Few Treatments Limit Ovarian Hyperstimulation Syndrome Incidence in IVF

Only a few interventions for ovarian hyperstimulation syndrome are considered efficacious for reducing its incidence and severity among patients undergoing in vitro fertilization (IVF), according to a systematic review published in Reproductive Biology and Endocrinology.

Ovarian hyperstimulation, which can occur in the early luteal phase of the menstrual cycle or early pregnancy after IVF treatment, is a life-threatening iatrogenic complication. The study authors state that previous ovarian hyperstimulation syndrome studies are based on outdated clinical guidelines and claim that a paucity of information exists for detailing the effects of available interventions.

In order to establish more updated guidelines, investigators performed a meta-analysis to examine the efficacy of preventative and incidence-reducing strategies for ovarian hyperstimulation syndrome in patients undergoing IVF. After applying exclusion criteria, the researchers included 28 studies — 23 were high quality, 2 were moderate quality, and 3 were low quality. Overall, the team identified 37 interventions. A certainty of evidence assessment revealed that 1 had high certainty, 5 had moderate certainty, and 26 had low or very low certainty. The certainty of evidence was not reported in 5 cases.

Gonadotropin-releasing hormone antagonist (GnRH-ant) co-treatment (odds ratio [OR], 0.61; 95% CI, 0.51-0.72; I², 31%) and GnRH-a triggering (OR, 0.15; 95% CI, 0.05-0.47; I², 42%) were the most efficacious interventions for preventing ovarian hyperstimulation syndrome, the report shows. There was a moderate certainty of evidence reported for most of these studies, with low certainty of evidence reported for elective embryo cryopreservation.

Studies with a moderate certainty of evidence showed that coadministration of dopaminergic agonists (10 RCTs; n=1202; OR, 0.32; 95% CI, 0.23-0.44; I², 13%) and mild ovarian stimulation (9 RCTs; n=1925; risk ratio [RR], 0.26; 95% CI, 0.14-0.49; I², 0%) were considered effective and safe.

Limitations of this review included a low quality of evidence in the available studies, small sample sizes with few events reported, and the outdated management approaches used in several studies.

“Although, the GnRH-ant protocol should be preferred in the presumed high-risk [ovarian hyperstimulation syndrome] patients, identifying high-risk patients remains an unsolved issue, and a formal consensus defining a patient as a “hyper-responder” is currently lacking,” according to the researchers. “Moreover, [ovarian hyperstimulation syndrome] should be considered in all women undergoing ovarian stimulation for fertility treatment, as the condition is largely unpredictable and genetic predisposition plays a crucial role.”