Abstract
Purpose: Early timed follicular aspiration (ETFA) of one ovary 10–12 hr after administration of chorionic gonadotropin (hCG) is an attempt to prevent severe ovarian hyperstimulation syndrome (OHSS). After the introduction of early timed follicular aspiration ETFA of one ovary in IVF/ET cycles at high risk for severe OHSS, no cases of severe OHSS were registered in the Ljubljana IVF/ET program. In the period before preventive ETFA (1984–1992) there were 16 cases of severe OHSS of 4798 IVF/ET cycles followed by 577 clinical pregnancies. After the introduction of ETFA (1992–1993) there were no cases of severe OHSS of 2289 IVF/ET cycles followed by 364 clinical pregnancies.
Methods: We attempted to evaluate the significance of this observation by comparing two groups of female infertility IVF/ET cycles at high risk for severe OHSS. The occurrence of severe OHSS and clinical parameters in the two groups of IVF/ET cycles at high risk for severe OHSS were compared.
Results: In the group of 106 IVF/ET female infertility cycles at high risk of severe OHSS with preventive ETFA, there were no cases of severe OHSS. In the control group of 92 IVF/ET female infertility cycles at high risk for severe OHSS with normally timed follicular aspiration (NTFA) of both ovaries, severe OHSS occurred in 16 cases. The difference in the occurrence of severe OHSS between the two groups is highly significant (P<0.005), both in hMG/hCG- and in GnRHa/hMG/hCG-induced IVF/ET cycles. No difference in live birth rate (16 vs. 16%) between the two groups was noted.
Conclusions: Considering these results we conclude that ETFA is another successful option to decrease the incidence of severe OHSS in assisted reproduction. The preventive effect of follicular aspiration seems to depend on its timing.
Similar content being viewed by others
References
Schenker J G: Prevention and treatment of ovarian hyperstimulation. Hum Reprod 1993;8:653–659
Salat-Baroux J, Alvarez S, Antoine J M, Cornet D, Tibi Ch, Plachot M, Mandelbaum J: Treatment of hyperstimulation during in vitro fertilization. Hum Reprod 1990;5:36–39
Sher G, Salem R, Feinman M, Dodge S, Zouves C, Knutzen V: Eliminating the risk of life endangering complications following overstimulation with menotropin fertility agents: A report on women undergoing in vitro fertilization and embryo transfer. Obstet Gynecol 1993;81:1009–1011
Navot D, Bergh P A, Laufer N: Ovarian hyperstimulation syndrome in novel reproductive technologies: Prevention and treatment. Fertil Steril 1992;58:249–261
Asch R H, Ivery G, Goldsman M, Frederick J L, Stone S C, Balmeceda J P: The use of intravenous albumin in patients at high risk for severe ovarian hyperstimulation syndrome. Hum Reprod 1993;8:1015–1020
Amit A, Yaron Y, Peyser M R, David M P, Botchan A, Lessing J B: Repeated aspiration of ovarian follicles and early corpus luteum cysts in an in vitro fertilization programme reduces the risk of ovarian hyperstimulation syndrome in high responders. Hum Reprod 1993;8:1184–1186
Meden-Vrtovec H, Tomaževič T: Preventing severe ovarian hyperstimulation syndrome in an in vitro fertilization/embryo transfer program. J Reprod Med 1995;40:37–40
Tomaževič T, Meden-Vrtovec H: Early timed follicular aspiration (ETFA) of one ovary—protecting the development of ovarian hyperstimulation syndrome and providing high pregnancy rates in IVF/ET. 8th Congress on In Vitro Fertilization and Alternate Assisted Reproduction, Kyoto Japan—Abstracts. J Assist Reprod Genet 1993;10:94
