Clinical Study On Ganirelix In Preventing Ovarian Hyperstimulation Syndrome

Objective:To discuss the clinical efficacy of Ganirelix Injection in the prevention of ovarian hyperstimulation syndrome(OHSS).At present,this method has not been reported.This study compares the efficacy of occlusion with Ganirelix Injection and Voluven,as well as clinically used Voluven in the prevention and treatment of early-onset OHSS,aiming to explore a more economical,effective,and convenient treatment for OHSS.Methods:168 high risk patients with OHSS who received assisted reproduction and ovulation induction treatment(long protocol/super long protocol)from January 2016 to December 2017 In Assisted Reproductive Centre,Sichuan Provincial People's Hospital,with informed consent of patients?Randomly dividing the high risk patients with OHSS into experimental group(n=83)and control group(n=85).experimental group(n=83): receive subcutaneous injection of Ganirelix Injection(2.5mg)immediately after obtain ovum,1 time/day for 3 days,with Hydroxyethyl Starch 130/0.4 and Sodium Chloride Injection(Voluven)500 ml,Intravenous drips,1 time/day for 7 days.control group(n=85): receive subcutaneous injection of Normal saline(2ml)immediately after obtain ovum,1 time/day for 3 days,with Hydroxyethyl Starch 130/0.4 and Sodium Chloride Injection(Voluven)500 ml,Intravenous drips,1 time/day for 7 days.Observation index: the comparison of assisted reproduction outcome between the 2 groups,incidence rate,classification and distribution of OHSS,hydrothorax and ascites,blood routine,coagulation function,D-dimer,biochemical indicators of liver and kidney function,and sex hormone conditions.Results:1.There was no statistical difference on the constituent ratio of scheme between 2 groups(P>0.05),there was no statistical difference on the constituent ratio of ovulation induction between 2 groups(P>0.05);there was no statistical significance between age,menstrual cycle,body mass index(BMI),Infertile years,Basal antral follicle number(bAFC),Estrogen(E2),Luteinizing hormone(LH),Follicle stimulating hormone(FSH)level?starting amount of Gonadotropin(Gn)?Gn days?Gn amount?E2 level of HCG/day?Number of acquired eggs,Mature egg rate,Optimal embryo rate etc(P>0.05).2.Incidence rate,classification and distribution of OHSS: 3 days after after obtain ovum,incidence rate of OHSS was 8.43%(experimental group)vs 22.35%(control group),differences are significant(P=0.013);there was no severe OHSS patient in experimental group,1 severe OHSS patient in control group;there was no extremely severe OHSS patient in both groups.7 days after obtain ovum,there were 12 OHSS patients in experimental group and 25 in control group,incidence rate was 14.46% vs 29.41%,differences are significant(P=0.019).The incidence of mild and moderate incidence was statistically different between the two groups(P=0.017).3.Ovarian size and hydrothorax and ascites depth: 1day and 3 days after obtain ovum,there was no statistical significance in ovarian size and hydrothorax and ascites depth between 2 groups(P>0.05);7 days after obtain ovum,there was no statistical significance in ovarian size and ascites depth between 2 groups(P>0.05),The incidence of hydrothorax depth in the control group was higher(4.82% vs 17.64%)(P=0.013).4.Biochemical Indicators: There was no significant difference in serum potassium concentration,sodiumion concentration,alanine transaminase concentration,glutamic pyruvic aminotransferase concentration and albumin concentration in the two groups on the 1rd,3rd or 7th days after oocyte retrieval(P>0.05).5.Blood routine related indicators: There were no significant differences about white blood cell(WBC)amount,Red blood cell(RBC)amount,hemoglobin(Hb),Hematocrit(HCT),mean corpuscular volume(MCV),Platelet(PLT),no matter on the 1st,3rd or 7th days after oocyte retrieval.6.as for coagulation and fibrinolytic indicators: There was no significant difference between the two groups of prothrombin time,activated thromboplastin time,plasma fibrinogen and thrombin time(P>0.05),and the D-dimer on the 7th day was significantly lower than that in the control group(P=0.042).7.Sex hormone: The content of estrogen is obviously lower than the control group(P=0.032,P=0.036),there was no statistical significance in luteinizing hormone(LH)and Follicle stimulating hormone(FSH)between 2 groups(P>0.05).Conclusions:1.The use of Ganirelix Injection can effectively reducing the occurrence of OHSS after obtain ovum,and reducing the extent of OHSS occurrence?2.The use of Ganirelix Injection can significantly lower the level of sex hormone,especially estradiol level after obtain ovum.Also can reduce the amount of the patient's incidence of hydrothorax to a certain extent,improve the symptoms of OHSS.To a certain extent,the use ofGanirelix Injection can reduce pachyemia and hypercoagulative state after obtain ovum.3.The use of Ganirelix Injection convenient and safe after obtain ovum,It can be used as a new choice for clinical prevention of OHSS.