Prediction of Ovarian Hyperstimulation Syndrome in Patients Treated with Corifollitropin alfa or rFSH in a GnRH Antagonist Protocol
| Autor: | Basil C. Tarlatzis, Georg Griesinger, Barbara J. Stegmann, Keith Gordon, Paul Devroey, Davis Gates, P. Verweij |
|---|---|
| Přispěvatelé: | Vriendenkring VUB, Centre for Reproductive Medicine - Gynaecology, Reproduction and Genetics |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Physiology medicine.medical_treatment Maternal Health Peptide Hormones Ovarian hyperstimulation syndrome lcsh:Medicine Gonadotropin-releasing hormone Drug research and development Hormone antagonist Biochemistry Chorionic Gonadotropin Ovarian Hyperstimulation Syndrome/chemically induced Hormone Antagonists/adverse effects Gonadotropin-Releasing Hormone Follicle-stimulating hormone 0302 clinical medicine Clinical trials Ovarian Follicle Animal Cells Pregnancy GnRH stimulation test Ovarian Follicle/drug effects Follicle Stimulating Hormone Human/adverse effects Lipid Hormones lcsh:Science Pharmacologic-based diagnostics Chorionic Gonadotropin/adverse effects In Vitro Fertilization Clinical Trials as Topic 030219 obstetrics & reproductive medicine Multidisciplinary Estradiol musculoskeletal neural and ocular physiology Obstetrics and Gynecology Organ Size Prognosis Phase III clinical investigation medicine.anatomical_structure Physiological Parameters OVA Ovulation Induction/adverse effects Female Follicle Stimulating Hormone Human Cellular Types hormones hormone substitutes and hormone antagonists Research Article Adult medicine.medical_specialty endocrine system Estradiol/metabolism Adolescent macromolecular substances 03 medical and health sciences Ovarian Hyperstimulation Syndrome Young Adult Gonadotropin-Releasing Hormone/antagonists & inhibitors Hormone Antagonists Ovulation Induction medicine Humans Organ Size/drug effects Ovarian follicle Retrospective Studies Gynecology Medicine and health sciences Pharmacology In vitro fertilisation business.industry Body Weight lcsh:R Biology and Life Sciences Cell Biology medicine.disease Hormones Follicle-Stimulating Hormone Research and analysis methods 030104 developmental biology Germ Cells nervous system Clinical medicine Fertilization Oocytes Women's Health Ovulation induction lcsh:Q business Developmental Biology |
| Zdroj: | PLoS ONE, Vol 11, Iss 3, p e0149615 (2016) PLoS ONE |
| ISSN: | 1932-6203 |
| Popis: | STUDY QUESTION: What is the threshold for the prediction of moderate to severe or severe ovarian hyperstimulation syndrome (OHSS) based on the number of growing follicles ≥ 11 mm and/or estradiol (E2) levels? SUMMARY ANSWER: The optimal threshold of follicles ≥11 mm on the day of hCG to identify those at risk was 19 for both moderate to severe OHSS and for severe OHSS. Estradiol (E2) levels were less prognostic of OHSS than the number of follicles ≥ 11 mm. WHAT IS KNOWN ALREADY: In comparison to long gonadotropin-releasing hormone (GnRH) agonist protocols, the risk of severe OHSS is reduced by approximately 50% in a GnRH antagonist protocol for ovarian stimulation prior to in vitro fertilisation (IVF), while the two protocols provide equal chances of pregnancy per initiated cycle. Nevertheless, moderate to severe OHSS may still occur in GnRH antagonist protocols if human chorionic gonadotropin (hCG) is administered to trigger final oocyte maturation, especially in high responder patients. Severe OHSS following hCG trigger may occur with an incidence of 1-2% in a relatively young (aged 18 to 36 years) IVF population treated in a GnRH-antagonist protocol. STUDY DESIGN, SIZE, DURATION: From the Engage, Ensure and Trust trials, in total, 2,433 women who received hCG for oocyte maturation and for whom the number of follicles ≥ 11 mm and the level of E2 on the day of hCG administration were known were included in the analyses. PARTICIPANTS/MATERIALS, SETTING, METHODS: The threshold for OHSS prediction of moderate and severe OHSS was assessed in women treated with corifollitropin alfa or daily recombinant follicle stimulation hormone (rFSH) in a gonadotropin-releasing hormone (GnRH)-antagonist protocol. Receiver operating characteristics curve analyses for moderate to severe OHSS and severe OHSS were performed on the combined dataset and the sensitivity and specificity for the optimal threshold of number of follicles ≥ 11 mm, E2 levels on the day of (hCG), and a combination of both, were determined. MAIN RESULTS AND THE ROLE OF CHANCE: The optimal threshold of follicles ≥ 11 mm on the day of hCG to identify those at risk of moderate to severe OHSS was 19 (sensitivity and specificity 62.3% and 75.6%, respectively) and for severe OHSS was also 19 (sensitivity and specificity 74.3% and 75.3%, respectively). The positive and negative predictive values were 6.9% and 98.6%, respectively, for moderate to severe OHSS, and 4.2% and 99.5% for severe OHSS. LIMITATIONS, REASONS FOR CAUTION: This was a retrospective analysis of combined data from three trials following ovarian stimulation with two different gonadotropins. WIDER IMPLICATIONS OF THE FINDINGS: For patients with 19 follicles or more ≥11 mm on the day of hCG, measures to prevent the development of OHSS should be considered. Secondary preventive measures include cycle cancellation or coasting, use of a GnRH agonist to trigger final oocyte maturation in place of hCG and a freeze all strategy. TRIAL REGISTRATION: ClinicalTrials.gov NCT00702845 NCT00696800 NCT00696878. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|