Ovarian hyperstimulation syndrome: steps to maximize success and minimize effect for assisted reproductive outcome.
OBJECTIVE
To investigate the strategies used to decrease the risk of ovarian hyperstimulation syndrome (OHSS) and their impact on pregnancy and live birth rates.


METHODS
Retrospective cohort analysis.


METHODS
University hospital.


METHODS
One hundred eighty-eight patients undergoing fresh in vitro fertilization (IVF) cycles between 2000 and 2004, with peak serum estradiol levels >2500 pg/mL and presumed to be at risk for OHSS.


METHODS
Coasting and elective embryo cryopreservation were evaluated for their effect on OHSS and live birth rates.


METHODS
Pregnancy, live birth rates, and OHSS incidence.


RESULTS
Out of 188 patients at risk for OHSS, 21 patients had their cycles coasted (group 1), and elective embryo cryopreservation was performed in 32 patients (group 2). In 135 patients with no other risk factors, ovulation was triggered with human chorionic gonadotropin and embryo transfer was performed (group 3). The incidence in our IVF population was 38 out of 1002 (3.8%). The overall incidence of OHSS for those who had an estradiol level >2500 pg/mL was 20.2% (38 out of 188), and none of the patients in group 1 developed OHSS; 13 out of 32 patients in group 2 (40.6%) and 25 out of 135 (18.5%) patients in group 3 developed OHSS. The live birth rate was 38%, 40%, and 45% in groups 1, 2, and 3, respectively, and the cumulative live birth rate was 52%, 75%, and 59%, respectively.


CONCLUSIONS
Elective cryopreservation of embryos with subsequent frozen embryo transfer and coasting are effective ways of maximizing pregnancy and limiting severe OHSS.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Puja S
PS
Gera
Laura L
LL
Tatpati
Michael C
MC
Allemand
Mark A
MA
Wentworth
Charles C
CC
Coddington
D000328:Adult; D001723:Birth Rate / Q000639:trends; D015331:Cohort Studies; D004624:Embryo Transfer / Q000379:methods / Q000639:trends; D005260:Female; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted / Q000639:trends; D012189:Retrospective Studies; D016896:Treatment Outcome