Human Reproduction, Vol. 7, No. 5, pp. 597-600, 1992
© 1992 European Society of Human Reproduction and Embryology
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In vitro fertilization and the ovarian hyperstimulation syndrome
1The Hallam Medical Centre 112 Harley Street, London WIN 8AA, UK 2Department of Reproductive Endocrinology, The Middlesex Hospital Mortimer Street, London WIN 1AF, UK 3Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry Denmark Hill, London SE5 8RX, UK
Correspondence: 3To whom correspondence should be addressed
Eight patients who developed severe ovarian hyperstimulation syndrome (OHSS) were identified among 1302 patients undergoing in-vitro fertilization (IVF) over a 1 year period (prevalence of 0.6%); 63% had ultrasonically diagnosed polycystic ovaries (PCO) and 75% were undergoing their first attempt at IVF. Pretreatment with a superactive luteinlzing hormone-releasing hormone (LHRH) analogue significantly increased the prevalence of severe OHSS (1.1% versus 0.2%, P < 0.05) compared with ovarian stimulation with clomiphene citrate and human menopausal gonadotrophin (HMG). The mean serum oestradiol concentration on the day of human chorionic gonadotrophin (HCG) administration was 8200 ± 2300 pmol/1. A mean of 19.6 ± 6.8 follicles had been aspirated and 13.1 ± 7.7 oocytes recovered at transvaginal ultrasound-directed oocyte recovery. All patients had an embryo transfer and luteal support in the form of HCG. The clinical pregnancy rate was 88%, multiple pregnancy rate 71% and implantation rate 63.5 ± 41.3%. In a group of seven patients who were hospitalized for moderate OHSS during the same period, peak oestradiol levels were significantly lower than in those with severe OHSS (P < 0.05). Of the group with moderate OHSS, 57% had PCO, the clinical pregnancy rate was 100% and multiple pregnancy rate 43%. Patients with ultrasound-diagnosed PCO have an increased risk of developing OHSS and the dose of HMG administered to them should be minimized. In patients at risk of developing OHSS, progesterone instead of HCG should be used for luteal support. Transfer of a maximum of two embryos or freezing all embryos for transfer in a subsequent cycle may reduce the likelihood of multiple pregnancy.
Key words: in-vitro fertilization/ovarian hyperstimulation syndrome/polycystic ovaries
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