Administration of intravenous albumin around the time of oocyte retrieval to prevent ovarian hyperstimulation syndrome: a meta-analysis

Background: Complications associated with oocyte retrieval include ovarian hyperstimulation syndrome, ovarian torsion, infection, bleeding, and even acute urinary retention. Case: A 29 year old female presented to the emergency department for dizziness and syncope following oocyte retrieval and was admitted for ovarian hyperstimulation syndrome. Her urinary catheter was obstructed by blood clots and relieved with bladder irrigated. The catheter was removed after twenty-four hours, and she was able to void spontaneously. Four days after discharge, she returned for urinary retention. She underwent cystoscopy and 10cc of blood clots was evacuated. The bladder appeared normal without intravesicular bleeding, and she was discharged home. Twelve hours later, the patient returned for urinary retention. Another cystoscopy was performed and 150cc of blood clots was evacuation. Her symptoms resolved. Conclusion: Hematuria and urinary retention are rare but serious complications of oocyte retrieval. Management options include a urinary catheter, bladder irrigation, urologic imaging, and cystoscopy

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Severe ovarian hyperstimulation syndrome with GnRH agonist trigger during the COVID pandemic: lessons learned from an unusual case

Obstetrics Gynecology and Reproductive Sciences ◽

10.31579/2578-8965/070 ◽

2021 ◽

Vol 5 (04) ◽

pp. 01-04

Author(s):

Bradley S Hurst ◽

Evan Schrader ◽

Tanner Hurley ◽

Lariena Welch ◽

Ying Ying ◽

...

Keyword(s):

Gnrh Agonist ◽

Ovarian Hyperstimulation Syndrome ◽

Unusual Case ◽

Oocyte Retrieval ◽

Lessons Learned ◽

Ovarian Hyperstimulation ◽

Gnrh Agonist Trigger ◽

Severe Ovarian Hyperstimulation Syndrome ◽

Agonist Trigger ◽

Severe Ohss

Background: Injectable gonadotropins stimulate multi-follicular recruitment and allows retrieval of multiple oocytes for assisted reproduction. The widespread utilization of gonadotropin releasing hormone agonist (GnRHa) to induce oocyte maturation for oocyte retrieval has nearly eliminated the risk of severe ovarian hyperstimulation syndrome (OHSS), and only a few cases have been reported in the literature. The rarity of severe OHSS may lead to the mistaken conclusion that gonadotropin stimulation can be safely administered with limited monitoring, even in high-risk patients. We present an unusual case of a woman with limited monitoring due to the COVID pandemic who developed severe OHSS before GnRH agonist trigger and oocyte. Case Presentation: A 29-year-old nulliparous woman with polycystic ovarian syndrome (PCOS) initiated ovarian stimulation for oocyte retrieval. She had a robust initial response, and developed worsening abdominal pain, bloating, nausea, vomiting, and decreased appetite before retrieval. GnRH agonist was given to “trigger ovulation and retrieval scheduled due to the low reported incidence of severe OHSS. Symptoms progressed, and on the morning of retrieval, ultrasound demonstrated bilaterally enlarged ovaries >10cm and 48 oocytes were retrieved for a planned cryo-all cycle. She was hospitalized on the day of retrieval for severe OHSS and had two large-volume paracenteses. She was stable and discharged home by day 5, and symptoms markedly improved with the onset of menses. She has an ongoing pregnancy from her first frozen embryo transfer. Conclusion: We add a rare case of severe OHSS with a GnRHa trigger and cryo-all protocol with the onset of symptoms before GnRH agonist administration. Although rare, severe OHSS may still occur with a GnRHa trigger, and caution is needed when an initial robust response is identified. Here we also provide an opportunity to review the important patient risk factors for the development of OHSS and measures to reduce the risk in excessive responders.

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Reproductive Outcomes of Women with Polycystic Ovarian Syndrome Following In-Vitro Fertilization — A Meta-Analysis and Systematic Review

Fertility & Reproduction ◽

10.1142/s2661318219500221 ◽

2019 ◽

Vol 01 (04) ◽

pp. 193-201

Author(s):

I-Ferne Tan ◽

Audrey J. R. Lim ◽

Inthrani R. Indran ◽

Michael S. Kramer ◽

Eu-Leong Yong

Keyword(s):

Live Birth ◽

Ovarian Hyperstimulation Syndrome ◽

Birth Rate ◽

Meta Analysis ◽

Live Birth Rate ◽

Ovarian Hyperstimulation ◽

Vitro Fertilization ◽

Ivf Outcomes ◽

Ovarian Syndrome

Background: Polycystic ovarian syndrome (PCOS) is a common cause of infertility in women. In-vitro fertilization (IVF) is required in 20–30% of women with PCOS trying to conceive. This is associated with increased risk of multiple gestation and ovarian hyperstimulation syndrome. Improvements in IVF techniques, safety standards, and the increased use of frozen embryos in recent years have lead to improved outcomes for women with PCOS. We performed a systematic review and meta-analysis to compare these outcomes with women without PCOS. Search Methods: A search of PubMed, EMBASE, the Cochrane Central Register of clinical trials, and Scopus databases for all articles published until November 16th, 2017 identified 21 studies comparing IVF outcomes in PCOS and non-PCOS women. Inclusion criteria were Rotterdam criteria PCOS, comparable IVF regimes, immediate IVF outcomes, and pregnancy outcomes. Studies were excluded if the control group included any PCOS criteria, donor oocytes, or in-vitro maturation. Outcomes: No difference was observed in live birth rate per cycle in women with vs. without PCOS (RR [Formula: see text] 1.01 [0.89, 1.16]; [Formula: see text] 82%), but the live birth rate per first cycle in PCOS cycles (RR [Formula: see text] 0.93 [0.88, 0.99]) was slightly lower. There was also no difference in the clinical pregnancy rate (RR 1.02 [0.89, 1.17]) or biochemical pregnancy rate (RR 1.03 [0.99, 1.08]) observed between the two groups. PCOS was associated with a significantly higher number of oocytes retrieved (mean difference [Formula: see text] 3.6; 95% CI [2.8, 4.4]), risk of miscarriage (RR 2.90 [2.09, 4.02]), and risk of ovarian hyperstimulation syndrome (RR 3.42 [2.28, 5.13]) per cycle. Conclusion: Despite a widespread perception of poor reproductive potential, women with PCOS experience IVF outcomes similar to those without PCOS. Although there is a slightly lower live birth rate during their first stimulation cycle, success rates are similar after multiple cycles. PCOS is associated with a higher risk of ovarian hyperstimulation syndrome. Further studies are required to mitigate this risk.

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