J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 8, Number 5, May 2016, pages 396-401

Is It Possible to Prevent Ovarian Hyperstimulation Syndrome by Gonadotropin-Releasing Hormone Agonist Triggering and Modified Luteal Support in Patients With Polycystic Ovarian Morphology?

**Table 1.** Patient Characteristics
Values are mean ± SD. *Values are median (minimum - maximum). SD: standard deviation; BMI: body mass index; AFC: antral follicul count.
Age (years)*	27.93 ± 4.36 (21 - 29)
BMI (kg/m²)*	24.75 ± 5.37 (19 - 34)
Previous cycles**	1 (0 - 9)
AFC**	26 (17 - 34)
Etiology combined to PCO
Male	35.9%
Tubal	4%
Endometriosis	2%

Table 1. Patient Characteristics

*Values are mean ± SD. **Values are median (minimum - maximum). SD: standard deviation; BMI: body mass index; AFC: antral follicul count.

Age (years)*

27.93 ± 4.36 (21 - 29)

BMI (kg/m²)*

24.75 ± 5.37 (19 - 34)

Previous cycles**

1 (0 - 9)

AFC**

26 (17 - 34)

Etiology combined to PCO

Male

35.9%

Tubal

Endometriosis

**Table 2.** Ovarian Stimulation Outcomes
Values are mean ± SD. *Values are median (minimum - maximum). SD: standard deviation.
Coasting, n (%)	70 (79.5%)
Dopamine agonist, n (%)	24 (27.2%)
Serum peak estradiol (pg/mL)*	5,336 ± 2,341 (1,187 - 19,746)
Number of follicules > 12 mm on the day of trigger*	22 ± 7 (9 - 51)
Number of oocytes collected*	17 ± 8 (0 - 45)
Number of metaphase II oocytes*	11 ± 5 (0 - 23)
Number of embryos produced (n)**	8 (1 - 18)
Total number of cycles with embryo transfer (ET), n (%)	84 (95.4%)
Duration of ovarian stimulation (days)**	9 (6 - 16)
Total dose of gonadotropins (IU)*	1,794 ± 858 (700 - 4,500)
Number of embryos transferred (n)**	1 (0 - 2)
Number of embryos cryopreserved (n)**	2 (0 - 10)
OHSS rate	12/88 (13.6%)
Number of cycles with all embryos cryopreserved, n (%)	21 (23.8%)
Embryo transfer canceled, n (%)	4 (4.5%)
Positive pregnancy rate, n (% per embryo transfer)	46/84 (54.7%)
Clinical pregnancy rate, n (% per embryo transfer)	39/84 (46.4%)
Miscarriages, n (% per cycle with embryo transfer)	9 (10.2%)

Table 2. Ovarian Stimulation Outcomes

*Values are mean ± SD. **Values are median (minimum - maximum). SD: standard deviation.

Coasting, n (%)

70 (79.5%)

Dopamine agonist, n (%)

24 (27.2%)

Serum peak estradiol (pg/mL)*

5,336 ± 2,341 (1,187 - 19,746)

Number of follicules > 12 mm on the day of trigger*

22 ± 7 (9 - 51)

Number of oocytes collected*

17 ± 8 (0 - 45)

Number of metaphase II oocytes*

11 ± 5 (0 - 23)

Number of embryos produced (n)**

8 (1 - 18)

Total number of cycles with embryo transfer (ET), n (%)

84 (95.4%)

Duration of ovarian stimulation (days)**

9 (6 - 16)

Total dose of gonadotropins (IU)*

1,794 ± 858 (700 - 4,500)

Number of embryos transferred (n)**

1 (0 - 2)

Number of embryos cryopreserved (n)**

2 (0 - 10)

OHSS rate

12/88 (13.6%)

Number of cycles with all embryos cryopreserved, n (%)

21 (23.8%)

Embryo transfer canceled, n (%)

4 (4.5%)

Positive pregnancy rate, n (% per embryo transfer)

46/84 (54.7%)

Clinical pregnancy rate, n (% per embryo transfer)

39/84 (46.4%)

Miscarriages, n (% per cycle with embryo transfer)

9 (10.2%)

**Table 3.** Patient and COS Cycle Characteristics of OHSS Cases
	Age	BMI	Gonodotropin starting dosage (IU/day)	Total gonadotropin dosage	Co-treatment	Number of follicules ≥ 12 mm	Peak estradiol in ng/mL	Number of oocytes collected (metaphase 2)	Luteal hCG support	Number of transferred
BMI: body mass index; hCG: human chorionic gonadotropin.
Case 1	24	21	125	1,075	Coasting	15	5,000	13 (11)	Yes	1
Case 2	26	19	150	1,237	Coasting	21	3,817	20 (11)	Yes	1
Case 3	26	20	200	1,800	Coasting	18	5,894	17 (12)	Yes	2
Case 4	23	20	225	1,950	Coasting-cabergoline	30	7,012	29 (18)	Yes	2
Case 5	31	33	225	1,950	Coasting	15	6,386	13 (5)	Yes	2
Case 6	26	26	150	1,125	Coasting	20	5,090	19 (10)	Yes	2
Case 7	36	21	125	875	Coasting	15	6,513	14 (12)	Yes	2
Case 8	27	23.9	125	725	Coasting	29	5,985	27 (18)	No	Freeze
Case 9	31	31	150	2,160	Coasting-cabergoline	35	8,644	8 (3)	No	Freeze
Case 10	26	23	125	1,250	Coasting	42	5,570	24 (21)	Yes	Freeze
Case 11	30	31	225	2,250	None	51	6,040	45 (20)	No	Freeze
Case 12	25	22	200	1,150	Coasting-cabergoline	33	5,071	24 (11)	Yes	1

Table 3. Patient and COS Cycle Characteristics of OHSS Cases

Age

BMI

Gonodotropin starting dosage (IU/day)

Total gonadotropin dosage

Co-treatment

Number of follicules ≥ 12 mm

Peak estradiol
in ng/mL

Number of oocytes collected
(metaphase 2)

Luteal hCG support

Number of transferred

BMI: body mass index; hCG: human chorionic gonadotropin.