Tomaževič T, Meden-Vrtovec H, Pompe-Tanšek M, Ribič-Pucelj M, Vogler A, Hren-Vencelj H, Bernjak I, Žemva Ž: The Ljubljana IVF/ET program—brief report. J Vitro Fert Embryo Transfer 1990;7:295–296
Tomaževič T, Meden-Vrtovec H, Ribič-Pucelj M, Pompe-Tanšek M, Vogler A, Kos D, Veble A, Valentinčič B: Ten years of IVF/ET at the University Women Hospital Ljubljana. Zdrav Vestn 1994;63:579–583
Schenker J G, Weinstein D: Ovarian hyperstimulation syndrome: A current survey. Fertil Steril 1978;30:255–268
Hazout A, Porchier J, Frydman R: Une alternative a la reduction embryonnaire: la reduction folliculaire. Gynecologie 1984;66:220–224
Rabinowitz R, Laufer N, Schenker J G: Rate of ovarian hyperstimulation syndrome after high dose hMG for induction of ovulation in IVF cycles. 5th Congress on IVF-ET, Norfolk, CT, 1987, p 111 (abstract 5000)
Navot D, Margalioth E J, Laufer N, Birkenfeld A, Relou A, Rosler A,et al. Direct correlation between plasma renin activity and severity of ovarian hyperstimulation syndrome. Fertil Steril 1987;48:57–61
Laufer N, Grunfeld L, Garisi G J: In vitro fertilization.In Infertility: Comprehensive Text, Leibel MM (ed). Norwalk, CT, Appleton-Lange, 1990, pp 481–511
Friedman C I, Schmidt G E, Chang F E, Kim M H: Severe ovarian hyperstimulation following follicular aspiration. Am J Obstet Gynecol 1984;150:436–437
Rizk B, Smitz J: Ovarian hyperstimulation syndrome after superovulation using GnRH agonists for IVF and related procedures. Hum Reprod 1992;7:320–327
Aboulghar M A, Mansour R T, Serour G I, Elattar I, Amin Y: Follicular aspiration does not protect against the development of ovarian hyperstimulation syndrome. J Assist Reprod Genet 1992;9:238–243
Golan A, Ron-El R, Herman A, Weinraub Z, Soffer Y, Caspi E: Ovarian hyperstimulation syndrome following D-Trp-6 luteinizing hormone-releasing hormone microcapsules and menotropin for in vitro fertilization. Fertil Steril 1988;50:912–916
Asch R H, Li H P, Balmaceda J P, Weckstein L N, Stone S C: Severe ovarian hyperstimulation syndrome in assisted reproductive technology: Definition of high risk groups. Hum Reprod 1991;6:1395–1399
Meden-Vrtovec H, Tomaževič T: Severe ovarian hyperstimulation syndrome in the IVF-ET program. ARTA 1992;3:347–353
Jamieson M E, Fleming R, Kader S, Ross K S, Yates R W S, Coutts J R T: In vivo and in vitro maturation of human oocytes: Effects on embryo development and polyspermic fertilization. Fertil Steril 1991;56:93–97
Bouchard P: Facteurs de croissance et cytokines: role dans la maturation folliculaire et ovulation. Abstracts of Deuxiemes Journees Europeennes de la Societe Francaise de Gynecologie, Versailles, Oct 12–14, 1994
Mori T, Fujiwara H, Hattori N, Honda T, Nakamura K, Adachi N, Hashii K, Kataoka N, Fukuoka M, Ueda M, Maeda M: Dual control of ovarian function through endocrine and immune system. IX World Congress on In Vitro Fertilization and Alternated Assisted Reproduction, Vienna, Austria, April 3–7 1995, pp 3–6
Bergh P A, Navot D: Ovarian hyperstimulation syndrome: A review of pathophysiology. J Assist Reprod Genet 1992;9:429–438
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tomaževič, T., Meden-Vrtovec, H. Early timed follicular aspiration prevents severe ovarian hyperstimulation syndrome. J Assist Reprod Genet 13, 282–286 (1996). https://doi.org/10.1007/BF02070139
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02070139