Acute renal failure following IVF: case report

IVF is one of the most comprehensively registered interventions in clinical medicine. IVF is regarded as safe with very few complications. We report a woman who developed acute renal failure due to compression of both ureters from enlarged stimulated ovaries. The condition was diagnosed using ultrasound and magnetic resonance imaging (MRI). The condition was treated with insertion of double-J stents in both ureters and resolved without need of dialysis. Compression of the ureters due to enlarged ovaries should be considered if a patient develops acute renal failure following IVF.     

Ovarian hyperstimulation syndrome (OHSS): diagnosis and management

Objective: To present our experience and the current knowledge about pathophysiology, diagnosis, and management of the ovarian hyperstimulation syndrome (OHSS). Design: Retrospective study concerning clinical and laboratory findings of severe OHSS. Setting: General ICU at a maternity-surgical hospital. Patients: Ten patients suffering from severe OHSS. Interventions: Supportive and preventive therapeutic measures applied are described. Measurements and results: Admission and discharge data as well as worst values during disease course were recorded. Clinical and laboratory findings showed third space fluid shift leading to weight gain, generalized tissue edema, ascites, hydrothorax, abdominal distension and pain, chest discomfort, hypovolemia, dehydration, ovaries enlargement, electrolyte disturbances, hypoalbuminemia, high hematocrit, urea, and WBC. Conclusions: OHSS is an iatrogenic complication of assisted conception of unknown pathogenesis, with potentially life-threatening sequelae due to hemoconcentration such as circulatory shock, ARDS, hepato-renal failure, thromboembolic phenomena, and multi-organ dysfunction syndrome. Gynecologists and intensivists must be aware of the diagnosis and management of the syndrome because of the widely used reproductive techniques for assisted conception. Received: 8 July 1999 Final revision received: 3 January 2000 Accepted: 15 February 2000     

Ovarian hyperstimulation syndrome is associated with reversible impairment of vascular reactivity

OBJECTIVE: To determine if there is a loss of normal peripheral arteriolar vasoconstrictor reactivity in women with severe ovarian hyperstimulation syndrome (OHSS). SETTING: Prospective controlled study. DESIGN: National University Hospital, Singapore. PATIENT(S): Forty-three women undergoing treatment in an IVF program: 22 women with severe OHSS and 21 normal women without OHSS. INTERVENTION(S): Measurement and quantification of the cutaneous arteriolar vasoconstrictor response using laser Doppler fluximetry. MAIN OUTCOME MEASURE(S): Changes in blood flow as an index of vasoconstrictor response before and after treatment for OHSS with albumin. RESULT(S): The mean (+/-SE) percentage (%) change in normal control women was -68.3% +/- 4.7. This was significantly different from women with OHSS (-32.3% +/- 11.1). The response in women with OHSS changed significantly after treatment with IV albumin (-60.4% +/- 5.7) and was no different than the control response. The reproducibility of the technique was -13.6% (+/-2.8). CONCLUSION(S): Women with OHSS have impaired vascular reactivity when compared with normal women.     

卵巢过度刺激综合征动物模型制备

目的　构建卵巢过度刺激综合征 (ovarianhyperstimulationsyndrome ,OHSS)的大鼠模型。方法　 18只雌性Wistar大鼠 ,2 2日龄 ,体重 4 2 0～ 5 0 0 g ,随机分成超排卵组 1、组 2和对照组。卵巢过度刺激组从 2 2～ 2 5日龄连续 4d皮下注射马促性腺激素 (eCG) 10IU(0 1ml生理盐水稀释 ) ,在第 2 6日龄皮下注射绒毛膜促性腺激素 (hCG) 30IU、10 0IU ;对照组从第 2 2～ 2 6日龄连续 5d注射生理盐水。在hCG注射 4 8h后 (即 2 8日龄 )尾静脉注射 1%EB(Evensblue)染料 0 1ml,6 0min后腹腔灌注 5ml生理盐水 ,回收灌注液并置一个含有 5 0 μl0 1NNaOH的试管中 ,双侧卵巢分别称重后 ,把左侧卵巢置于 4ml甲酰胺中萃取EB。结果　卵巢过度刺激综合征组卵巢重量组 1为 (4 0 0 5 0±5 1 0 6 )mg ;组 2 (4 2 1 83± 88 93)mg ,显著高于对照组的 (32 82± 5 2 0 )mg(P <0 0 1)。卵巢EB浓度组 1为 (73 18± 11 38)ng/mg ;组 2 (73 2 6± 18 4 4 )ng/mg ,显著高于对照组 (35 87± 5 14 ) ng/mg(P <0 0 1)。组 1腹腔EB浓度 (13 994± 0 4 5 6 ) μg/ml,组 2 (4 15 4± 1 0 90 ) μg/ml,显著高于对照组 (0 333± 0 0 82 ) μg/ml(P <0 0 1)。 结论　利用适当日龄Wister大鼠构建OHSS动物模型成功。     

