scholarly journals Prediction of Patients with Ovarian Hyperstimulation Syndrome in Gnrh-A Prolonged Protocol : A Retrospective Study

2021 ◽  
Author(s):  
Yang Zexing ◽  
Wen Ya ◽  
Limei He ◽  
Yuhang Zheng ◽  
Meng Rao ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ovarian Hyperstimulation Syndrome ◽  
Clinical Symptoms ◽  
Area Under The Curve ◽  
Common Adverse Effect ◽  
Predictive Ability ◽  
Roc Curves ◽  
Fertility Treatment ◽  
Ovarian Hyperstimulation ◽  
Severe Ohss

Abstract Background: OHSS (ovarian hyperstimulation syndrome) is a life-threatening complication and most common adverse effect of fertility treatmentObjectives: To investigate associated risk factors of ovarian hyperstimulation syndrome (OHSS) in stimulated ovarian cycles with assisted reproductive technology, may provide guidance for clinicians on how to prevent OHSS. Methods: A Logistic regression analysis was conducted in 336 patients who had completed IVF-ICSI/ET cycles between April 2019 and April 2020 in the first affiliated hospital of kunming medical university. Receiver-operating characteristic (ROC) curves for OHSS were calculated for each predictor using cut-off values. Area under the curve (AUC) analysis and logistic regression models were performed to compare the performance of laboratory biomarkers. Results: According to clinical diagnosis, 61 cycles developed OHSS of 336 cycles, with an incidence of 18.15%. Patients were graded according to their clinical symptoms and severity, including 27 cycles of moderate OHSS (8.04%) and 8 cycles of severe OHSS (2.38%). The cut-off value of AMH, E2 on HCG day, egg retrieved to predict moderate and severe OHSS were 7.495ng/ml, 4828pg/ml and 19.5 in GnRH-a Prolonged Protocol, with sensitivities of 77.0%, 67.2%, 80.3%, and specificity of 68.0%, 70.9%, 81.5% respectively. The area under the curve (AUC) values of AMH, E2 on HCG day, Number of oocytes retrieved to predict moderate and severe OHSS were 0.754, 0.738, 0.876, respectively. And the AUC value of combined index to predict moderate and severe OHSS was 0.898, achieved the highest AUC with 85.2% sensitivity and 83.6% specificity. Conclusions:AMH, E2 day of HCG and number of eggs obtained have a good predictive effect on the occurrence of OHSS, and the predictive ability is further improved after the combination of the three indicators.

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

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.

scholarly journals Prediction of severe ovarian hyperstimulation syndrome in women undergoing in vitro fertilization using estradiol levels, collected ova, and number of follicles

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094555
Author(s):  
Ivan Madrazo ◽  
Monserrat Fabiola Vélez ◽  
Josue Jonathan Hidalgo ◽  
Ginna Ortiz ◽  
Juan José Suárez ◽  
...  
Keyword(s):  
Ovarian Hyperstimulation Syndrome ◽  
Characteristic Curve ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Ovarian Hyperstimulation ◽  
Vitro Fertilization ◽  
American Society ◽  
Severe Ovarian Hyperstimulation Syndrome ◽  
Severe Ohss

Objective Our objective was to determine whether estradiol (E2) levels (Day 3 and fold change to Day 10), antral follicle count (AFC), and number of ova collected could predict ovarian hyperstimulation syndrome (OHSS) and culdocentesis intervention. Methods We conducted a retrospective review of patient charts between January 2008 and December 2017. OHSS was defined using American Society for Reproductive Medicine criteria. Predictability was evaluated by measuring the area under the receiver operating characteristic curve (AUC). Results The cohort included 319 women (166 controls, 153 OHSS, of whom 54 had severe OHSS). The OHSS group had higher E2Day 3 (249 ± 177 vs. 150 ± 230 ng/L), E2FoldChange (32.2 ± 29.1 vs. 20.1 ± 23.8), AFC (18.2 ± 9.1 vs. 11.6 ± 8.3), and number of ova collected (21.1 ± 9.0 vs. 10.1 ± 6.5). E2Day 3 (AUC = 0.76, 95%CI: 0.71–0.82), E2FoldChange (AUC = 0.71, 95%CI: 0.65–0.77), AFC (AUC = 0.75, 95%CI: 0.70–0.81), and number of ova collected (AUC = 0.85, 95%CI: 0.81–0.89) were predictive for OHSS. All variables were predictive for culdocentesis intervention (E2Day 3: AUC = 0.63, 95%CI: 0.55–0.70; E2FoldChange: AUC = 0.63, 95%CI: 0.55–0.71; AFC: AUC = 0.74, 95%CI: 0.68–0.80; number of ova collected: AUC = 0.80, 95%CI: 0.75–0.85). Conclusions Day 3 E2 levels and number of ova collected predict patients who could develop OHSS and may require culdocentesis.

