Can we eliminate severe ovarian hyperstimulation syndrome? Comment 2

Diane De Neubourg1 and J. Gerris

Centre for Reproductive Medicine, Middelheim Hospital, Lindendreef 1, 2020 Antwerp, Belgium

1 To whom correspondence should be addressed. Email: diane.deneubourg{at}zna.be

Sir,

We read with great interest the opinion paper by Orvieto (2005) which addresses the question of the possibility to eliminate severe ovarian hyperstimulation syndrome (OHSS). A patient-tailored flow chart is proposed because previously described risk factors such as serum estradiol levels and number of follicles appear insufficient to predict occurrence of severe OHSS. In this flow chart, however, single blastocyst transfer is proposed as a method to decrease multiple pregnancy and the authors conclude that the risk of late OHSS can be eliminated. It is correct that with postponement of transfer, the patient can be evaluated and transfer considered or postponed. However, to our knowledge it has never been published that avoidance of multiple pregnancy is sufficient to reduce the risk of OHSS. In the literature, an association between multiple pregnancies and the late form of OHSS is given (Lyons et al., 1994Go; Papanikolaou et al., 2005Go). We recently found that, unfortunately, singleton pregnancies are affected by OHSS as frequently as twin pregnancies (De Neubourg et al., 2004Go). This is probably because the patients at risk for OHSS are the same but receive only one embryo for transfer. The risk for OHSS seems to be more related to a threshold value of hCG in patients at risk rather than to the number of embryos transferred.

References

De Neubourg D, Mangelschots K, Van Royen E, Vercruyssen M and Gerris J (2004) Singleton pregnancies are equally affected by ovarian hyperstimulation syndrome as twin pregnancies. Fertil Steril 82, 1691–1693.[CrossRef][ISI][Medline]

Lyons CA, Wheeler CA, Frishman GN, Hackett RJ, Seifer DB and Haning RV Jr (1994) Early and late presentation of ovarian hyperstimulation syndrome. Hum Reprod 9, 792–799.[Abstract]

Orvieto R (2005) Can we eliminate severe ovarian hyperstimulation syndrome? Hum Reprod 20, 320–322.[Abstract/Free Full Text]

Papanikolaou E, Tournaye H, Verpoest W, Camus M, Vernaeve V, Van Steirteghem A and Devroey P (2005) Early and late ovarian hyperstimulation syndrome: early pregnancy outcome and profile. Hum Reprod 20, 636–641.[Abstract/Free Full Text]

Submitted on March 14, 2005; accepted on April 5, 2005.





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