Skip to main content

Advertisement

SpringerLink
Log in

The influence of obesity on incidence of complications in patients hospitalized with ovarian hyperstimulation syndrome

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To study the impact of body habitus on risk of complications resulting from ovarian hyperstimulation syndrome (OHSS) in hospitalized patients.

Methods

This is a retrospective observational study examining the National Inpatient Sample between January 2012 and September 2015. Patients were women < 50 years of age diagnosed with OHSS, classified as non-obese, class I–II obesity, or class III obesity. Intervention included multinomial logistic regression to identify factors associated with obesity and binary logistic regression for independent risk factors for complications. Main outcome measures were incidence of (i) any or (ii) multiple complication(s).

Results

Of 2745 women hospitalized with OHSS, 2440 (88.9%) were non-obese, 155 (5.6%) had class I–II obesity, and 150 (5.5%) had class III obesity. Obese women (either class I–II or III) had a higher degree of comorbidity, had lower incomes, and were less likely to have private insurance than non-obese women (all P < 0.001). Obese women had lower rates of OHSS-related complications than non-obese women (any complication: non-obese 65.2%, class I–II 54.8%, and class III 46.7%, P < 0.001; and multiple complications: non-obese 38.5%, class I–II 32.3%, and class III 20.0%, P < 0.001). In the multivariable model, obesity remained independently associated with a decreased risk of complications (class I–II odds ratio 0.57, 95% confidence interval 0.39–0.83, P = 0.003; class III odds ratio 0.30, 95% confidence interval 0.20–0.44, P < 0.001). Obese women were also less likely to require paracentesis (non-obese 32.8%, class I–II 9.7%, and class III 13.3%, P < 0.001).

Conclusion

Our study suggests that obesity is associated with decreased OHSS-related complication rates in hospitalized patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data on which this study is based are publicly available upon request at https://www.hcup-us.ahrq.gov.

References

  1. ART Success Rates, Final Data (2018) Centers for Disease Control and Prevention. https://www.cdc.gov/art/artdata/index.html. Accessed 3 Jun 2020

  2. Goldsman MP, Pedram A, Dominguez CE, Ciuffardi I, Levin E, Asch RH (1995) Increased capillary permeability induced by human follicular fluid: a hypothesis for an ovarian origin of the hyperstimulation syndrome. Fertil Steril 63:268–272

    Article  CAS  PubMed  Google Scholar 

  3. Practice Committee of American Society for Reproductive Medicine (2008) Ovarian hyperstimulation syndrome. Fertil Steril 90:S188–S193

    Article  Google Scholar 

  4. McClure N, Healy DL, Rogers PA, Sullivan J, Beaton L, Haning RV Jr et al (1994) Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome. Lancet (London, England) 344:235–236

    Article  CAS  Google Scholar 

  5. Selter J, Wen T, Palmerola KL, Friedman AM, Williams Z, Forman EJ (2019) Life-threatening complications among women with severe ovarian hyperstimulation syndrome. Am J Obstet Gynecol 220:575.e1-e11

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  7. Luke B, Brown MB, Morbeck DE, Hudson SB, Coddington CC 3rd, Stern JE (2010) Factors associated with ovarian hyperstimulation syndrome (OHSS) and its effect on assisted reproductive technology (ART) treatment and outcome. Fertil Steril 94:1399–1404

    Article  CAS  PubMed  Google Scholar 

  8. Fiedler K, Ezcurra D (2012) Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment. Reprod Biol Endocrinol 10:32

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Practice Committee of the American Society for Reproductive Medicine (2016) Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertil Steril 106:1634–1647

    Article  Google Scholar 

  10. Danninger B, Brunner M, Obruca A, Feichtinger W (1996) Prediction of ovarian hyperstimulation syndrome by ultrasound volumetric assessment [corrected] of baseline ovarian volume prior to stimulation. Hum Reprod 11:1597–1599

    Article  CAS  PubMed  Google Scholar 

  11. Aramwit P, Pruksananonda K, Kasettratat N, Jammeechai K (2008) Risk factors for ovarian hyperstimulation syndrome in Thai patients using gonadotropins for in vitro fertilization. Am J Health Syst Pharm 65:1148–1153