scholarly journals Symptomatic Isolated Pleural Effusion as an Atypical Presentation of Ovarian Hyperstimulation Syndrome

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Christine M. Mullin ◽  
M. Elizabeth Fino ◽  
Andrea Reh ◽  
Jamie A. Grifo ◽  
Frederick Licciardi
Keyword(s):  
Risk Factors ◽  
Pleural Effusion ◽  
Ovarian Stimulation ◽  
Ovarian Hyperstimulation Syndrome ◽  
Clinical Manifestations ◽  
Ovarian Hyperstimulation ◽  
Atypical Presentation ◽  
Pleural Effusions ◽  
Reasonable Amount ◽  
Severe Ohss

Ovarian hyperstimulation syndrome (OHSS) presents in ~33% of ovarian stimulation cycles with clinical manifestations varying from mild to severe. Its pathogenesis is unknown. Pleural effusion is reported in ~10% of severe OHSS cases and is usually associated with marked ascites. The isolated finding of pleural effusions without ascites, as the main presenting symptom of OHSS is not frequently reported and its pathogenesis is also unknown. We describe two unusual cases of OHSS where dyspnea secondary to unilateral pleural effusion was the only presenting symptom. By reporting our experience, we would like to heighten physicians' awareness in detecting these cases early, as it is our belief that the incidence of pleural effusion in the absence of most commonly recognized risk factors for OHSS may be underestimated and may significantly compromise the health of the patient if treatment is not initiated in a reasonable amount of time.

scholarly journals Spontaneous Pregnancy with Severe Ovarian Hyperstimulation Syndrome Undergoing IVF-ET Cycle: A Case Report and Review

2020 ◽  
Author(s):  
Chaonan Peng ◽  
Zhixiao Wang
Keyword(s):  
Embryo Transfer ◽  
Ovarian Hyperstimulation Syndrome ◽  
Induction Treatment ◽  
Ovarian Hyperstimulation ◽  
Self Healing ◽  
Spontaneous Pregnancy ◽  
Severe Ovarian Hyperstimulation Syndrome ◽  
Severe Ohss ◽  
Ivf Et

Abstract It is relatively rare that a natural spontaneous with severe ovarian hyperstimulation syndrome (OHSS) occurs undergoing in vitro fertilization and embryo transfer (IVF-ET).Pregnancy can cause OHSS to be delayed, and even lead to pregnancy loss in severe cases.In this case, we introduced the case of a 32-year-old female infertile patient with PCOS who underwent IVF-ET cycle and developed severe OHSS before embryo transfer. After volume expansion, symptomatic and supportive treatment and four times of abdominal puncture to extract ascites, the patient's condition is still protracted.However, interestingly, two weeks after giving up treatment, the patient found a spontaneous pregnancy and ended up with biochemical pregnancy. Severe OHSS was also gradually self-healing after biochemical pregnancy.This case emphasizes that pregnancy is one of the high-risk factors of OHSS, which can lead to the delay of the patient's condition with OHSS. Clinicians should be alert to the possibility of spontaneous pregnancy when they take luteal phase ovulation induction treatment undergoing IVF-ET cycle.

scholarly journals The Relationship Between Tactical Positioning and the Race Outcome in 800-M Running at the 2016 Olympic Games and 2017 IAAF World Championship

2020 ◽  
Vol 71 (1) ◽  
pp. 299-305
Author(s):  
Fernando González-Mohíno ◽  
Jesús Santos del Cerro ◽  
Andrew Renfree ◽  
Inmaculada Yustres ◽  
José Mª González-Ravé
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Olympic Games ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Significance Test ◽  
Final Position ◽  
The Difference ◽  
The Relationship

AbstractThe purpose of this analysis was to quantify the probability of achieving a top-3 finishing position during 800-m races at a global championship, based on dispersion of the runners during the first and second laps and the difference in split times between laps. Overall race times, intermediate and finishing positions and 400 m split times were obtained for 43 races over 800 m (21 men’s and 22 women’s) comprising 334 individual performances, 128 of which resulted in higher positions (top-3) and 206 the remaining positions. Intermediate and final positions along with times, the dispersion of the runners during the intermediate and final splits (SS1 and SS2), as well as differences between the two split times (Dsplits) were calculated. A logistic regression model was created to determine the influence of these factors in achieving a top-3 position. The final position was most strongly associated with SS2, but also with SS1 and Dsplits. The Global Significance Test showed that the model was significant (p < 0.001) with a predictive ability of 91.08% and an area under the curve coefficient of 0.9598. The values of sensitivity and specificity were 96.8% and 82.5%, respectively. The model demonstrated that SS1, SS2 and Dplits explained the finishing position in the 800-m event in global championships.

