Tehran University Medical Journal

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The objective of this study was to examine the correlation between both midfollicular FSH/LH ratio and number(s) of follicles with ovarian hyperstimulation syndrome (OHSS) in patients with polycystic ovarian syndrome (PCOS). This was carried out in IVF unit at Mirza Kouchak Khan Hospital. To induce ovulation, PCOS patients were stimulated with gonadotropines. Fifty four PCOS patients with normal basal level of FSH, LH were studied prospectively. 22 patients did not receive HCG and stimulation cycle was canceled due to OHSS. 32 patients received HCG and stimulation cycle was completed. In all patients mid-follicular (day 8 of stimulation protocol) serum FSH/LH ratio was measured. On the same day number of ovarian follicles were also counted using vaginal sonography. In canceled cycles, LH on day 8 was shown to be low along with increased number of follicles. The risk of cycle cancelation raised twice with one increment of FSH/LH ratio. Also, with increase of one follicle the risk of cycle cancellation increased 1.3 times. To induce ovulation by gonadotropine stimulation in PCOS patients, the dose should be carefully monitored. Measuring FSH/LH ratio and number of follicles on day 8 of stimulation protocol are reliable guides in order to predict those patients prone to develop OHSS.

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Background: Ovarian hyper stimulation syndrome (OHSS) and its consequences, especially thromboembolic events, are of the most dangerous complications of assisted reproductive technologies (ART). It is unclear whether a thrombophilic predisposition or changes in blood components during clinical presentation of OHSS increase thrombotic risks. Testing for certain thrombophilias in selected high risk patients may help risk assessment and decision-making about prophylactic measures.

Methods: In this study carried out in April 2010 to March 2011, 108 in vitro fertilization candidates with ≥20 follicles following ovarian stimulation were recruited. Protein S, protein C, antithrombin, lupus anticoagulant and anticardiolipin antibodies were measured. Blood tests were compared between severe and non-severe OHSS groups and their changes were traced after onset of clinical OHSS in 43 patients presenting with severe symptoms by repeating the tests at hospital admission.

Results: Mean protein S activity was lower in severe OHSS group (101.7±16.3 vs. 118.4±17.0 P<0.001). After clinical presentation of severe OHSS, this level decreased to 91.6±20.1 (P<0.001). Antithrombin levels decreased 2.09% after the onset of symptoms in the group with severe OHSS, but this difference was not statistically significant (P=0.051). Protein C, lupus anticoagulant and anticardiolipin antibodies were not correlated to severe OHSS development.

Conclusion: Patients with relatively lower protein S activity were at higher risk for the development of severe OHSS, and its dangerous consequences. During clinical OHSS presentation, protein S decreased even more, and patients were more vulnerable to hypercoagulability states. These points should be kept in mind in risk assessment and adoption of prophylactic strategies.

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Background: Polycystic ovarian syndrome (PCOS) is the most common endocrinological disorders that affect approximately 5-7% of women in reproductive age. There is not any consensus about the efficient in vitro fertilization (IVF) protocol for patients with PCOS. The aim of the present study was to compare the half and one-third dose depot gonadotropin-releasing hormone (GnRH) agonist protocols versus the GnRH antagonist protocol in PCOS patients.
Methods: In the present study, we retrospectively evaluated 119 infertile women with PCOS. The patients entered in the study in accordance with Rotterdam criteria. According to GnRH analogue used for pituitary suppression, patients were divided into three groups: half and one-third dose depot GnRH agonist protocols and GnRH antagonist protocol. In GnRH agonist protocol, half or one-third dose depot Decapeptyl (1.875 mg, 1.25 mg) was injected on 21st day of previous cycle. In GnRH antagonist cycles, cetrotide 0.25 mg were administered daily when the leading follicles reached 14 mm. All basal and controlled ovarian hyperstimulation (COH) characteristics were analyzed.
Results: Basal characteristics including: age, FBS, prolactin, hirsutism, length of menstrual cycle were similar between 3 groups. Statically significant decreases in days of stimulation, number of gonadotrophin ampoules and metaphase II (MII) oocytes were found in GnRH antagonist protocol (P<0.001, P<0.001 and P=0.045), while the decrease in biochemical pregnancy (P=0.083) and live birth rate (P=0.169) wasn't significant. Number of embryos transferred were similar in the half and one-third dose depot GnRH agonist and GnRH antagonist cycles (P=0.881). The incidence of OHSS weren't significantly different between 3 groups (5%, 4.9% and 12.8%, P=0.308).
Conclusion: Our study suggest that one-third dose depot GnRH agonist protocol could be a suitable choice for treatment of PCOS because of lower incidence of ovarian hyperstimulation syndrome (OHSS) as compared with half dose depot GnRH agonist and higher pregnancy rate as compared with GnRH antagonist.