Two cases of polycystic ovary syndrome with onset of severe ovarian hyperstimulation syndrome following controlled ovarian stimulation with aromatase inhibitors for fertility preservation before breast cancer treatment

IntroductionAge, polycystic ovary syndrome (PCOS), low body mass index (BMI), high antral follicle count (AFC), increased anti-Muller hormone (AMH) levels, and elevated serum estradiol (E2) concentrations are risk factors for ovarian hyperstimulation syndrome (OHSS). However, data on the relationship between risk factors and OHSS severity in patients with PCOS are rare.ObjectiveThis retrospective study examined the risk factors for OHSS and their effect on OHSS severity in patients with PCOS undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).MethodThe records of 2,699 women were reviewed and included in this study. These women were diagnosed with PCOS during their first IVF/ICSI cycle between January 2010 and December 2017. We analyzed the association between each of the interrogated risk factors (including female age, BMI, AFC, basal serum E2, and the number of oocytes retrieved) and OHSS. The effects of each risk factor on OHSS severity were further explored. Logistic regression was performed as part of the above analysis.ResultsOf the 2,699 women with PCOS who underwent assisted reproductive technology (ART), 75.2% had a normal response to controlled ovarian hyperstimulation (COH), while 24.8% developed OHSS. All OHSS patients were younger and had lower BMIs and basal serum follicle-stimulating hormone (FSH) and E2 levels but higher AFCs than those in the normal group. AFC demonstrated a strong correlation with OHSS, with a cutoff value of 24 in patients with PCOS. A total of 19.5% of the patients had mild OHSS, while 80.5% had moderate OHSS. Compared with those in the moderate OHSS group, those in the mild OHSS group were older and had higher basal serum FSH levels and lower serum E2 and T levels. However, BMI and AFC were not different between the mild and moderate OHSS groups. Basal serum E2 showed a strong correlation with OHSS severity, with a cutoff value of 37.94 pg/ml.ConclusionsAFC is a strong marker of OHSS, and basal serum E2 is the best predictor of OHSS severity in women with PCOS undergoing IVF treatment.

Download Full-text

Octreotide is not useful for clomiphene citrate resistance in patients with polycystic ovary syndrome but may reduce the likelihood of ovarian hyperstimulation syndrome

Fertility and Sterility ◽

10.1016/s0015-0282(98)00475-0 ◽

1999 ◽

Vol 71 (3) ◽

pp. 452-456 ◽

Cited By ~ 7

Author(s):

Randy S Morris ◽

Vishvanath C Karande ◽

Alan Dudkiewicz ◽

Jody L Morris ◽

Norbert Gleicher

Keyword(s):

Polycystic Ovary Syndrome ◽

Ovarian Hyperstimulation Syndrome ◽

Polycystic Ovary ◽

Clomiphene Citrate ◽

Ovarian Hyperstimulation ◽

Ovary Syndrome

Download Full-text

Severe Ovarian Hyperstimulation Syndrome despite low dose stimulation in Polycystic Ovarian Syndrome

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i3.22728 ◽

2019 ◽

Vol 10 (3) ◽

pp. 50-53

Author(s):

Robin George Manappallil ◽

Sivadas Vilakupadath Kokoori ◽

Nandini Valsala

Keyword(s):

Ovarian Hyperstimulation Syndrome ◽

Low Dose ◽

Polycystic Ovary ◽

Ovarian Hyperstimulation ◽

Fluid Shift ◽

Ovary Syndrome ◽

Assisted Reproduction Technology ◽

Ovarian Syndrome ◽

Severe Ovarian Hyperstimulation Syndrome ◽

Severe Ohss

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology. There is cystic enlargement of the ovaries along with fluid shift from the intravascular compartment to the third space due to increased capillary permeability and ovarian neoangiogenesis. Severe OHSS is uncommon and the condition can be fatal. Low-dose gonadotropin protocols have been introduced to reduce the risk of OHSS in patients with polycystic ovary syndrome (PCOS). The patient being reported had PCOS and developed severe OHSS despite low dose gonadotropin stimulation; which is a rare scenario.

