Bioimpedance analysis – a new method in prediction and early detection of ovarian hyperstimulation syndrome?

Česká verzia

Authors: P. Feldmár ¹; M. Hrehorčák ¹; M. Korbeľ ²; I. Malá ³; K. Šuchová ¹; M. Halaška ¹; R. Chmel ¹ ; Lukáš Rob ¹
Authors place of work: Gynekologicko–porodnická klinika 2. LF UK a FN Motol, Praha, přednosta doc. MUDr. L. Rob, CSc. ¹; I. gynekologicko–pôrodnícka klinika LF UK, Bratislava, přednosta prof. MUDr. M. Borovský, Ph. D. ²; Katedra statistiky a pravděpodobnosti, VŠE, Praha, přednosta doc. RNDr. L. Marek, CSc. ³
Published in the journal: Ceska Gynekol 2009; 74(1): 8-12

Summary

Objective:
The aim of the study was to establish a new method of the multiple-frequency bioimpedance analysis (MFBIA) for patients with controlled ovarian hyperstimulation (COH) and to determine the significance of this method in prediction and early diagnosis of severe forms of ovarian hyperstimulation syndrome (OHSS).

Design:
Prospective case control study.

Setting:
Department of Obstetrics and Gynecology, 2nd Medical Faculty, Charles University and University Hospital Motol, Prague.

Methods:
53 patients were recruited into the case control study. The surface body impedances for the frequencies of the current 1, 5, 50 and 100 kHz were measured. Study group included 13 patients with developed OHSS grade III. -V. according Golans classification. The control group included 40 women undergoing COH without developed OHSS. Measurements of impedances were performed by MFBIA device.

Results:
The decrease of the values of impedance between the day of oocyte retrieval and the day of embryotransfer significantly increases relative risk of OHSS grade III.-V. development. The best correlation was found for the frequency of 5 kHz (9.08 p<0.0001). The study suggests, the predictive value of MFBIA in OHSS development might be higher than the number of retrieved oocytes (>20 oocytes – RR 5,71).

Conclusion:
Patients in risk of OHSS development are those with decreasing impedances. The highest predictive value of OHSS development is for the impedances at frequency of 5 kHz. Greater multicenter studies should be done to confirm our preliminary results.

Key words:
multiple-frequency bioimpedance analysis (MFBIA), ovarian hyperstimulation syndrome (OHSS), controlled ovarian hyperstimulation (COH), predictive markers of OHSS, ascites.

Zdroje

1. Aboulghar, MA., Mansour, RT., Serour, GI., et al. Management of severe ovarian hyperstimulation syndrome by ascitic fluid aspiration and intensive intravenous fluid therapy. Obstet Gynecol, 1993, 81, p. 108–111.

2. Balash, J., Fábregues, F., Arroyo, V. Peripheral arterial vasodilatation hypothesis: a new insight into pathogenesis of ovarian hyperstimulation syndrome. Human Reprod, 1998, 13, p. 2718-2730.

3. Brinsden, PR., Wada, I., Tan, SL., et al. Diagnosis, prevention and management of ovarian hyperstimulation syndrome. Br J Obstet Gynaecol, 1995, 102, p. 767-772.

4. Coccia, ME., Bracco, GL., Cattaneo, A., Scarselli, G. Massive vulvar edema in ovarian hyperstimulation syndrome. A case report. J Reprod Med, 1995, 40, p. 659-660.

5. Cornish, BH., Thomas, BJ., Ward, LC. Improved prediction of extracellular and total body water using impedance loci generated by multiple frequency bioelectrical impedance analysis. Phys Med Biol, 1993, 38, p. 337-346.

6. Cornish, BH., Chapman, C., Hirst, C., et al. Early diagnosis of lymphoedema using multiple frequency bioimpedance. Lymphology, 2001, 34, p. 2-11.

7. Delvigne, A., Rozenberg, S. Review of clinical course and treatment of ovarian hyperstimulation syndrome (OHSS). Hum Reprod Update, 2003, 9, p. 77-96.

8. Dittmar, M., Reber, H. New equations for estimating body cell mass from bioimpedance parallel models in healthy older Germans. Am J Physiol Endocrinol Metab, 2001, 5, p. 1005-1014.

9. Fabregues, F., Balasch, J., Manau, D., et al. Haematocrit, leukocyte and platelet counts and the severity of the ovarian hyperstimulation syndrome. Hum Reprod, 1998, 13, p. 2406-2410.

10. Feldmár, P., Korbel, M., Hrehorčák, M., et al. Current means in early detection and prevention of ovarian hyperstimulation syndrom. Slov Gynek Porod, 2007, 14, s. 23–30.

11. Golan, A., Ron-El, R., Herman, A., et al. Ovarian hyperstimulation syndrome following D-Trp-6 luteinizing hormone-releasing hormone microcapsules and menotropin for in vitro fertilization. Fertil Steril, 1988, 50, 6, p. 912-916.

12. Golan, A., Ron-El, R., Herman, A., et al. Ovarian hyperstimulation syndrome following D-Trp-6 luteinizing hormone-releasing hormone microcapsules and menotropin for in vitro fertilization. Fertil Steril, 1998, 50, p. 912-916.

13. Greb, RR., Behre, HM., Simoni, M. Pharmacogenetics in ovarian stimulation - current concepts and future options. Reprod Biomed Online, 2005, 11, p. 589-600.

14. Gudivaka, R., Schoeller, DA., Kushner, RF., Bolt, MJ. Single- and multifrequency models for bioelectrical impedance analysis of body water compartments. J Appl Physiol, 1999, 3, p. 1087-1096.

15. Halaška, M., Strnad, P., Chod, J., et al. Detection of postoperative lymphoedema in patients with breast cancer. Ces Gynek, 72, 2007, s. 299-304.

16. Hayes, S., Cornish, B., Newman, B. Comparison of methods to diagnose lymphoedema among breast cancer survivors: 6-month follow-up. Breast Cancer Res Treat. 89, 2005, s. 221-226.

17. Levin ER, Rosen GF, Cassidenti DL, et al. Role of vascular endothelial cell growth factor in Ovarian Hyperstimulation Syndrome. J Clin Invest., 102, 1998, s.1978-1985.

18. McDonald, CM., Carter, GT., Abresch, RT., et al. Body composition and water compartment measurements in boys with Duchenne muscular dystrophy. Am J Phys Med Rehabil, 2005, 84, p. 483-491.

19. Mocanu, E., Redmond, M.L., Hennelly, B., et al. Odds of ovarian hyperstimulation syndrome (OHSS) - time for reassessment. Hum Fertil (Camb), 2007, 10, p. 175-181.

20. Papanikolaou, G.E., Tournaye, H., Verpoest, W., et al. Early and late ovarian hyperstimulation syndrome: early pregnancy outcome and profile. Hum Reprod, 2005, 20, p. 636-641.

21. Vavilis, D., Tzitzimikas, S., Agorastos T., et al. Postparacentesis bilateral massive vulvar edema in a treatment of OHSS patient with severe ovarian hyperstimulation syndrome. Fertil Steril, 2002, 77, p. 841-843.

22. Ward, LC., Heitmann, BL., Craig, P., et al. Association between ethnicity, body mass index, and bioelectrical impedance. Implications for the population specificity of prediction equations. Ann N Y Acad Sci, 2000, p. 199-202.

23. Whelan, JG., Vlahos, NF. The ovarian hyperstimulation syndrome. Fertil Steril, 2000, 73, p. 883-896.