    Article  CAS  PubMed  Google Scholar 

  12. Lee TH, Liu CH, Huang CC, Wu YL, Shih YT, Ho HN et al (2008) Serum anti-Müllerian hormone and estradiol levels as predictors of ovarian hyperstimulation syndrome in assisted reproduction technology cycles. Hum Reprod 23:160–167

    Article  CAS  PubMed  Google Scholar 

  13. Navot D, Bergh PA, Laufer N (1992) Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil Steril 58:249–261

    Article  CAS  PubMed  Google Scholar 

  14. Adult obesity facts. In: Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/data/adult.html. Accessed 3 Jun 2020

  15. Koning AM, Kuchenbecker WK, Groen H, Hoek A, Land JA, Khan KS et al (2010) Economic consequences of overweight and obesity in infertility: a framework for evaluating the costs and outcomes of fertility care. Hum Reprod Update 16:246–254

    Article  CAS  PubMed  Google Scholar 

  16. Turner-McGrievy GM, Grant BL (2015) Prevalence of body mass index and body weight cut-off points for in vitro fertilization treatment at U.S. clinics and current clinic weight loss strategy recommendations. Hum Fertil (Cambridge, England) 18:215–219

    Article  Google Scholar 

  17. Koning AM, Mutsaerts MA, Kuchenbecker WK, Broekmans FJ, Land JA, Mol BW et al (2012) Complications and outcome of assisted reproduction technologies in overweight and obese women. Hum Reprod (Oxford, England) 27:457–467

    Article  CAS  Google Scholar 

  18. Bailey AP, Hawkins LK, Missmer SA, Correia KF, Yanushpolsky EH (2014) Effect of body mass index on in vitro fertilization outcomes in women with polycystic ovary syndrome. Am J Obstet Gynecol 211(163):e1-6

    Google Scholar 

  19. Maheshwari A, Stofberg L, Bhattacharya S (2007) Effect of overweight and obesity on assisted reproductive technology—a systematic review. Hum Reprod Update 13:433–444

    Article  CAS  PubMed  Google Scholar 

  20. Milone M, Fernandez LMS, Sosa Fernandez LV, Manigrasso M, Elmore U, De Palma GD et al (2017) Does bariatric surgery improve assisted reproductive technology outcomes in obese infertile women? Obes Surg 27:2106–2112

    Article  PubMed  Google Scholar 

  21. HCUP National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP). 2001–2015. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 23 Jun 2020

  22. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  23. Mandelbaum RS, Smith MB, Violette CJ, Matsuzaki S, Matsushima K, Klar M et al (2020) Conservative surgery for ovarian torsion in young women: perioperative complications and national trends. BJOG 127:957–965

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. HCUP NIS Description of Data Elements, Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/vars/hosp_bedsize/nisnote.jsp. Accessed 23 Jun 2020

  25. Kumar P, Sait SF, Sharma A, Kumar M (2011) Ovarian hyperstimulation syndrome. J Hum Reprod Sci 4:70–75

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Sharma S, Gautam PL, Singh T, Sobti RS, Sandhu JS, Puri S (2016) Critical ovarian hyperstimulation syndrome and management. J Obstet Gynaecol India 66:131–133

    Article  PubMed  Google Scholar 

  27. Abramov Y, Elchalal U, Schenker JG (1999) Pulmonary manifestations of severe ovarian hyperstimulation syndrome: a multicenter study. Fertil Steril 71:645–651

    Article  CAS  PubMed  Google Scholar 

  28. Yang S, Li R, Chen XN, Fu Y, Yi M, Ma CH et al (2015) Acute cerebral thrombosis following ovarian hyperstimulation syndrome: a case report. Chin Med J (Engl) 128:3383–3384

    Article  Google Scholar 

  29. Humaidan P, Nelson SM, Devroey P, Coddington CC, Schwartz LB, Gordon K et al (2016) Ovarian hyperstimulation syndrome: review and new classification criteria for reporting in clinical trials. Hum Reprod (Oxford, England) 31:1997–2004

    Article  CAS  Google Scholar 

  30. Greenland S, Daniel R, Pearce N (2016) Outcome modelling strategies in epidemiology: traditional methods and basic alternatives. Int J Epidemiol 45:565–575

    Article  PubMed  PubMed Central  Google Scholar 

  31. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP et al (2014) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12:1495–1499

