Ovarian hyperstimulation syndrome after assisted reproductive technologies: trends, predictors, and pregnancy outcomes

David A Schirmer 3rd; Aniket D Kulkarni; Yujia Zhang; Jennifer F Kawwass; Sheree L Boulet; Dmitry M Kissin

doi:10.1016/j.fertnstert.2020.04.004

Assisted Reproduction Safety and Risks

Ovarian hyperstimulation syndrome after assisted reproductive technologies: trends, predictors, and pregnancy outcomes

Schirmer DA 3rd, Kulkarni AD, Zhang Y, Kawwass JF, Boulet SL, Kissin DM

Published September 2020 Fertility and Sterility

DOI 10.1016/j.fertnstert.2020.04.004 PMID 32680613 PMC PMC8041489

RRM Academy Synopsis

Ovarian hyperstimulation syndrome linked to preterm delivery in IVF

Ovarian hyperstimulation syndrome (OHSS) after IVF was linked to more preterm delivery and low birth weight. A US registry cohort of IVF cycles from 2000 to 2015 tracked OHSS. Cases rose to 14.34 per 1,000 cycles by 2006, then fell to 5.27 per 1,000 by 2015.

Study at a glance, retrospective cohort: OHSS after IVF was linked to more preterm delivery and low birth weight. Source: Schirmer DA 3rd et al., 2020, PMID 32680613.

Key Findings

OHSS cases climbed from 9.96 to 14.34 per 1,000 cycles between 2000 and 2006, then dropped to 5.27 per 1,000 cycles by 2015.
OHSS risk was highest when more than 30 eggs were retrieved: adjusted risk ratio (aRR) 3.85 (95% CI 3.36–4.41) against 11–15 eggs. Cycles ending in pregnancy: aRR 3.12 (95% CI 2.81–3.47).
Singleton pregnancies after OHSS: aRR 1.29 (95% CI 1.10–1.51) for low birth weight and aRR 1.32 (95% CI 1.15–1.51) for preterm delivery.
Twin pregnancies after OHSS: aRR 1.16 (95% CI 1.10–1.22) for preterm delivery and aRR 1.06 for low birth weight.
Across all multiple gestations, second-trimester loss had an aRR of 1.81 (95% CI 1.17–2.81). First-trimester loss and stillbirth showed no significant difference.

Interpretation

The study is a retrospective cohort from a national surveillance registry, so it shows associations, and the authors note residual confounding may remain. The registry lacks the criteria clinics used to diagnose OHSS and the extent of their reporting. For singletons, the authors call the average gaps in birth weight and length of pregnancy small and likely not clinically significant. Twin pregnancies with OHSS ended nearly 1 week earlier on average. Outcome analyses covered fresh cycles that ended in pregnancy. The registry did not record several prevention measures, so the study could not assess them.

RRM Context

OHSS is an iatrogenic complication: the treatment causes it. The authors call it potentially life-threatening. IVF bypasses the reasons conception fails without resolving them. This registry links affected cycles to more preterm delivery and low birth weight. Restorative reproductive medicine evaluates both partners to find the cause and works with the woman's own ovulatory cycle.

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

Abstract

Objectives

To assess trends, predictors, and perinatal outcomes of ovarian hyperstimulation syndrome (OHSS) associated with in vitro fertilization (IVF) cycles in the United States.

Design

Retrospective cohort study using National Assisted Reproductive Technology Surveillance System (NASS) data.

Setting

Not applicable.

Patients

Fresh autologous and embryo-banking cycles performed from 2000 to 2015. INTERVENTIONS(S): None.

Main Outcome Measures

OHSS, first-trimester loss, second-trimester loss, stillbirth, low birth weight, and preterm delivery.

Results

The proportion of IVF cycles complicated by OHSS increased from 10.0 to 14.3 cases per 1,000 from 2000 to 2006, and decreased to 5.3 per 1,000 from 2006 to 2015. The risk of OHSS was highest for cycles with more than 30 oocytes retrieved (adjusted risk ratio [aRR] 3.85). OHSS was associated with a diagnosis of ovulatory disorder (aRR 2.61), tubal factor (aRR 1.14), uterine factor (aRR 1.17) and cycles resulting in pregnancy (aRR 3.12). In singleton pregnancies, OHSS was associated with increased risk of low birth weight (aRR 1.29) and preterm delivery (aRR 1.32). In twin pregnancies, OHSS was associated with an increased risk of second-trimester loss (aRR 1.81), low birth weight (aRR 1.06), and preterm delivery (aRR 1.16).

Conclusions

Modifiable predictive factors for OHSS include number of oocytes retrieved, pregnancy following fresh embryo transfer, and the type of medication used for pituitary suppression during controlled ovarian hyperstimulation. Patients affected by OHSS had a higher risk of preterm delivery and low birth weight. Clinicians should take measures to reduce the risk of OHSS whenever possible.

Topics

Assisted Reproduction › Safety and Risks › Ovarian Hyperstimulation Syndrome · Pregnancy › Pregnancy Complications › Hypertensive Disorders

David A Schirmer 3rd, Aniket D Kulkarni, Yujia Zhang, Jennifer F Kawwass, Sheree L Boulet, Dmitry M Kissin

Dave 3rd, D 3rd, A Kulkarni, Y Zhang, Jen Kawwass, Jenny Kawwass, J Kawwass, S Boulet, D Kissin

PMID 32680613 32680613 DOI 10.1016/j.fertnstert.2020.04.004 10.1016/j.fertnstert.2020.04.004 Schirmer 3rd et al. 2020, Schirmer 3rd 2020

Ovarian hyperstimulation syndrome after assisted reproductive technologies: trends, predictors, and pregnancy outcomes

Ovarian hyperstimulation syndrome linked to preterm delivery in IVF

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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