Download Full-text

Truncated in vitro fertilization (IVF) in women with polycystic ovary syndrome results in equivalent pregnancy rates but lower risk of ovarian hyperstimulation syndrome compared to traditional IVF

Fertility and Sterility ◽

10.1016/j.fertnstert.2010.07.980 ◽

2010 ◽

Vol 94 (4) ◽

pp. S253 ◽

Cited By ~ 2

Author(s):

P.S. Uzelac ◽

J.S. Archer ◽

G.L. Christensen ◽

H.C. Bohler ◽

S.T. Nakajima

Keyword(s):

In Vitro Fertilization ◽

Polycystic Ovary Syndrome ◽

Lower Risk ◽

Ovarian Hyperstimulation Syndrome ◽

Polycystic Ovary ◽

Pregnancy Rates ◽

Ovarian Hyperstimulation ◽

Ovary Syndrome ◽

Vitro Fertilization

Download Full-text

A Retrospective Study of Letrozole Treatment Prior to Human Chorionic Gonadotropin in Women with Polycystic Ovary Syndrome Undergoing In Vitro Fertilization at Risk of Ovarian Hyperstimulation Syndrome

Medical Science Monitor ◽

10.12659/msm.910743 ◽

2018 ◽

Vol 24 ◽

pp. 4248-4253 ◽

Cited By ~ 2

Author(s):

Yilu Chen ◽

Tanchu Yang ◽

Cuifang Hao ◽

Junzhao Zhao

Keyword(s):

Retrospective Study ◽

In Vitro Fertilization ◽

Polycystic Ovary Syndrome ◽

Ovarian Hyperstimulation Syndrome ◽

Polycystic Ovary ◽

Ovarian Hyperstimulation ◽

Ovary Syndrome ◽

Vitro Fertilization ◽

Letrozole Treatment

Download Full-text

Induction of ovulation with letrozole in women with polycystic ovary syndrome

GYNECOLOGY ◽

10.26442/2079-5696_19.6.19-23 ◽

2017 ◽

Vol 19 (6) ◽

pp. 19-23

Author(s):

G E Chernukha ◽

E K Kaprina ◽

A A Naidukova

Keyword(s):

Polycystic Ovary Syndrome ◽

Ovarian Hyperstimulation Syndrome ◽

Polycystic Ovary ◽

Multiple Pregnancy ◽

Ovarian Hyperstimulation ◽

Ovary Syndrome ◽

Good Tolerability ◽

Induction Of Ovulation ◽

Effect Of Therapy ◽

Anovulatory Infertility

The aim of the study was to evaluate the effectiveness of the use of letrozole as an inducer of ovulation in women with polycystic ovary syndrome (PCOS) and anovulatory infertility and to determine possible clinical and laboratory predictors of the effect of therapy. Materials and methods: 61 women with anovulatory infertility and PCOS (mean age 28.5 ± 3.3 years, mean body mass index - BMI 21.8 ± 2.7 kg / m2) were included in the study. In order to induce ovulation, the patient received letrozole at a dose of 2.5-5 mg / day from day 3 to 7 of the menstrual cycle under the control of folliculometry, ultrasound m / pelvis on the 20-24 day cycle and the level of progesterone in the blood. Results: the frequency of ovulation per cycle was 77.2% (146/189), 98.4% for women, 24.9% for conception (47/189), 77% for women (47/61) , in 6 (12.8%) women the pregnancy was biochemical, in 1 (2.1%) ectopic, multiple pregnancy took place in 2 (5%) women with progressive uterine pregnancy, spontaneous abortion in the period up to 12 weeks of gestation occurred in 5 (12.5%) women, there was no case of ovarian hyperstimulation syndrome or other side effects. Comparative analysis revealed higher levels of BMI, the percentage of total adipose tissue by densitometry, and the number of antral follicles in the volume of the ovaries in the group with no pregnancy. Conclusion: letrozole is an effective medication for induction of ovulation and pregnancy in the treatment of infertility in patients with PCOS, characterized by good tolerability, low risk of multiple pregnancies and the absence of cases of ovarian hyperstimulation syndrome.

Download Full-text