title: Ovarian hyperstimulation syndrome: a clinical report on 4894 consecutive ART treatment cycles.
abstract: BACKGROUND
  Although a large number of studies have been dedicated to ovarian hyperstimulation syndrome (OHSS) none gave full embryological and clinical outcomes comparing oocyte trigger with human chorionic gonadotrophin (HCG) versus with a gonadotrophin-releasing hormone (GnRH) agonist (Buserelin) in cases with suspicious OHSS. The aim of the present study was thus to analyze 4894 consecutive assisted reproductive treatment cycles to undercover associated risk factors for development of OHSS, and the effects of the use of Buserelin as ovulation trigger on embryological and clinical outcomes.
  
  
  METHODS
  In the 51 cases that developed OHSS, ovulation trigger was performed with HCG as indicators were not suspicious for OHSS. These were compared against two types of groups: 71 cases where Buserelin was used for ovulation induction due to suspicious development of OHSS; and those remaining 4772 cases where ovulation trigger was currently performed with HCG (control).
  
  
  RESULTS
  Of the cases treated with Buserelin the oocyte maturation rate and the ongoing pregnancy rate were significantly lower, with higher rates of ectopic pregnancy and newborn malformations, but none developed OHSS. Of the OHSS cases, 23 needed hospitalization, with no major complications.
  
  
  CONCLUSIONS
  Young age, lower time of infertility, lower basal follicle stimulating hormone levels, higher number of cases with female factor and polycystic ovarian syndrome, high number of follicles and higher estradiol concentrations were the risk factors found associated with OHSS. Cases with OHSS also presented higher follicle count but the estradiol levels were within the normal range. It thus remains to develop more strict criteria to avoid all cases with OHSS.
authors.affiliation: Department of Microscopy, Laboratory of Cell Biology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal. msousa@icbas.up.pt.|Multidisciplinary Unit for Biomedical Research-UMIB, ICBAS-UP, Rua Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal. msousa@icbas.up.pt.
authors.forename: Mário
authors.initials: M
authors.lastname: Sousa
authors.affiliation: Centre for Reproductive Genetics Alberto Barros, Av. do Bessa, 240, 1° Dto. Frente, 4100-012, Porto, Portugal. marianacunha@hotmail.com.
authors.forename: Mariana
authors.initials: M
authors.lastname: Cunha
authors.affiliation: Centre for Reproductive Genetics Alberto Barros, Av. do Bessa, 240, 1° Dto. Frente, 4100-012, Porto, Portugal. jmsts8@gmail.com.
authors.forename: José
authors.initials: J
authors.lastname: Teixeira da Silva
authors.affiliation: Centre for Reproductive Genetics Alberto Barros, Av. do Bessa, 240, 1° Dto. Frente, 4100-012, Porto, Portugal. cristianojoliveira@hotmail.com.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Oliveira
authors.affiliation: Centre for Reproductive Genetics Alberto Barros, Av. do Bessa, 240, 1° Dto. Frente, 4100-012, Porto, Portugal. joaquinapsilva@gmail.com.
authors.forename: Joaquina
authors.initials: J
authors.lastname: Silva
authors.affiliation: Centre for Reproductive Genetics Alberto Barros, Av. do Bessa, 240, 1° Dto. Frente, 4100-012, Porto, Portugal. paulo.viana@gmail.com.
authors.forename: Paulo
authors.initials: P
authors.lastname: Viana
authors.affiliation: Centre for Reproductive Genetics Alberto Barros, Av. do Bessa, 240, 1° Dto. Frente, 4100-012, Porto, Portugal. abarros@med.up.pt.|Department of Genetics, Faculty of Medicine, University of Porto (FMUP), Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. abarros@med.up.pt.|Institute of Health Research an Innovation, University of Porto, Porto, Portugal. abarros@med.up.pt.
authors.forename: Alberto
authors.initials: A
authors.lastname: Barros
mesh_terms: D002064:Buserelin / Q000009:adverse effects* / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects* / Q000627:therapeutic use; D005307:Fertilization in Vitro / Q000009:adverse effects*; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced*; D010062:Ovulation Induction / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies
chemical_list: D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D002064:Buserelin