod. 1992;7:918–21.CrossRefPubMedGoogle Scholar
  49. 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.CrossRefPubMedGoogle Scholar
  50. 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.CrossRefPubMedGoogle Scholar
  51. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Theoni B Tarlatzi
    • 1
  • Christos A Venetis
    • 2
  • Fabienne Devreker
    • 1
  • Yvon Englert
    • 1
  • Anne Delbaere
    • 1
  1. 1.Fertility Clinic, Department of Obstetrics and Gynecology, Erasme HospitalUniversité Libre de BruxellesBrusselsBelgium
  2. 2.Women’s and Children’s Health, St George HospitalUniversity of New South WalesSydneyAustralia

Personalised recommendations