Case 1

125

1,075

Coasting

5,000

13 (11)

Yes

Case 2

150

1,237

Coasting

3,817

20 (11)

Yes

Case 3

200

1,800

Coasting

5,894

17 (12)

Yes

Case 4

225

1,950

Coasting-cabergoline

7,012

29 (18)

Yes

Case 5

225

1,950

Coasting

6,386

13 (5)

Yes

Case 6

150

1,125

Coasting

5,090

19 (10)

Yes

Case 7

125

875

Coasting

6,513

14 (12)

Yes

Case 8

23.9

125

725

Coasting

5,985

27 (18)

Freeze

Case 9

150

2,160

Coasting-cabergoline

8,644

8 (3)

Freeze

Case 10

125

1,250

Coasting

5,570

24 (21)

Yes

Freeze

Case 11

225

2,250

None

6,040

45 (20)

Freeze

Case 12

200

1,150

Coasting-cabergoline

5,071

24 (11)

Yes

**Table 4.** Clinical Characteristics of OHSS Cases
	OHSS	OHSS type	WBC (µL)	Hct (%)	Paracentesis (amount drained)	Pregnancy
OHSS: ovarian hyperstimulation syndrome; WBC: white blood cell; Hct: hematocrit.
Case 1	Late	Severe	19,400	0.46	Once (1 L)	Yes
Case 2	Early	Severe	20,100	0.43	Once (1.4 L)	No
Case 3	Early	Severe	24,000	0.43	Once (1.8 L)	No
Case 4	Early	Severe	20,800	0.41	Once (1 L)	Yes
Case 5	Late	Severe	28,000	0.49	Twice (2.9 L)	Yes
Case 6	Early	Severe	19,400	0.43	Once (1.5 L)	Yes
Case 7	Early	Severe	20,100	0.50	Once (1.8 L)	No
Case 8	Early	Severe	24,000	0.50	Three times (3 L)	Embryos freezed
Case 9	Early	Severe	20,800	0.45	Once (0.5 L)	Embryos freezed
Case 10	Early	Moderate	21,000	0.42	Once (0.5 L)	Embryos freezed
Case 11	Early	Moderate	21,900	0.36	Twice (1 L)	Embryos freezed
Case 12	Early	Severe	31,700	0.51	Three times (5.5 L)	Yes

Table 4. Clinical Characteristics of OHSS Cases

OHSS

OHSS type

WBC (µL)

Hct (%)

Paracentesis (amount drained)

Pregnancy

OHSS: ovarian hyperstimulation syndrome; WBC: white blood cell; Hct: hematocrit.

Case 1

Late

Severe

19,400

0.46

Once (1 L)

Yes

Case 2

Early

Severe

20,100

0.43

Once (1.4 L)

Case 3

Early

Severe

24,000

0.43

Once (1.8 L)

Case 4

Early

Severe

20,800

0.41

Once (1 L)

Yes

Case 5

Late

Severe

28,000

0.49

Twice (2.9 L)

Yes

Case 6

Early

Severe

19,400

0.43

Once (1.5 L)

Yes

Case 7

Early

Severe

20,100

0.50

Once (1.8 L)

Case 8

Early

Severe

24,000

0.50

Three times (3 L)

Embryos freezed

Case 9

Early

Severe

20,800

0.45

Once (0.5 L)

Embryos freezed

Case 10

Early

Moderate

21,000

0.42

Once (0.5 L)

Embryos freezed

Case 11

Early

Moderate

21,900

0.36

Twice (1 L)

Embryos freezed

Case 12

Early

Severe

31,700

0.51

Three times (5.5 L)

Yes

**Table 5.** Comparison of Women Who Did and Did Not Develop OHSS
	OHSS group	Non-OHSS group	P-value
OHSS: ovarian hyperstimulation syndrome; BMI: body mass index.
Age in years	27.5 ± 3.7	27.9 ± 4.4	0.48
BMI (kg/m²)	23.5 ± 4.41	24.9 ± 2.4	0.36
Number of follicles > 12 mm on the day of trigger	27.5 ± 11.1	21.6 ± 6.4	0.005
Coasting (%)	10/12 (83.3)	58/76 (76.3)	0.90
Cabergoline (%)	3/12 (25)	21/76 (27.6)	0.60
Total FSH dosage	1,492 ± 525	1,846 ± 890	0.18
Peak estradiol in pg/mL	5,598 ± 1,506	5,295 ± 2,450	0.27

Table 5. Comparison of Women Who Did and Did Not Develop OHSS

OHSS group

Non-OHSS group

P-value

OHSS: ovarian hyperstimulation syndrome; BMI: body mass index.

Age in years

27.5 ± 3.7

27.9 ± 4.4

0.48

BMI (kg/m²)

23.5 ± 4.41

24.9 ± 2.4

0.36

Number of follicles > 12 mm on the day of trigger

27.5 ± 11.1

21.6 ± 6.4

0.005

Coasting (%)

10/12 (83.3)

58/76 (76.3)

0.90

Cabergoline (%)

3/12 (25)

21/76 (27.6)

0.60

Total FSH dosage

1,492 ± 525

1,846 ± 890

0.18

Peak estradiol in pg/mL

5,598 ± 1,506

5,295 ± 2,450

0.27