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 »

Advertisements




Etiology of OHSS

14 03 2012

To the Editor:

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

OHSS, being a major complication of controlled ovarian hyperstimulation (COH), is characterized by marked ovarian enlargement and acute third space fluid sequestration that almost always develops after hCG administration or in early pregnancy. OHSS is similar to vascular leak syndrome (VLS), which may be attributable to the massive increase in systemic inflammatory cytokines, including vascular endothelial growth factor (VEGF), observed also during the course of severe OHSS (2).

As was already mentioned (1), many factors and mediators have been proposed as the intermediate, released by gonadotropin-hyperstimulated ovaries at ovulation, which causes the increase in capillary permeability. However, no significant evidence exists to prove any absolute or ultimate role of these ovarian regulators in the pathophysiology of OHSS (2). Read the rest of this entry »





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 »





Ovarian Hyperstimulation Syndrome in a Patient Treated with Tamoxifen for Breast Cancer

9 06 2011

To the Editor:

I read with great interest the case report by Baigent and Lashen (1) describing a case of bilateral ovarian cysts induced by tamoxifen therapy for breast cancer in a 50-year-old woman. The authors performed laparoscopic bilateral salpingo-oophorectomy to enable a histological examination as well as eliminate the source of estrogen.

We have already described ovarian cysts in 80% out of twenty premenopausal breast cancer tamoxifen-treated patients accompanied by high levels of estradiol. At the same time, these findings were found in only one (out of 12) similar patients not treated with tamoxifen (2). Read the rest of this entry »





Defining Case Control Studies

6 04 2011

We read with great interest the article “Obstetric outcome of women with in vitro fertilization pregnancies hospitalized for ovarian hyperstimulation syndrome: a case-control study” by Courbiere et al. (1). It is our belief that, despite the title, the study did not adhere to the principles of a case-control study. Read the rest of this entry »