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

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.

scholarly journals Severe Ovarian Hyperstimulation Syndrome in a Woman With Breast Cancer Under Letrozole Triggered With GnRH Agonist: A Case Report and Review of the Literature

2021 ◽  
Vol 3 ◽  
Author(s):  
Giuseppe Gabriele Iorio ◽  
Marika Ylenia Rovetto ◽  
Alessandro Conforti ◽  
Luigi Carbone ◽  
Roberta Vallone ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Hyperstimulation Syndrome ◽  
Polycystic Ovary ◽  
Complete Recovery ◽  
Human Albumin ◽  
Ovarian Hyperstimulation ◽  
Risk Patients ◽  
History Of ◽  
Ovarian Syndrome ◽  
Severe Ovarian Hyperstimulation Syndrome

We report a rare case of ovarian hyperstimulation syndrome (OHSS) in a 28-year-old woman with breast cancer and with a history of polycystic ovary syndrome (PCOS) despite treatment with letrozole and gonadotropin-releasing hormone agonist (GnRH-a) triggering in a GnRH antagonist (GnRH-ant) protocol without the administration of any human chorionic gonadotropin (hCG) for luteal-phase support. The patient, who underwent controlled ovarian syndrome (COS)-oocyte cryopreservation before chemotherapy, required hospitalization. Complete recovery was achieved after treatment with volume expanders, human albumin, and cabergoline. Based on our case and literature review, it is possible to establish that estradiol (E2) modulation with letrozole and GnRH-a triggering does not eliminate the risk of OHSS. Furthermore, it is advisable to postpone GnRH-a depot to minimize the risk of OHSS after the suspension of letrozole, following menstruation or at least 7–8 days after triggering. It would be desirable to identify high-risk patients, also on a genetic basis, in order to avoid delays in oncologic treatments that could strongly impact life expectancy.

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 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.

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