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Journal of Assisted Reproduction and Genetics

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01.02.2010 | Gonad Physiology and Disease

Ovarian hyperstimulation syndrome: pathophysiology and prevention

verfasst von: Carolina O. Nastri, Rui A. Ferriani, Isa A. Rocha, Wellington P. Martins

Erschienen in: Journal of Assisted Reproduction and Genetics | Ausgabe 2-3/2010

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Abstract

Purpose

To review and discuss the pathophysiology and prevention strategies for ovarian hyperstimulation syndrome (OHSS), which is a condition that may occur in up to 20% of the high risk women submitted to assisted reproductive technology cycles.

Methods

The English language literature on these topics were reviewed through PubMed and discussed with emphasis on recent data.

Results

The role of estradiol, luteinizing hormone, human chorionic gonadotropin (hCG), inflammatory mediators, the renin-angiotensin system and vascular endothelial growth factor is discussed in the pathophysiology of OHSS. In addition we consider the prevention strategies, including coasting, administration of albumin, renin-angiotensin system blockage, dopamine agonist administration, non-steroidal anti-inflammatory administration, GnRH antagonist protocols, reducing hCG dosage, replacement of hCG and in vitro maturation of oocytes (IVM).

Conclusions

Among the many prevention strategies that have been discussed, the current evidence points to the replacement of hCG by GnRH agonists in antagonist cycles and the performance of IVM procedures as the safest approaches.

Delvigne A, Rozenberg S. Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review. Hum Reprod Updat. 2002;8:559–77.CrossRef

Vlahos NF, Gregoriou O. Prevention and management of ovarian hyperstimulation syndrome. Ann N Y Acad Sci. 2006;1092:247–64.CrossRefPubMed

Gera PS, Tatpati LL, Allemand MC, Wentworth MA, Coddington CC. Ovarian hyperstimulation syndrome: steps to maximize success and minimize effect for assisted reproductive outcome. Fertil Steril. 2009.

Michaelson-Cohen R, Altarescu G, Beller U, Reens R, Halevy-Shalem T, Eldar-Geva T. Does elevated human chorionic gonadotropin alone trigger spontaneous ovarian hyperstimulation syndrome? Fertil Steril. 2008;90:1869–74.CrossRefPubMed

ASRM. Ovarian hyperstimulation syndrome. Fertil Steril. 2008;90:S188–93.

Aboulghar MA, Mansour RT. Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures. Hum Reprod Updat. 2003;9:275–89.CrossRef

Goldsman MP, Pedram A, Dominguez CE, Ciuffardi I, Levin E, Asch RH. Increased capillary permeability induced by human follicular fluid: a hypothesis for an ovarian origin of the hyperstimulation syndrome. Fertil Steril. 1995;63:268–72.PubMed

Tollan A, Holst N, Forsdahl F, Fadnes HO, Oian P, Maltau JM. Transcapillary fluid dynamics during ovarian stimulation for in vitro fertilization. Am J Obstet Gynecol. 1990;162:554–8.PubMed

Asch RH, Li HP, Balmaceda JP, Weckstein LN, Stone SC. Severe ovarian hyperstimulation syndrome in assisted reproductive technology: definition of high risk groups. Hum Reprod. 1991;6:1395–9.PubMed

10.

Pellicer A, Miro F, Sampaio M, Gomez E, Bonilla-Musoles FM. In vitro fertilization as a diagnostic and therapeutic tool in a patient with partial 17, 20-desmolase deficiency. Fertil Steril. 1991;55:970–5.PubMed

11.

Soares SR, Gomez R, Simon C, Garcia-Velasco JA, Pellicer A. Targeting the vascular endothelial growth factor system to prevent ovarian hyperstimulation syndrome. Hum Reprod Updat. 2008;14:321–33.CrossRef

12.

Rizk B, Aboulghar M, Smitz J, Ron-El R. The role of vascular endothelial growth factor and interleukins in the pathogenesis of severe ovarian hyperstimulation syndrome. Hum Reprod Updat. 1997;3:255–66.CrossRef

13.

Navot D, Margalioth EJ, Laufer N, Birkenfeld A, Relou A, Rosler A, et al. Direct correlation between plasma renin activity and severity of the ovarian hyperstimulation syndrome. Fertil Steril. 1987;48:57–61.PubMed

14.

Blankestijn PJ, Derkx FH, Van Geelen JA, De Jong FH, Schalekamp MA. Increase in plasma prorenin during the menstrual cycle of a bilaterally nephrectomized woman. Br J Obstet Gynaecol. 1990;97:1038–42.PubMed

15.

Fernandez LA, Tarlatzis BC, Rzasa PJ, Caride VJ, Laufer N, Negro-Vilar AF, et al. Renin-like activity in ovarian follicular fluid. Fertil Steril. 1985;44:219–23.PubMed

16.

Morris RS, Paulson RJ. Increased angiotensin-converting enzyme activity in a patient with severe ovarian hyperstimulation syndrome. Fertil Steril. 1999;71:562–3.CrossRefPubMed

17.

