PREVENTING SEVERE OVARIAN HYPERSTIMULATION SYNDROME IN AN IN-VITRO FERTILIZATION-EMBRYO TRANSFER PROGRAM - USE OF FOLLICULAR ASPIRATION AFTER HUMAN CHORIONIC-GONADOTROPIN ADMINISTRATION

In 3,972 human menopausal gonadotropin (hMG) and human chorionic gonad otropin (hCG)-stimulated menstrual cycles, severe ovarian hyperstimula tion syndrome (SOHSS) developed in 10 patients (0.25%), while in 627 h MG-, hCG- and gonadotropin releasing hormone analog (GnRH-a)-stimulate d cycles, 6 patients (0.95%) developed SOHSS. In cases of threatening SOHSS in the follicular phase (excessive estradiol values, multiple fo llicles), a preventive method was applied: follicular aspiration 12 ho urs after hCG administration and regular oocyte retrieval 36 hours aft er hCG (17 patients). The method of post-hCG aspiration in one ovary w as effective, leading to the withdrawal of all signs of SOHSS within s ix days after the second aspiration. In hMG-stimulated, pretreated pat ients there were four deliveries of seven healthy infants (two singlet on, one twin and one triplet), while one pregnancy in seven GnRH-a-sti mulated and pretreated patients ended in a spontaneous abortion. Post- hCG aspiration is a quick, simple and effective method that prevents t he development of SOHSS and permits pregnancy in the treated cycle. Al though the pregnancy rate in patients who developed SOHSS was higher ( 100% per embryo transfer), one should also consider the high spontaneo us abortion rate (33.3% for the hMG- and 50% for the GnRH-a/hMG-treate d groups) and the fact that SOHSS is a life-threatening condition, dem anding expensive, intensive care. According to our experience, post-hC G follicular aspiration is the treatment of choice in patients with si gns of SOHSS.