scholarly journals PIVET rFSH dosing algorithms for individualized controlled ovarian stimulation enables optimized pregnancy productivity rates and avoidance of ovarian hyperstimulation syndrome

2016 ◽  
Vol Volume 10 ◽  
pp. 2561-2573 ◽  
Author(s):  
John Yovich ◽  
Birgit Alsbjerg ◽  
Jason Conceicao ◽  
Peter Hinchliffe ◽  
Kevin Keane
Keyword(s):  
Ovarian Stimulation ◽  
Ovarian Hyperstimulation Syndrome ◽  
Controlled Ovarian Stimulation ◽  
Ovarian Hyperstimulation

scholarly journals Antral follicle count and anti-Müllerian hormone level as predictors of ovarian hyperstimulation syndrome in women with polycystic ovarian syndrome undergoing controlled ovarian stimulation

2021 ◽  
Vol 21 (86) ◽  
pp. e200-e205
Author(s):  
Rubina Izhar ◽  
◽  
Samia Husain ◽  
Muhammad Ahmad Tahir ◽  
Mauzma Kausar ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Ovarian Stimulation ◽  
Ovarian Hyperstimulation Syndrome ◽  
Polycystic Ovarian Syndrome ◽  
Hormone Level ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Controlled Ovarian Stimulation ◽  
Ovarian Hyperstimulation ◽  
Ovarian Syndrome

Aim: To compare the rate of ovarian hyperstimulation syndrome in women with and without polycystic ovarian syndrome, and to determine the cut-off for the antral follicle count and the anti-Müllerian hormone level predictive of ovarian hyperstimulation syndrome in both groups. Methods: This was a prospective cohort study conducted in women aged 20–35 years who were undergoing controlled ovarian stimulation. The women were divided into those with polycystic ovarian syndrome and the controls on the basis of the Rotterdam criteria. The outcome of stimulation was recorded, and the ovarian response markers were compared in both groups. Results: Among 689 women included in the study, 276 (40.1%) had polycystic ovarian syndrome, and 476 (59.9%) were used as the controls. Ovarian hyperstimulation syndrome occurred in 19.6% of the cases, and in 7.7% of the controls (p <0.001). The conception rate was greater in the group of cases (52.5% vs. 16.5%, p = 0.001). Among the cases, the sensitivity and specificity for the prediction of hyper-response were 94.4% and 97.3% for AFC, and 92.6% and 93.7% for the anti-Müllerian hormone, at the cut-off values of ≥18 and ≥6.425 ng/ml, respectively. Among the controls, the sensitivity and specificity for the prediction of hyper-response were 93.8% and 97.1% for the antral follicle count, and 93.6% and 94.5% for the anti-Müllerian hormone, at the cut-off values of ≥10 and ≥3.95 ng/ml, respectively. Conclusion: Group-specific values should be used to identify and counsel women undergoing controlled ovarian stimulation. In light of available evidence, gynaecologists should be trained to perform ultrasound evaluation, determine the antral follicle count of their patients, and offer them appropriate counselling.

scholarly journals Influence of controlled ovarian stimulation protocols on ovarian hyperstimulation syndrome patterns during in vitro fertilization programs

2019 ◽  
Vol 16 (4) ◽  
pp. 443-453
Author(s):  
S. V. Zhukovskaya ◽  
L. F. Mozhejko
Keyword(s):  
Embryo Transfer ◽  
Ovarian Stimulation ◽  
Ovarian Hyperstimulation Syndrome ◽  
Controlled Ovarian Stimulation ◽  
Ovarian Hyperstimulation ◽  
Gnrh Agonists ◽  
Early Form ◽  
The Impact ◽  
Group 1