Manno M, Tomei F. Renin-angiotensin system activation during severe OHSS: cause or effect? Fertil Steril. 2008;89:488.CrossRefPubMed

18.

McClure N, Healy DL, Rogers PA, Sullivan J, Beaton L, Haning Jr RV, et al. Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome. Lancet. 1994;344:235–6.CrossRefPubMed

19.

Gomez R, Simon C, Remohi J, Pellicer A. Administration of moderate and high doses of gonadotropins to female rats increases ovarian vascular endothelial growth factor (VEGF) and VEGF receptor-2 expression that is associated to vascular hyperpermeability. Biol Reprod. 2003;68:2164–71.CrossRefPubMed

20.

Wang TH, Horng SG, Chang CL, Wu HM, Tsai YJ, Wang HS, et al. Human chorionic gonadotropin-induced ovarian hyperstimulation syndrome is associated with up-regulation of vascular endothelial growth factor. J Clin Endocrinol Metab. 2002;87:3300–8.CrossRefPubMed

21.

Villasante A, Pacheco A, Ruiz A, Pellicer A, Garcia-Velasco JA. Vascular endothelial cadherin regulates vascular permeability: Implications for ovarian hyperstimulation syndrome. J Clin Endocrinol Metab. 2007;92:314–21.CrossRefPubMed

22.

Rodewald M, Herr D, Duncan WC, Fraser HM, Hack G, Konrad R, et al. Molecular mechanisms of ovarian hyperstimulation syndrome: paracrine reduction of endothelial claudin 5 by hCG in vitro is associated with increased endothelial permeability. Hum Reprod. 2009;24(5):1191–9.CrossRefPubMed

23.

Nardo LG, Cheema P, Gelbaya TA, Horne G, Fitzgerald CT, Pease EH, et al. The optimal length of ‘coasting protocol’ in women at risk of ovarian hyperstimulation syndrome undergoing in vitro fertilization. Hum Fertil (Camb). 2006;9:175–80.CrossRef

24.

Ho Yuen B, Nguyen TA, Cheung AP, Leung PC: Clinical and endocrine response to the withdrawal of gonadotropin-releasing hormone agonists during prolonged coasting. Fertil Steril. 2008.

25.

Moon HS, Joo BS, Moon SE, Lee SK, Kim KS, Koo JS. Short coasting of 1 or 2 days by withholding both gonadotropins and gonadotropin-releasing hormone agonist prevents ovarian hyperstimulation syndrome without compromising the outcome. Fertil Steril. 2008;90:2172–8.CrossRefPubMed

26.

Yilmaz N, Uygur D, Ozgu E, Batioglu S: Does coasting, a procedure to avoid ovarian hyperstimulation syndrome, affect assisted reproduction cycle outcome? Fertil Steril. 2009.

27.

Garcia-Velasco JA, Zuniga A, Pacheco A, Gomez R, Simon C, Remohi J, et al. Coasting acts through downregulation of VEGF gene expression and protein secretion. Hum Reprod. 2004;19:1530–8.CrossRefPubMed

28.

D’Angelo A, Amso N: “Coasting” (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2002;CD002811.

29.

Huddleston HG, Racowsky C, Jackson KV, Fox JH, Ginsburg ES. Coasting vs. cryopreservation of all embryos for prevention of ovarian hyperstimulation syndrome in in vitro fertilization. Fertil Steril. 2008;90:1259–62.CrossRefPubMed

30.

Aboulghar M, Evers JH, Al-Inany H. Intravenous albumin for preventing severe ovarian hyperstimulation syndrome: a Cochrane review. Hum Reprod. 2002;17:3027–32.CrossRefPubMed

31.

Isikoglu M, Berkkanoglu M, Senturk Z, Ozgur K. Human albumin does not prevent ovarian hyperstimulation syndrome in assisted reproductive technology program: a prospective randomized placebo-controlled double blind study. Fertil Steril. 2007;88:982–5.CrossRefPubMed

32.

Bellver J, Munoz EA, Ballesteros A, Soares SR, Bosch E, Simon C, et al. Intravenous albumin does not prevent moderate-severe ovarian hyperstimulation syndrome in high-risk IVF patients: a randomized controlled study. Hum Reprod. 2003;18:2283–8.CrossRefPubMed

33.

Ando H, Furugori K, Shibata D, Harata T, Murata Y, Mizutani S. Dual renin-angiotensin blockade therapy in patients at high risk of early ovarian hyperstimulation syndrome receiving IVF and elective embryo cryopreservation: a case series. Hum Reprod. 2003;18:1219–22.CrossRefPubMed

34.

Ata B, Yakin K, Alatas C, Urman B. Dual renin-angiotensin blockage and total embryo cryopreservation is not a risk-free strategy in patients at high risk for ovarian hyperstimulation syndrome. Fertil Steril. 2008;90:531–6.CrossRefPubMed

35.