应用hMG/HCG超促排卵治疗不孕症50例

为了研究国产人类绝经期促性腹激素（hMG）配伍绒促性素（HCG）的超促排卵作用，50例病人90个周期接受了hMG／HCG超排卵治疗。自月经周期第5天开始肌注hMG75u，用B超、宫颈粘液评分及血雌激素、孕激素监测排卵，当优势卵泡平均直径≥18mm时，停用hMG，肌注HCG5000u促排卵。结果显示：hMG／HCG促排卵治疗排卵率为91.0％，妊娠率为24.0％，卵巢过度刺激综合征（OHSS）发生率为44.0％、OHSS发生时妊娠率显著升高达45．4％，尤以多囊卵巢综合征明显。结论：hMG／HCG超排卵治疗不孕症有较好的疗效，国产hMG治疗效果基本与国外产品相近。     

不同促排卵方案在多囊卵巢综合征病人行体外受精 -胚胎移植 /卵胞质内单精子注射中的应用探讨

目的 探讨卵泡期长方案、改良超长方案以及拮抗剂方案3种不同超促排卵方案在行体外受精-胚胎移植/卵胞质内单精子注射(IVF-ET/ICSI)助孕的多囊卵巢综合征(PCOS)病人中应用价值.方法 回顾性分析在郴州市第一人民医院生殖中心2017年7月至2019年5月间行IVF-ET/ICSI治疗的PCOS病人527个周期的临床资料,根据促排卵方案的不同分为三组,卵泡期长方案组(A组),改良超长方案组(B组),拮抗剂方案组(C组).比较三组病人的一般资料、促排卵情况及种植率、临床妊娠率、中重度卵巢过度刺激综合征(OHSS)发生率、抱婴率等临床结局差异.结果(1)三组病人一般情况、基础性激素水平和促排卵药物、促性腺激素(Gn)天数、Gn量、绒毛膜促性腺激素(HCG)日雌二醇值、获卵数、2PN受精率、卵裂率、优胚率、移植胚胎数、OHSS发生率、早期流产率比较差异无统计学意义(P>0.05).(2)A组及B组启动日黄体生成素(LH)、雌二醇值、HCG日LH值均显著低于C组,A组、B组重组人黄体生成素(r-hLH)用量显著高于C组(P<0.05).(3)A组、B组HCG日内膜厚度[(11.22±2.51)mm,(11.10±2.73)mm]、临床妊娠率(70.23％,65.83％)、种植率(53.78％,50.00％)、抱婴率(59.54％,55.28％)均显著高于C组[(9.81±2.35)mm,50.94％,38.04％,39.62％],A组OHSS风险取消移植率(18.93％)显著低于C组(36.78％)(P<0.05).结论 卵泡期长方案与改良超长方案的临床妊娠率、抱婴率高于拮抗剂方案,可为PCOS病人行IVF-ET/ICSI助孕提供方案选择.     

卵巢过度刺激综合征发病机理的研究

卵巢过度刺激综合征(OHSS)的发病机理目前仍不清楚，可能与在控制性超排卵过程中卵巢过量分泌和产生血管活性物质引起的毛细血管通透性增加有关。这些血管活性物质主要包括卵巢来源的肾素、血管紧张素Ⅱ、炎性细胞因子如IL-1、2、6、8、10、TNFa以及血管内皮细胞生长因子(VEGF)。它们之间可能协同发挥作用，导致OHSS的发生。     

卵巢过度刺激综合征相关分子机制的研究进展

［摘要］　卵巢过度刺激综合征（OHSS）是辅助生殖技术中最严重的医源性并发症之一。在控制性促排卵过程中,部分患者会发生OHSS,影响到辅助生殖技术治疗的临床结局,增加患者的心理和经济负担,严重者危及生命安全。因此,解析探讨OHSS相关分子机制的研究对于临床预防和治疗有重大意义。该文就近年来与OHSS发生的相关分子机制研究进展作一综述。