    Article  Google Scholar 

  32. Navot D, Relou A, Birkenfeld A, Rabinowitz R, Brzezinski A, Margalioth EJ (1988) Risk factors and prognostic variables in the ovarian hyperstimulation syndrome. Am J Obstet Gynecol 159:210–215

    Article  CAS  PubMed  Google Scholar 

  33. Fauser BC, Diedrich K, Devroey P (2008) Predictors of ovarian response: progress towards individualized treatment in ovulation induction and ovarian stimulation. Hum Reprod Update 14:1–14

    Article  CAS  PubMed  Google Scholar 

  34. Courbiere B, Oborski V, Braunstein D, Desparoir A, Noizet A, Gamerre M (2011) Obstetric outcome of women with in vitro fertilization pregnancies hospitalized for ovarian hyperstimulation syndrome: a case-control study. Fertil Steril 95:1629–1632

    Article  PubMed  Google Scholar 

  35. Leijdekkers JA, van Tilborg TC, Torrance HL, Oudshoorn SC, Brinkhuis EA, Koks CAM et al (2019) Do female age and body weight modify the effect of individualized FSH dosing in IVF/ICSI treatment? A secondary analysis of the OPTIMIST trial. Acta Obstet Gynecol Scand 98:1332–1340

    Article  CAS  PubMed  Google Scholar 

  36. Enskog A, Henriksson M, Unander M, Nilsson L, Brännström M (1999) 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 71:808–814

    Article  CAS  PubMed  Google Scholar 

  37. Lewis CG, Warnes GM, Wang XJ, Matthews CD (1990) Failure of body mass index or body weight to influence markedly the response to ovarian hyperstimulation in normal cycling women. Fertil Steril 53:1097–1099

    Article  CAS  PubMed  Google Scholar 

  38. Delvigne A, Dubois M, Battheu B, Bassil S, Meuleman C, De Sutter P et al (1993) The ovarian hyperstimulation syndrome in in-vitro fertilization: a Belgian multicentric study. II. Multiple discriminant analysis for risk prediction. Hum Reprod (Oxford, England) 8:1361–1366

    Article  CAS  Google Scholar 

  39. Sousa M, Cunha M, da Silva JT, Oliveira C, Silva J, Viana P et al (2015) Ovarian hyperstimulation syndrome: a clinical report on 4894 consecutive ART treatment cycles. Reprod Biol Endocrinol 13:66

    Article  PubMed  PubMed Central  Google Scholar 

  40. Sheng Y, Lu G, Liu J, Liang X, Ma Y, Zhang X et al (2017) Effect of body mass index on the outcomes of controlled ovarian hyperstimulation in Chinese women with polycystic ovary syndrome: a multicenter, prospective, observational study. J Assist Reprod Genet 34:61–70

    Article  PubMed  Google Scholar 

  41. Oudshoorn SC, van Tilborg TC, Eijkemans MJC, Oosterhuis GJE, Friederich J, van Hooff MHA et al (2017) Individualized versus standard FSH dosing in women starting IVF/ICSI: an RCT. Part 2: the predicted hyper responder. Hum Reprod (Oxford, England) 32:2506–2514

    Article  CAS  Google Scholar 

  42. Habbu A, Lakkis NM, Dokainish H (2006) The obesity paradox: fact or fiction? Am J Cardiol 98:944–948

    Article  PubMed  Google Scholar 

  43. Nouri K, Ott J, Lenart C, Walch K, Promberger R, Tempfer CB (2016) Predictors of paracentesis in women with severe ovarian hyperstimulation syndrome: a retrospective cohort study. Gynecol Obstet Invest 81:504–511

    Article  CAS  PubMed  Google Scholar 

  44. Marci R, Lisi F, Soave I, Lo Monte G, Patella A, Caserta D et al (2012) Ovarian stimulation in women with high and normal body mass index: GnRH agonist versus GnRH antagonist. Gynecol Endocrinol 28:792–795

    Article  CAS  PubMed  Google Scholar 

  45. Dodson WC, Kunselman AR, Legro RS (2006) Association of obesity with treatment outcomes in ovulatory infertile women undergoing superovulation and intrauterine insemination. Fertil Steril 86:642–646