scholarly journals An ovarian hyperstimulation syndrome caused by gonadotropinoma in a young woman

2019 ◽  
Vol 65 (4) ◽  
pp. 278-288
Author(s):  
Anna M. Gorbacheva ◽  
Elena G. Przhiyalkovskaya ◽  
Vilen N. Azizyan ◽  
Irina V. Stanoevich ◽  
Andrey Yu. Grigoriev ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Ovarian Hyperstimulation Syndrome ◽  
Clinical Case ◽  
Clinical Symptoms ◽  
Pituitary Tumors ◽  
Immunohistochemical Analysis ◽  
Common Type ◽  
Biologically Active ◽  
Reproductive Age ◽  
Ovarian Hyperstimulation

From 14 to 54% of all pituitary adenomas are nonfunctioning pituitary adenomas (NPAs), their prevalence is estimated as 7.041.3 cases per 100 000 population. The most common type of NPAs (73% of cases) are gonadotropinomas. In most cases, gonadotropinoma is characterized by secretion of biologically inactive hormones, so the release of gonadotropins does not lead to the development of any clinical symptoms. For this reason the diagnosis of gonadotropinomas is most often performed on the basis of immunohistochemical analysis. However, in rare cases, gonadotropinomas secrete biologically active hormones, most often follicle-stimulating (FSH). Ovarian hyperstimulation syndrome due to gonadotropin-secreting pituitary tumors occurs in about 3% of women with hormonally inactive pituitary adenomas at reproductive age and in 8% of patients with verified gonadotropinomas. This clinical case describes a young patient with a rare pathology: FSH/LH-secreting macroadenoma of the pituitary, which led to the development of ovary hyperstymulation symdrome. The diagnosis of pituitary adenoma was performed due to the identified hyperprolactinemia one month before the development of visual impairment, which can be considered a late diagnosis. Surgical treatment of gonadotropinomy was carried out successfully and without complications, remission of the disease was achieved, visual function was restored, the patient successfully became pregnant.

scholarly journals LOW DOSE HCG IN PREVENTING OHSS IN HIGH-RISK WOMEN

2021 ◽  
pp. 7-8
Author(s):  
Dantam Hymavathi Devi
Keyword(s):  
Ovarian Hyperstimulation Syndrome ◽  
Low Dose ◽  
Previous History ◽  
High Serum ◽  
Fertility Treatment ◽  
Ovarian Hyperstimulation ◽  
High Concentration ◽  
High Risk Women ◽  
Increased Risk ◽  
History Of

Ovarian hyperstimulation syndrome(OHSS) is a complication of fertility treatment, which uses pharmacological ovarian stimulation to increase the number of oocytes and therefore embryos available during assisted reproductive technology (ART).Severe ovarian hyperstimulation syndrome (OHSS) is well known to be a rare but potentially fatal condition in anovulatory women with polycystic ovarian syndrome (PCOS) when undergoing IVF. Low-dose stimulation is thus recommended,but it can still lead to ovarian hyperstimulation associated with high serum oestradiol concentrations by the time leading follicles reach maturity. Several methods have, therefore, been applied to prevent OHSS. First, risk assessment is made on the basis of the previous history of OHSS and the identification of women with PCO. Second, in treatment cycles a high concentration of oestradiol and three ultrasound parameters (i.e. high number of follicles, large ovarian volume, and high stromal vascularity) on the day of human chorionic gonadotrophin (HCG) are all predictive of increased risk of developing OHSS.

An Unusual Cause of Stroke: Internal Carotid Artery Occlusion as a Complication of Ovarian Hyperstimulation Syndrome

2012 ◽  
Vol 19 (6) ◽  
pp. 408-410
Author(s):  
B Bayram ◽  
O Limon ◽  
G Limon ◽  
S Akay
Keyword(s):  
Ovarian Hyperstimulation Syndrome ◽  
Internal Carotid ◽  
Healthy Woman ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Cerebral Stroke ◽  
Ovarian Hyperstimulation ◽  
Middle Cerebral Artery Infarction ◽  
Life Threatening ◽  
Severe Ohss

Ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication of ovarian stimulation. Thromboembolic events are the most feared complication of OHSS. Most of the thrombotic events (75%) are of the venous origin. Stroke represents a rare but life-threatening complication of severe OHSS. A 29-year old woman was admitted to our emergency room, with left sided weakness, difficulty in breathing and nausea. The patient was given the diagnosis of OHSS and right middle cerebral artery infarction. Here we emphasise that the development of ovulation induction is a newly recognised cause of cerebral stroke in an otherwise healthy woman.

scholarly journals Ovarian Hyperstimulation Syndrome, the Master of Disguise?

