The reasons for severe ovarian hyperstimulation syndrome in patients requiring hospitalisation

Česká verzia

Authors: L. Maršík; A. Ďurechová; M. Borovský; M. Petrenko; H. Urban
Authors place of work: Univerzitné pracovisko reprodukčnej medicíny, I. gynekologicko-pôrodnícka klinika, LF UK a UN Bratislava, Slovenská republika
Published in the journal: Prakt Gyn 2011; 15(3-4): 137-143
Category: Original Article

Summary

Objective:
Prevention and early management of ovarian hyperstimulation syndrome (OHSS) prevents a development of severe forms of the syndrome. Despite this, hospitals frequently admit patients with untreated OHSS following IVF. The aim of the study was to identify the reasons for a development of severe OHSS requiring hospitalization and to establish an effective communication with IVF centres, to protect high-risk patients in the future.

Materials and Methods:
We conducted an analysis of the last five-year clinical data (2006–2010) on patients with severe OHSS, ovary size exceeding 10 cm, ascites and at least laboratory signs of haemoconcentration and hypercoagulation treated at the 1^st Depatment of Obstetrics and Gynaecology of Commenius University in Bratislava. The data were obtained through an anamnesis, from the medical documentation and, where possible, by communication with an IVF centre.

Results:
Between 2006–2010, 17 patients were treated for severe OHSS. The stimulation was performed at 6 different IVF centres in 4 different countries (Slovakia, Czech Republic, Austria and Hungary). Complete information on the stimulation was obtained from the patients, from medical documentation and by consultation with the IVF centre in 9 patients. This information was obtained from the patient and the IVF centre only in 3 patients, no valid medical documentation was available. The information was provided by the patient only in 5 cases, there was no valid medical documentation and no possibility to consult the IVF centre. The most frequent reason for the development of OHSS was an administration of an inadequately high dose of gonadotropins with respect to patient age and risk factors (14 patients). The most frequent error of the cycle management was luteal supplementation performed via HCG (5 cases). OHSS prevention was performed in 7 patients only, the rest (10/17) were not considered to be in a high risk of OHSS. One patient was hospitalized twice for severe OHSS during the data collection period, her case report is included.

Conclusion:
The main reason for the development of endangering forms of OHSS was the breach of preventive steps in IVF centres. High responders were not provided with sufficient care. Inadequate cooperation by the patient, frequently declared by the IVF centres, was not proved as the reason for the development of OHSS.

Key words:
ovarian hyperstimulation syndrome (OHSS) – assisted reproduction (AR) – in vitro fertilisation (IVF) – controlled ovarian hyperstimulation (COH) – complications – hospitalization

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