What are the risks of Ovarian Hyperstimulation Syndrome (OHSS) with oocyte retrieval?

From the Guidelines

To minimize the risk of Ovarian Hyperstimulation Syndrome (OHSS) with egg retrieval, it is crucial to use gonadotrophin regimens with 75 IU or lower, as higher doses have similar pregnancy rates but increase multiple pregnancy rates and potentially the risk of OHSS. When considering the prevention of OHSS in the context of egg retrieval, several factors come into play, including the dosage of gonadotrophins used, the type of medication (such as clomiphene citrate or tamoxifen as alternatives to gonadotrophins), and the individualization of treatment protocols to minimize the risk of multifollicular growth 1. Key points to consider include:

• The use of lower doses of gonadotrophins (75 IU or lower) to prevent multifollicular growth and subsequent increased risk of OHSS and multiple pregnancies 1.
• The consideration of clomiphene citrate or tamoxifen as alternatives to low-dose gonadotrophins for reducing multiple birth rates, although these may result in lower live birth rates 1.
• The importance of individualizing treatment protocols to prevent the growth of more than two to three dominant follicles, as multifollicular growth significantly increases the risk of multiple pregnancies and potentially OHSS 1.
• The application of primary measures to prevent multiple pregnancies, including the appropriate drug and dose selection, and the potential for aspirating excess follicles at the time of HCG injection or LH surge as an alternative to cycle cancellation 1. Given the potential severity of OHSS and its impact on morbidity, mortality, and quality of life, prioritizing preventive measures and careful management of ovarian stimulation is essential in the context of egg retrieval and fertility treatments.

From the Research

OHSS with Egg Retrieval

• Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of assisted reproductive treatment, affecting 1% to 14% of all in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) cycles 2.
• The use of gonadotropin-releasing hormone (GnRH) antagonist protocols is recommended in patients at high risk for OHSS, as it can reduce the incidence of severe OHSS 3.
• Coasting may reduce the incidence of severe OHSS, but coasting for longer than 3 days can reduce in vitro fertilization pregnancy rates 3.
• The administration of human albumin at the time of oocyte retrieval has been shown to have a borderline statistically significant decrease in the incidence of severe OHSS 2.
• Hydroxyethyl starch has been shown to markedly decrease the incidence of severe OHSS 2.

Prevention and Management

• Preventative measures, early recognition, and prompt systematic supportive care can help avoid poor outcomes in OHSS patients 3.
• Outpatient management of severe OHSS has been found to be safe and cost-effective compared to inpatient management, with paracentesis of ascitic fluid being an effective treatment 4.
• GnRH antagonist has been shown to be effective in the treatment of early severe OHSS, although further research is required to assess its role in this context 4.
• Elective single embryo transfer is recommended in patients at high risk for OHSS 3.
• Progesterone, rather than human chorionic gonadotropin, should be used for luteal phase support to reduce the risk of OHSS 3.

Risk Factors and Complications

• Risk factors for the development of OHSS include age < 35, history of polycystic ovarian syndrome or previous OHSS, and pregnancy 5.
• Complications of OHSS include ascites, abdominal compartment syndrome, renal dysfunction, acute respiratory distress syndrome, thromboembolic disease, and hemodynamic instability 5.
• Critical patients with OHSS should be evaluated in the resuscitation bay, and consultation with the primary obstetrics/gynecology team is needed to improve patient outcomes 5.