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Emily Charlotte Ironside ◽  
Andrew James Hotchen
Keyword(s):  
Ovarian Hyperstimulation Syndrome ◽  
Careful Examination ◽  
Low Molecular Weight ◽  
Ovarian Hyperstimulation ◽  
Potential Harm ◽  
Blood Tests ◽  
The Past ◽  
Drug History ◽  
D Dimer ◽  
Severe Ohss

The use of IVF has risen dramatically over the past 10 years and with this the complications of such treatments have also risen. One such complication is ovarian hyperstimulation syndrome with which patients can present acutely to hospital with shortness of breath. On admission, a series of blood tests are routinely performed, including the d-dimer. We present a case of a 41-year-old lady who had recently undergone IVF and presented with chest pain and dyspnoea. In the emergency department, a d-dimer returned as mildly elevated. Consequential admission onto MAU initiated several avoidable investigations for venous thromboembolism. Careful examination elicited a mild ascites and a thorough drug history gave recent low molecular weight heparin usage. Ultrasound scan of the abdomen subsequently confirmed the diagnosis of severe OHSS. The d-dimer should therefore be used to negate and not to substantiate a diagnosis of VTE. This case report aims to highlight the importance of OHSS as an uncommon cause of dyspnoea but whose prevalence is likely to increase in the forthcoming years. We discuss the complications of the misdiagnosis of OHSS, the physiology behind raised d-dimers, and the potential harm from incorrect treatment or inappropriate imaging.

scholarly journals Clinical Pregnancy and Incidence of Ovarian Hyperstimulation Syndrome in High Ovarian Responders Receiving Different Doses of hCG Supplementation in a GnRH-Agonist Trigger Protocol

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Xiuzhen Shen ◽  
Qinjie Yang ◽  
Lanfang Li ◽  
Wenhao Lu
Keyword(s):  
Gnrh Agonist ◽  
Ovarian Hyperstimulation Syndrome ◽  
Abortion Rate ◽  
Clinical Pregnancy ◽  
Ovarian Hyperstimulation ◽  
High Quality ◽  
Gnrh Agonist Trigger ◽  
Different Doses ◽  
Agonist Trigger ◽  
Severe Ohss

Objective. Ovarian hyperstimulation syndrome (OHSS) is a side effect of the exogenous human chorionic gonadotropin (hCG) hormones used to trigger oocyte maturation. High ovarian responders represent a population with a higher risk of OHSS and are characterized by an exaggerated response to gonadotropin administration. In this study, we compared clinical pregnancy and incidence of OHSS in high ovarian responders receiving different doses of hCG supplementation in a GnRH-agonist trigger protocol. Methods. A total of 205 high ovarian responders who were to undergo in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles were recruited and randomly assigned to receive different doses of hCG supplementation in a GnRH-agonist trigger protocol: GnRH-a (n = 42), GnRH-a + 1000 IU hCG (n = 49), GnRH-a + 2000 IU hCG (n = 54), and GnRH-a + 3000 IU hCG (n = 60) groups. Results. The GnRH-a + 1000 IU hCG, GnRH-a + 2000 IU hCG, and GnRH-a + 3000 IU hCG groups had more oocytes retrieved, embryos, high-quality embryos, and a higher rate of high-quality embryos than the GnRH-a group ( p < 0.05 ). The GnRH-a + 1000 IU hCG group demonstrated more oocytes retrieved, embryos, high-quality embryos, and a higher rate of high-quality embryos than the GnRH-a + 2000 IU hCG and GnRH-a + 3000 IU hCG groups ( p < 0.05 ). No moderate and severe OHSS cases occurred in the GnRH-a and GnRH-a + 1000 IU hCG groups. The incidence rate of moderate and severe OHSS was remarkably lower in the GnRH-a group and GnRH-a + 1000 IU hCG groups than in the GnRH-a + 2000 IU hCG and GnRH-a + 3000 IU hCG groups ( p < 0.05 ). The GnRH-a + 1000 IU hCG, GnRH-a + 2000 IU hCG, and GnRH-a + 3000 IU hCG groups had a higher clinical pregnancy rate than the GnRH-a group, showing no significant difference ( p > 0.05 ). The GnRH-a + 1000 IU hCG, GnRH-a + 2000 IU hCG, and GnRH-a + 3000 IU hCG groups had a lower abortion rate than the GnRH-a group ( p < 0.05 ). Conclusion. Based on the data obtained from this prospective study, we recommend 1000 IU hCG supplementation in a GnRH-agonist trigger protocol for high ovarian responders during IVF/ICSI cycles considering a higher rate of high-quality embryos, a lower incidence rate of moderate and severe OHSS, and a lower abortion rate.

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