Prevention Of Moderare And Severe Ovarian Hyperstimulation Syndrome

Objective:To investigate whether the incidence of early-onset moderate and severe ovarian hyperstimulation syndrome(OHSS)would be reduced effectively by applying the protocol of progestin primed ovarian stimulation(PPOS)in patients expected to have high ovarian response or using these treatments listed below: bromocriptine,letrozole,and traditional Chinese medicine,acupuncture and moxibustion,in patients with high risk factors of OHSS after oocyte retrieval.Methods:A total of 95 patients expected to have high ovarian response who were treated with assisted reproductive technology and controlled ovarian hyperstimulitionin the Reproductive and genetic center of Xiangtan CentralHospital from January2016 to December2017 were selected as subjectives,61 cases using standard GnRH-a protocol and 34 cases using PPOS protocol.The primary observation item was the incidence of early-onset moderate and severe OHSS and secondary observation items included:number of oocytes retrieved,number of Fertilization,number of cleavage,number of transplantable embryos,rate of oocytes retrieved,fertilization rate,cleavagerate and rate of high quality embryo.A total of 195 high risk patients of OHSS who used standard GnRH-a protocol in controlled ovulation hyperstimulation in the same center from January 2015 to November 2017 were also selected as subjectives.Patients in the control group(55 cases)were treated with hydroxyethyl starch and/or albumin after oocyte retrieval.On the basis of the application of traditional medicine,fourobservation groups were set up according to the additional application of bromocriptine,letrozole,and acupuncture along with moxibustion therapy:(1)Bromocriptine group(51 cases);(2)Bromocriptine+acupuncture and moxibustion therapy group(40cases);(3)Bromocriptine +letrozolegroup(12cases);(4)Bromocriptine+letrozole+acupuncture and moxibustion therapy group(37 cases).The incidence of early-onset moderate and severe OHSS in each group was observed.Results: Comparison of different ovulation stimulation protocols1.There were 6 cases of moderate OHSS and 3 cases of severe OHSS in the group of standard GnRH-a protocol.The incidence of moderate and severe OHSS was 14.8%(9/61).0 case of moderate and severe OHSS was found in the PPOS protocol group and the incidence was 0%(0/34).The incidence of moderate and severe OHSS in the PPOS protocol group was significantly lower than that in the group of standard GnRH-a protocol.2.The difference was not statistically significantbetween the group ofstandard GnRH-a protocol and PPOS protocol group in these items listed below:number of oocytes retrieved,number of Fertilization,number of cleavage,number of transplantable embryos,rate of oocytes retrieved,fertilization rate,cleavage rate and rate of high quality embryo.Comparison of different treatments in high risk patients of OHSS5 cases were moderate OHSSand 4 cases were severe OHSS in the control group.The incidence of moderate and severe OHSS was16.4%(9/55);When the number of oocytes retrieved was ?15,the incidence of moderate and severe OHSS was 25.0%(8/32).(1)There was 1 case of moderate OHSS and 1 case of severe OHSS in the bromocriptine group.The incidence was 3.9%(2/51)and was significantly lower than that of the control group.(2)In the bromocriptine+acupuncture and moxibustion therapy group,0 case of moderate and severe OHSS was found.The incidence was 0%(0/40)and was significantly lower than that of the control group.(3)There was 0 case of moderate OHSS and 1 case of severe OHSS inbromocriptine +letrozolegroup.The incidence was 8.3%(1/12)and was not significantly different compared with the control group.(4)There was 0 case of moderate OHSS and 2 cases of severe OHSSin the group of bromocriptine +letrozole+acupuncture and moxibustion therapy.The incidence of moderate and severe OHSS was 5.1%(2/37);When the number of oocytes retrieved was?15,the incidence was 2.9%(1/35)and was significantly lower than that of the control group.Conclusion:1.PPOS protocolmay beconsidered as a feasible ovarian stimulation regimen in patients expected to have high ovarian response to reduce the incidence of early-onset moderate and severe OHSS.2.On the basis of use of hydroxyethyl starch and/or albumin,early-onset moderate and severe OHSS could be effectively reduced by applying bromocriptine;or bromocriptine combined with acupuncture and moxibustion therapy;or combination of the three treatments:bromocriptine,letrozole and acupuncture along with moxibustion(the number of oocytes retrieved?15)in patients with high risk factors of OHSS after oocyte retrieval.