Elimination of OHSS

14 03 2012

To the Editor:

I read with interest the recently published discussion on the etiology and prevention of OHSS (1-2). While the reviews comprehensively covered their aims, there are some issues that should be highlighted.

Agonist and antagonist coast

Coasting, or the complete discontinuation of exogenous gonadotropin while continuing GnRH analogues administration, is a preventive measure that is completely related on serum E2 levels at gonadotropin discontinuation and on the drop in E2 levels on day of hCG administration (1). However, while “it is well established that high E2 levels are associated with a high incidence of OHSS” (1), OHSS may occur in patients who conceived spontaneously, and in those with low or high serum E2 levels on the day of hCG administration (details in ref. 3). These versatile observations actually suggest that the previously accepted risk factors to develop OHSS, especially high serum E2 levels, are unreliable for the prediction of severe OHSS (3).

Therefore, we were not surprised at the finding of the recently published Cochrane review (4), which reported no difference in the incidence of moderate or severe OHSS after coasting. Read the rest of this entry »

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Comment on the article by Madani et al. ‘Improvement of pregnancy rate by modification of embryo transfer technique: a randomized clinical trial’

28 06 2010

To the Editor:

I read with great interest the paper by Madani et al. (1). The authors report a randomized controlled study of 110 women in which pushing 0.2 mL of air into the uterus after embryo transfer (ET) was associated with a significant improvement of the clinical pregnancy rate from 9/55 (16.4%) in the control group to 22/55 (40%) in the study group. Read the rest of this entry »