Severe ovarian hyperstimulation syndrome in assisted reproductive technology: definition of high risk groups

Abstract

In a retrospective analysis of 637 cycles of ovarian stimulation and transvaginal follicular aspiration for various assisted reproductive technologies, severe ovarian hyperstimulation syndrome (SOH) occurred in six (0.94%) cycles. The patients at a high risk of developing SOH in cycles of assisted reproduction were those who had excessive serum oestradiol levels on the day of human chorionic gonadotrophin (HCG) administration (oestradiol > 6000 pg/ml; 38% SOH) and a high number of oocytes obtained (>30 oocytes; 23% SOH). In those patients with both oestradiol > 6000 pg/ml on the day of HCG administration and >30 eggs retrieved, the chance of developing SOH was 80%. The higher the serum oestradiol levels and the more eggs retrieved, the higher the pregnancy rates observed. High oestradiol level did not appear to have a detrimental effect on pregnancy rates and outcome. Furthermore, our results are not consistent with suggestions that the addition of gonadotrophin-releasing hormone agonist to ovarian stimulation protocols, follicular aspiration and/or luted support with progesterone may reduce the incidence of ovarian hyperstimulation syndrome.