Annual incidence of severe ovarian hyperstimulation syndrome

Claudia Tomás; Lotte Colmorn; Steen Rasmussen; Øjvind Lidegaard; Anja Pinborg; Anders Nyboe Andersen

Assisted Reproduction · Safety and Risks

Annual incidence of severe ovarian hyperstimulation syndrome

Tomás C, Colmorn L, Rasmussen S, Lidegaard Ø, Pinborg A, Andersen AN

Published January 26, 2021 Danish Medical Journal

PMID 33543701

RRM Academy Synopsis

Severe OHSS hospital admissions held near 1.2% of Danish IVF cycles

Severe OHSS hospital admissions stayed stable in Denmark from 2001 to 2017. OHSS (ovarian hyperstimulation syndrome) is a major IVF complication. A national register study found 2,261 admissions among 186,168 stimulated IVF/ICSI cycles. That is 1.2% of the cycles.

Key Findings

Between 2001 and 2017, 2,261 women were admitted with OHSS across 186,168 stimulated IVF/ICSI cycles, which is 1.2% per initiated cycle.
The yearly rate ranged from 0.9% in 2002 to 1.4% in 2003 and 2005, with no trend over time (p = 0.24). It was 1.3% in 2016 and 1.2% in 2017.
Of the women admitted with OHSS, 75% stayed more than 24 hours. Women with OHSS in a pregnancy cycle (late OHSS) stayed longer than those without one (early OHSS) (p < 0.001).
Among the women with OHSS, ovarian torsion occurred in 30 (1.3%) and ascites drainage was recorded in 250 (11%).
Among women with late OHSS, 123 (10.9%) had a recorded miscarriage (9.8%) or ectopic pregnancy (1.1%), and the overall prognosis for live birth was 89%.

Interpretation

The study is a national register-based historical cohort. It counts hospital admissions with an OHSS diagnosis code and links them to IVF/ICSI cycle records. The authors did not check diagnoses against medical records, and the classification may have changed over the years. The data hold no detail on how individual cycles were managed, so the authors call the reasons for the flat rate speculative. Treatment indication and BMI were unavailable. The authors suggest that OHSS preventive actions should be better implemented in Denmark.

RRM Context

OHSS follows ovarian stimulation for IVF, which bypasses the question of why conception is not happening. Restorative reproductive medicine asks that question and looks for the cause in both partners.

Our editorial summary of this paper, not the article's abstract.

Abstract

Introduction

Ovarian hyperstimulation syndrome (OHSS) is one of the major complications of assisted reproductive technology treatment. We assumed that it had declined in recent years owing to the options of new preventive strategies. The aim of the present study was to investigate the annual incidence of OHSS in Denmark in the course of a 17-year period.

Methods

This was a national register-based historical cohort study including all women with an OHSS diagnosis admitted to Danish hospitals between 2001 and 2017. Data included information on all OHSS diagnoses, duration of hospital stay, early pregnancy complications and other complications like thromboembolism and ovarian torsion. The annual number of initiated stimulated in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycles was based on the annual reporting by the Danish Fertility Society.

Results

From 2001 to 2017, a total of 2,261 (1.2%) women with an OHSS admission were identified among 186,168 stimulated IVF/ICSI cycles. The annual incidence of OHSS varied from 0.9% to 1.2-1.4% with no overall change over time (p = 0.24. Early OHSS (defined as OHSS without a pregnancy in the cycle) was seen in 48.5% of the events, late OHSS (defined as OHSS with a pregnancy in the cycle) in 51.2% of cycles. Among all women with OHSS, 75% were hospitalised for more than 24 hours, with mean 4.3 and 6.2 days in hospital for early and late OHSS, respectively.

Conclusions

The annual incidence of severe OHSS leading to a hospital admission remained stable for 17 years, which suggests that OHSS preventive actions like use of antagonist cycles, agonist triggering and freeze all should be better implemented in Denmark.

Funding

none.

Trial Registration

not relevant.

Topics

Assisted Reproduction Safety and Risks Ovarian Hyperstimulation Syndrome

Assisted Reproduction › Safety and Risks › Ovarian Hyperstimulation Syndrome

Claudia Tomás, Lotte Colmorn, Steen Rasmussen, Øjvind Lidegaard, Anja Pinborg, Anders Nyboe Andersen

C Tomás, L Colmorn, S Rasmussen, Ø Lidegaard, A Pinborg, A Andersen

PMID 33543701 33543701 Tomás et al. 2021, Tomás 2021

Annual incidence of severe ovarian hyperstimulation syndrome

Severe OHSS hospital admissions held near 1.2% of Danish IVF cycles

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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