Ovarian hyperstimulation syndrome or massive intraperitoneal hemorrhage?

21 06 2011

To the Editor:

I read with interest a recent paper by Griesinger et al. (1) describing, for the first time in the English literature, a case of severe ovarian hyperstimulation syndrome (OHSS) post-GnRH agonist trigger of ovulation. However, the clinical details of the case cast serious shadow on the correct diagnosis.

The hallmark of severe OHSS is elevated hematocrit (>45%, or >30% increment over baseline values) secondary to hemoconcentration (2). However, the described patient experienced severe intraperitoneal hemorrhage leading to decreasing hematocrit (41% on day of trigger, 37% on day of oocyte retrieval). Blood transfusion was given (no details on amount) due to “drastic decrease of hemoglobin levels to 4.9 mmol/L,” with hematocrit “15,000, oliguria, elevated creatinine, liver dysfunction, anasarca) were not given. Read the rest of this entry »

Diagnostic Value of Progesterone Level and Progesterone/Estradiol Ration on the Day of hCG Administration

23 05 2011

To the Editor:

Since the progesterone levels are related to serum estradiol levels, the use of the P/E ratio was proposed for the diagnosis of early luteinization, because it provided the best indicators in the ROC curve and logistics regression models. The poor response of the isolated determination of progeste-rone in these models is due to the fact that only excessive levels are associated to a detriment in the pregnancy rate, while in the rest of the spectrum both pregnancy rate and progesterone levels are associated positively. By contrast, the P/E ratio maintains a nearly constant negative relationship between its values and the pregnancy rate. Read the rest of this entry »

Prevention of ovarian hyperstimulation syndrome

7 04 2011

To the Editor:

I read the recent publication on ovarian hyperstimulation syndrome (OHSS) with great interest (1). The dopamine agonist bromocriptine and gonadotropin-releasing hormone agonist for the prevention of OHSS were mentioned (1,2). Indeed, there are many recent studies on how to prevent OHSS. Apart from using an agonist, there are also other concerns for management. The classification of the risk before the procedure (3) and the individualized adjustment of drug dosage (4) seem to be the two additional means for prevention of OHSS.

Viroj Wiwanitkit, M.D.
Wiwanitkit House
Bangkok, Thailand
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It ain’t necessarily so…

17 09 2009

To the Editor:

I have read with interest the case report by Azem et al. (1), and congratulate them. However, several points need clarification:
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Evidence-based medicine or just a theory?

17 03 2009

To the Editor:

Recent correspondence in this journal (1,2) renewed interest in GnRH agonist therapy as an “ovarian protectant” in female patients undergoing chemotherapy. Do we have evidence-based data to recommend this treatment? Twenty-eight years ago the concept was first introduced. One would expect an “evidence-based” answer to the question, by now. After all, this is a classic question that can only be answered by a multi-center, randomized prospective study.

Do we have the answer?

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