title: Dual renin-angiotensin blockage and total embryo cryopreservation is not a risk-free strategy in patients at high risk for ovarian hyperstimulation syndrome.
abstract: OBJECTIVE
  To evaluate the effectiveness and safety of dual renin-angiotensin system (RAS) blockage together with total embryo cryopreservation for prevention of ovarian hyperstimulation syndrome (OHSS) in overstimulated patients undergoing IVF.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  A private tertiary care hospital assisted reproduction program.
  
  
  METHODS
  Ten women at high risk for OHSS (mean E(2) level 9401 +/- 585 pg/mL on the day of hCG administration).
  
  
  METHODS
  Cancellation of ET and dual RAS blockage with an angiotensin receptor blocker (candesartan cilexetil) and an angiotensin-converting enzyme inhibitor (enalapril) starting from day 1 after oocyte retrieval. Embryos were cryopreserved and transferred in subsequent cycles.
  
  
  METHODS
  Development of OHSS and pregnancy and live birth rates after frozen-thawed ETs.
  
  
  RESULTS
  While eight women did not develop OHSS, two women (20%) developed severe OHSS requiring hospitalization. Subsequent frozen-thawed ETs resulted in an 80% clinical pregnancy rate and 40% live birth rate.
  
  
  CONCLUSIONS
  Dual RAS blockage with total embryo cryopreservation is a relatively new strategy that was proposed for use in patients at high risk for OHSS. It should be stressed that complete elimination of the syndrome is not possible with this treatment. Subsequent pregnancy rates with the transfer of frozen-thawed embryos are high.
authors.affiliation: Assisted Reproduction Unit of the American Hospital of Istanbul, Istanbul, Turkey. barisata@hotmail.com
authors.forename: Baris
authors.initials: B
authors.lastname: Ata
authors.forename: Kayhan
authors.initials: K
authors.lastname: Yakin
authors.forename: Cengiz
authors.initials: C
authors.lastname: Alatas
authors.forename: Bulent
authors.initials: B
authors.lastname: Urman
mesh_terms: D000328:Adult; D057911:Angiotensin Receptor Antagonists; D001562:Benzimidazoles / Q000008:administration & dosage*; D001713:Biphenyl Compounds / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D015925:Cryopreservation / Q000379:methods*; D004624:Embryo Transfer / Q000379:methods*; D004656:Enalapril / Q000008:administration & dosage*; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008297:Male; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology* / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D013777:Tetrazoles / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; D004656:Enalapril; C077793:candesartan cilexetil