Combined approach as an effective method in the prevention of severe ovarian hyperstimulation syndrome

The purpose of this study was to evaluate the effectiveness of combined app roach on the prevention of severe ovarian hyperstimulation syndrome (OHSS) in high risk patients undergoing controlled ovarian hyperstimulation for IV R. The combined approach consisted of: (1) step-down administration of gona dotropins: (2) lowering the dose of human chorionic gonadotropin; (3) intra venous albumin infusion at the time of oocyte retrieval and (4) progesteron e use for luteal support. Total of 87 high risk patients with a serum estra diol level >11,010 pmol/l or 3000 pg/ml on HCG day were managed by this com bined approach and their results were compared with 274 low risk patients. In all high risk patients, the gonadotrophin dose were decreased starting a s early as on day 4 of ovarian stimulation as necessary, ovulation was trig gered by a decreased HCG dose of 5000-7000 IU according to the level of est radiol, intravenous infusion of 20% human albumin, 50-100 ml were given jus t 1 h before the oocyte retrieval and luteal support was provided either by 50 mg progesterone in oil, IM or 600 mg micronized progesterone orally or vaginally until the day of beta -HCG determination. All patients were follo wed by serial ultrasonographic examinations and complete blood count analys is after embryo transfer to detect the early signs of DHSS and to allow ear ly intervention. Age and duration of infertility were similar in both group s. Although the number of gonadotrophin ampoules used (22.7 +/-4.7 versus 2 7.8 +/-3.7; P < 0.05) was significantly lower, estradiol levels (16,764<plu s/minus>6936 pmol/l versus 8870 +/- 2456 pmol/l; P < 0.05) and mean number of oocytes (18.3<plus/minus>5.9 versus 10.6 +/-5.4; P < 0.05) were signific antly higher in study group. There was no significant difference between gr oups in terms of the mean number of transferred embryos (3.2<plus/minus>1.1 versus 3.4 +/-1.1) and rate of pregnancies (50.5% versus 40.1%). There was only one moderate and no severe OHSS case in the high risk group, while fi ve moderate and one severe OHSS cases developed in the control group consis ting of low risk patients: In conclusion, intravenous albumin combined with low dose HCG, early step-down administration of gonadotropins and progeste rone use for luteal support, so called combined approach, proved to be effe ctive in the prevention of severe ovarian hyperstimulation syndrome in docu mented high risk patients. (C), 2001 Elsevier Science Ireland Ltd. All righ ts reserved.