Different protocols of controlled ovarian stimulation have a significant influence on ovarian hyperstimulation syndrome (OHSS) patterns in women who undergo in vitro fertilization programs (IVF).The objective of this research was to evaluate the impact of different ovarian stimulation protocols on various clinical and laboratory parameters of OHSS, such as embryologic characteristics, hormonal changes, hemostasis, and IVF outcomes. The study was made on the basis of the MPUE “Center of Reproductive Medicine” (Minsk, Belarus) and included,in total, 718 women who underwent IVF for infertility treatment. 103 patients developed OHSS and were divided into two groups based on hormonal stimulation protocols: Group 1 included 60 women who were stimulated with gonadotrophin releasing hormone (GnRH) agonists protocol; Group 2 consisted of 43 women who were prescribed GnRH antagonists during ovarian stimulation.In Group 1 (ovarian stimulation protocol with GnRH agonists), we established significantly higher serum concentrations of estradiol and progesterone during IVF and more marked hemostatic shift towards hypercoagulation: statistically significant elevation of fibrinogen and D-dimes simultaneously with decrease in the primary anticoagulants (antithrombin III and protein С) functional activity. Also, Group 1 had a significantly higher incidence of the early form of OHSS and embryo transfer cancellation caused by a high risk of severe OHSS.OHSS that has developed after the GnRH agonists protocol of controlled ovarian stimulation is associated with higher risks of complications and lower chances of successful pregnancy, which is explained by hyperestrogenic state, elevated progesterone levels, marked hypercoagulation, and higher incidence of early OHSS, which leads to the necessity of embryo transfer cancellation.

scholarly journals Prevention of the Onset of Ovarian Hyperstimulation Syndrome (OHSS) in the Rat After Ovulation Induction with a Low Molecular Weight Agonist of the LH Receptor Compared with hCG and rec-LH

Endocrinology ◽  
2011 ◽  
Vol 152 (11) ◽  
pp. 4350-4357 ◽  
Author(s):  
Ruud van de Lagemaat ◽  
B. C. Raafs ◽  
C. van Koppen ◽  
C. M. Timmers ◽  
S. M. Mulders ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Single Dose ◽  
Ovarian Stimulation ◽  
Ovulation Induction ◽  
Ovarian Hyperstimulation Syndrome ◽  
Controlled Ovarian Stimulation ◽  
Low Molecular Weight ◽  
Ovarian Hyperstimulation ◽  
Pregnant Mare Serum Gonadotropin ◽  
Serum Gonadotropin

Ovarian hyperstimulation syndrome (OHSS) incidentally occurs in controlled ovarian stimulation protocols and is associated with human chorionic gonadotropin (hCG) administration. OHSS is caused by increased vascular permeability (VP) and thought to be mediated by hypersecretion of vascular endothelial growth factor (VEGF) by granulosa cells. Low molecular weight (LMW)-LH agonists have a similar mode of action but a shorter half-life compared with hCG, which could potentially lead to a clinical benefit in reducing the risk for OHSS in controlled ovarian stimulation protocols. The objective of this study is to investigate the role of an orally active LMW-LH agonist in OHSS induction compared with recombinant LH (rec-LH) and hCG. Immature rats were hyperstimulated with pregnant mare serum gonadotropin, and ovulation was induced by hCG, rec-LH or a LMW-LH agonist. The degree of VP was determined by Evans Blue in the abdominal cavity. Ovaries were weighed, and VEGF concentration in the ovary was determined. Pregnant mare serum gonadotropin stimulation followed by single-dose hCG or rec-LH resulted in clear enlargement of the ovaries and increased VP and VEGF levels. However, ovulation induction with a single dose of the LMW-LH agonist did not result in increased VP and VEGF levels, and even multiple dosing to mimic a longer exposure did not induce OHSS symptoms. In conclusion, we demonstrated that the oral LMW-LH agonist did not induce VP in rat, indicative for OHSS, possibly due to reduced VEGF production. If this is translatable to human, this could potentially represent a clinical benefit in reducing the risk for OHSS when using these compounds in controlled ovarian stimulation protocols.

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