Gomez R, Gonzalez-Izquierdo M, Zimmermann RC, Novella-Maestre E, Alonso-Muriel I, Sanchez-Criado J, et al. Low-dose dopamine agonist administration blocks vascular endothelial growth factor (VEGF)-mediated vascular hyperpermeability without altering VEGF receptor 2-dependent luteal angiogenesis in a rat ovarian hyperstimulation model. Endocrinology. 2006;147:5400–11.CrossRefPubMed

36.

Carizza C, Abdelmassih V, Abdelmassih S, Ravizzini P, Salgueiro L, Salgueiro PT, et al. Cabergoline reduces the early onset of ovarian hyperstimulation syndrome: a prospective randomized study. Reprod Biomed Online. 2008;17:751–5.PubMedCrossRef

37.

Varnagy A, Bodis J, Manfai Z, Wilhelm F, Busznyak C, Koppan M: Low-dose aspirin therapy to prevent ovarian hyperstimulation syndrome. Fertil Steril. 2009.

38.

Quintana R, Kopcow L, Marconi G, Young E, Yovanovich C, Paz DA. Inhibition of cyclooxygenase-2 (COX-2) by meloxicam decreases the incidence of ovarian hyperstimulation syndrome in a rat model. Fertil Steril. 2008;90:1511–6.CrossRefPubMed

39.

Al-Inany HG, Abou-Setta AM, Aboulghar M. Gonadotrophin-releasing hormone antagonists for assisted conception: a Cochrane review. Reprod Biomed Online. 2007;14:640–9.PubMedCrossRef

40.

Schmidt DW, Maier DB, Nulsen JC, Benadiva CA. Reducing the dose of human chorionic gonadotropin in high responders does not affect the outcomes of in vitro fertilization. Fertil Steril. 2004;82:841–6.CrossRefPubMed

41.

Nargund G, Hutchison L, Scaramuzzi R, Campbell S. Low-dose HCG is useful in preventing OHSS in high-risk women without adversely affecting the outcome of IVF cycles. Reprod Biomed Online. 2007;14:682–5.PubMed

42.

Group TERLS. Human recombinant luteinizing hormone is as effective as, but safer than, urinary human chorionic gonadotropin in inducing final follicular maturation and ovulation in in vitro fertilization procedures: results of a multicenter double-blind study. J Clin Endocrinol Metab. 2001;86:2607–18.CrossRef

43.

Bodri D, Guillen JJ, Galindo A, Mataro D, Pujol A, Coll O. Triggering with human chorionic gonadotropin or a gonadotropin-releasing hormone agonist in gonadotropin-releasing hormone antagonist-treated oocyte donor cycles: findings of a large retrospective cohort study. Fertil Steril. 2009;91:365–71.CrossRefPubMed

44.

Galindo A, Bodri D, Guillen JJ, Colodron M, Vernaeve V, Coll O. Triggering with HCG or GnRH agonist in GnRH antagonist treated oocyte donation cycles: a randomised clinical trial. Gynecol Endocrinol. 2009;25:60–6.CrossRefPubMed

45.

Engmann L, DiLuigi A, Schmidt D, Nulsen J, Maier D, Benadiva C. The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. Fertil Steril. 2008;89:84–91.CrossRefPubMed

46.

Manzanares MA, Gomez-Palomares JL, Ricciarelli E, Hernandez ER: Triggering ovulation with gonadotropin-releasing hormone agonist in in vitro fertilization patients with polycystic ovaries does not cause ovarian hyperstimulation syndrome despite very high estradiol levels. Fertil Steril. 2009.

47.

Lanzendorf SE. Developmental potential of in vitro- and in vivo-matured human oocytes collected from stimulated and unstimulated ovaries. Fertil Steril. 2006;85:836–7.CrossRefPubMed

48.

Suikkari AM. In-vitro maturation: its role in fertility treatment. Curr Opin Obstet Gynecol. 2008;20:242–8.CrossRefPubMed

49.

Son WY, Chung JT, Demirtas E, Holzer H, Sylvestre C, Buckett W, et al. Comparison of in-vitro maturation cycles with and without in-vivo matured oocytes retrieved. Reprod Biomed Online. 2008;17:59–67.PubMed

50.

Son WY, Chung JT, Chian RC, Herrero B, Demirtas E, Elizur S, et al. A 38 h interval between hCG priming and oocyte retrieval increases in vivo and in vitro oocyte maturation rate in programmed IVM cycles. Hum Reprod. 2008;23:2010–6.CrossRefPubMed

Titel: Ovarian hyperstimulation syndrome: pathophysiology and prevention
verfasst von: Carolina O. Nastri
Rui A. Ferriani
Isa A. Rocha
Wellington P. Martins
Publikationsdatum: 01.02.2010
Verlag: Springer US
Erschienen in: Journal of Assisted Reproduction and Genetics / Ausgabe 2-3/2010
Print ISSN: 1058-0468
Elektronische ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-010-9387-6

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