    Article  PubMed  Google Scholar 

  46. Azziz R (1989) Reproductive endocrinologic alterations in female asymptomatic obesity. Fertil Steril 52:703–725

    Article  CAS  PubMed  Google Scholar 

  47. Siiteri PK (1987) Adipose tissue as a source of hormones. Am J Clin Nutr 45:277–282

    Article  CAS  PubMed  Google Scholar 

  48. Luo D, Westhoff CL, Edelman AB, Natavio M, Stanczyk FZ, Jusko WJ (2019) Altered pharmacokinetics of combined oral contraceptives in obesity—multistudy assessment. Contraception 99:256–263

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Ioannidou P, Papanikolaou D, Mikos T, Mastorakos G, Goulis DG (2019) Predictive factors of hyperemesis gravidarum: a systematic review. Eur J Obstet Gynecol Reprod Biol 238:178–187

    Article  PubMed  Google Scholar 

  50. Cedergren M, Brynhildsen J, Josefsson A, Sydsjö A, Sydsjö G (2008) Hyperemesis gravidarum that requires hospitalization and the use of antiemetic drugs in relation to maternal body composition. Am J Obstet Gynecol 198(412):e1-5

    Google Scholar 

  51. Matsuo K, Ushioda N, Nagamatsu M, Kimura T (2007) Hyperemesis gravidarum in Eastern Asian population. Gynecol Obstet Invest 64:213–216

    Article  PubMed  Google Scholar 

  52. Merhi Z, Bazzi AA, Bonney EA, Buyuk E (2019) Role of adiponectin in ovarian follicular development and ovarian reserve. Biomed Rep 1:1–5

    PubMed  Google Scholar 

  53. Nigro E, Scudiero O, Monaco ML, Palmieri A, Mazzarella G, Costagliola C et al (2014) New insight into adiponectin role in obesity and obesity-related diseases. Biomed Res Int 2014:658913

    Article  PubMed  PubMed Central  Google Scholar 

  54. Inal HA, Yilmaz N, Gorkem U, Oruc AS, Timur H (2016) The impact of follicular fluid adiponectin and ghrelin levels based on BMI on IVF outcomes in PCOS. J Endocrinol Invest 39:431–437

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

Ensign Endowment for Gynecologic Cancer Research (K.M.).

Author information

Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA

    Rachel S. Mandelbaum, Caroline J. Violette, Shinya Matsuzaki & Koji Matsuo

  2. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA

    Rachel S. Mandelbaum, Caroline J. Violette, Meghan B. Smith, Jacqueline R. Ho, Kristin A. Bendikson & Richard J. Paulson

  3. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Liat Bainvoll

  4. Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany

    Maximilian Klar

  5. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA

    Koji Matsuo

Authors
  1. Rachel S. Mandelbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Liat Bainvoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Caroline J. Violette
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Meghan B. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shinya Matsuzaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maximilian Klar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jacqueline R. Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kristin A. Bendikson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Richard J. Paulson
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Koji Matsuo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: RSM, KM; data curation: RSM; formal analysis: KM; funding acquisition: KM; investigation: all authors; methodology: KM, RSM; project administration: KM; resources: all; software: RSM, KM; supervision: RJP; validation: KM; visualization: RSM; writing—original draft: RSM, KM; writing—review and editing: all authors.

Corresponding author

Correspondence to Koji Matsuo.

Ethics declarations

Conflict of interest

All were outside the current work: honorarium, Chugai, textbook editorial expense, Springer, and investigator meeting attendance expense, VBL therapeutics (K.M.); advisory board, Tesaro, GSK (M.K.); research funding, Merck Sharp & Dorme (S.M.); consultant, Ferring (R.J.P.); none for others.

Ethical approval

This article used publicly available deidentified data, and does not contain any studies with human participants performed by any of the authors.

Informed consent

Not applicable for this study (Ethical Committee Exemption, HS-16-00481).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Presentation: 76th American Society of Reproductive Medicine Scientific Congress & Expo, Portland, OR, October 17–21, 2020.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 44 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mandelbaum, R.S., Bainvoll, L., Violette, C.J. et al. The influence of obesity on incidence of complications in patients hospitalized with ovarian hyperstimulation syndrome. Arch Gynecol Obstet 305, 483–493 (2022). https://doi.org/10.1007/s00404-021-06124-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-021-06124-5

Keywords

Search

Navigation