Practice Committe of the American Society for Reproductive Medicine (2003). Ovarian hyperstimulation syndrome. Fertility and Sterility, 80(5), 1309-1314. https://doi.org/10.1016/s0015-0282(03)02194-0
Practice Committe of the American Society for Reproductive Medicine. Ovarian hyperstimulation syndrome. Fertil Steril. 2003;80(5):1309-1314. doi:10.1016/s0015-0282(03)02194-0
Practice Committe of the American Society for Reproductive Medicine. "Ovarian hyperstimulation syndrome." Fertility and Sterility, vol. 80, no. 5, 2003, pp. 1309-1314.
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RRM Academy Synopsis
Ovarian hyperstimulation syndrome is usually mild but can turn severe
This is a 2003 guideline. A group of fertility doctors wrote it. The guideline looks at ovarian hyperstimulation syndrome (OHSS), a problem linked mainly to injectable fertility drugs used before IVF. Belly bloating happens in up to about 1 out of 3 stimulated cycles. Severe illness is much less common but can be life-threatening.
Key Findings
Common mild symptoms after ovarian stimulation include belly discomfort, nausea, vomiting, and loose stools; belly bloating happens in up to a third of cycles.
A review of five randomized trials tested giving albumin near egg retrieval to prevent OHSS. It found significantly lower odds of OHSS (odds ratio 0.28, 95% CI 0.11 to 0.73).
Based on that effect, albumin may be expected to prevent one severe case of OHSS for every 18 women at risk who receive it.
Known risk factors include being young, low body weight, and a past OHSS episode. Others are PCOS (also called PMOS, Polyendocrine Metabolic Ovarian Syndrome) and high or fast-rising estradiol.
Using progesterone instead of hCG for luteal support lowers the risk of OHSS. Freezing all embryos and delaying transfer to a later cycle may also reduce the risk of severe OHSS.
Interpretation
This is a guideline. The guideline combines many other studies instead of studying one group of patients, including one review of five randomized trials on using albumin to prevent OHSS. Because it combines many sources, each finding is only as strong as the study it came from. The guideline dates from 2003. Fertility drug practices have changed since then. The authors list known risk factors and ways doctors manage OHSS, but the guideline does not report results from its own group of patients.
RRM Context
Ovarian hyperstimulation syndrome is tied mainly to high-dose injectable fertility drugs used before IVF. The guideline says it is only rarely seen with other agents. Restorative reproductive medicine looks for and treats the cause of infertility, using cycle charting and testing. An approach that avoids pushing the ovaries to release many eggs at once largely sidesteps this risk.
Our editorial summary of this paper, not the article's abstract.
PMID 14607613 14607613 DOI 10.1016/s0015-0282(03)02194-0 10.1016/s0015-0282(03)02194-0 Practice Committe of the American Society for Reproductive Medicine et al. 2003, Practice Committe of the American Society for Reproductive Medicine 2003
008x12972 