1 / 29

Strategies for Prevention of Ovarian Hyperstimulation Syndrome

Jims
Download Presentation

Strategies for Prevention of Ovarian Hyperstimulation Syndrome

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Strategies for Prevention of Ovarian Hyperstimulation Syndrome By Ayman Nady Abdelmeged M.D. Lecturer of Obst.&Gyn. Minia University, Egypt. anady@repromed.ca

    4. Ovarian enlargement and increased capillary permeability leading to a ‘third space’ fluid shift characterize OHSS. These changes may cause haemoconcentration, electrolyte disturbance, liver and kidney dysfunction and thromboembolic sequelae. (Chen et al.,2003).

    5. Physical symptoms primarily consist of distended abdomen, gastrointestinal discomfort, dyspnoea and decreased urine output.

    7. Clinical signs and symptoms such as weight gain changes in abdominal girth and haemoconcentration are useful to monitor clinical progression. Treatment consists of supportive care and maintenance of vascular space integrity.

    8. Fortunately, OHSS is self limiting and if pregnancy does not occur, recovery often begins at the end of the luteal phase. However, if pregnancy occurs, the time course of the disease may be as long as several weeks ( Grudzinskas and Egbase,1998).

    9. Incidence The incidence of OHSS in different centers has been estimated to vary from 1 to 10% (Serour et al.,1998). Moreover, it occurred in a serious life-threatening form in 0.1-2% of treatment cycles (Whelan and Vlahos , 2000).

    10. Pathophysiology

    11. Risk Factors Risk factors include polycystic ovarian disease (PCOD). young age, history of previous OHSS and low body weight. (Enskog et al.,1999).

    12. A large cohort of antral follicles associated with high and rapidly increasing E2> 3000pg/ml on day of HCG,more than 20 follicles seen on ULS in the late follicular phase and greater than 15 oocytes retrieved, are all potential risk factors (Reljic et al.,1999).

    13. Classification of OHSS (Aboulghar and Mansour,2003)

    14. Prevention Strategies 1.Ovarian Stimulation 2.Coasting 3.Cryopreservation 4.Intravenous albumin 5.Intravenous hydroxyethyl starch 6.Gonadotrophin-releasing hormone agonist 7.Gonadotrophin-releasing hormone antagonist 8.Recombinant human LH 9.Follicular aspiration 10.In – vitro maturation of oocytes

    15. 1.Ovarian Stimulation (Homburg and Howles,1999)

    16. 2.Coasting (Aboulghar and Mansour,2003)

    17. 2.Coasting (Mansour et al., 2005)

    18. 3.Cryopreservation (Aboulghar and Mansour,2003)

    19. 4.Intravenous albumin (Aboulghar and Mansour,2003)

    20. 5.Intravenous hydroxyethyl starch (Konig et al.,1998)

    21. 6.Gonadotrophin-releasing hormone agonist (Griesinger et al.,2006)

    22. 6.Gonadotrophin-releasing hormone agonist (Engmann et al.,2008)

    23. 7.Gonadotrophin-releasing hormone antagonist( Aboulghar et al.,2007)

    24. 8.Recombinant human LH( European Recombinant LH Study Group,2001)

    25. 9.Follicular aspiration Various studies have demonstrated a protective value of follicular aspiration at the time of oocyte retrieval on OHSS outcome (Laufer et al., 1990 ). Many others have claimed that follicular aspiration for IVF does not prevent OHSS ( Aboulghar et al., 1992 ).

    26. 10.In - vitro maturation of oocytes Child et al., 2001 have demonstrated that for PCOS patients ,OHSS could be prevented by minimal stimulation and IVM of oocytes. However, IVM protocols have not achieved pregnancy rates that are comparable to rates following ovarian stimulation and IVF of mature oocytes ( Chan et al., 2003 ).

    27. Conclusions Ovarian hyperstimulation syndrome is a serious complication of ovarian stimulation, which could be life threatening. Identification of high risk patients and use of low dose protocols have an important rule in prevention. To date, no methods are available to completely prevent this complication. There are as yet no well randomized studies which provide the highest level of evidence to suggest the use of coasting in preference to other strategies.

    28. I.V albumin administration at the time of oocyte retrieval may help in the prevention, although the degree of protection is not complete. Insufficient evidence for the routine use of cryopreservation in prevention of OHSS. GnRH agonist or antagonist to trigger ovulation may have a protective effect ,as well as the use of recombinant LH. Large randomized studies comparing different modalities should be conducted to provide evidence - based practice.

    29. THANK YOU

More Related