Pigtail catheter for the treatment of ascites associated with ovarian hyperstimulation syndrome

BACKGROUND: Severe ovarian hyperstimulation syndrome (OHSS) is potentially dangerous. The study aim was to evaluate the efficacy and safety of percutaneous pigtail catheter drainage for the management of ascites complicating severe OHSS. METHODS: This was a prospective trial conducted at a private IVF centre and a tertiary teaching medical centre. A total of 26 patients with severe OHSS was recruited. Patients were divided into two groups. Patients in group 1 (n = 13) were hospitalized, while patients in group 2 (n = 13) were managed on an outpatient basis. A pigtail catheter was inserted under transabdominal ultrasound guidance and kept in place until drainage ceased. The main outcome measures were resolution of OHSS as determined by symptomatology and laboratory values, time to removal of catheter, patient tolerance of the procedure and complication rate. RESULTS: The catheter was successfully placed in all patients following one attempt and was kept in place for a mean +/- SD of 12.9 +/- 4.3 days (range 7-24). Average amount of fluid drained was 11.2 +/- 4.3 l (range: 3.35-18.5). An improvement of symptoms and signs was noted 24-48 h after catheter placement in all patients in both groups. Procedure was well tolerated and no complications reported. CONCLUSIONS: Percutaneous placement of a pigtail catheter is a safe and effective treatment modality for severe OHSS. It may represent an attractive alternative to multiple vaginal or abdominal paracentesis.     

The questionable use of albumin for the prevention of ovarian hyperstimulation syndrome in an IVF programme: a randomized placebo-controlled trial

BACKGROUND: The role of intravenous (IV) albumin administration in the prevention of ovarian hyperstimulation syndrome (OHSS) and in the improvement of IVF conception outcomes was evaluated in a prospective, randomized, placebo-controlled double blind study. METHODS: Ninety-eight women were enrolled in the study and were consecutively assigned to either a treatment group or a control group. Eleven patients were lost to follow-up after assignment. Of the remaining 87 women, 46 received albumin on the day of oocyte retrieval, and 41 received 0.9% sodium chloride solution as a placebo control. Outcome measures included OHSS incidence rates and pregnancy rates in the two trial groups. RESULTS: Four of the 46 patients in the study group developed severe OHSS and six developed moderate OHSS. In the control group, one of the 41 developed severe OHSS and five developed moderate OHSS. The difference in OHSS incidence rates between the two groups was not statistically significant [relative risk (RR) = 1.49, 95% CI = 0.59-3.73]. Fourteen patients (30%) in the intervention group conceived, compared with 16 patients (39%) in the control group. The difference in conception rates between the two groups was not statistically significant (RR = 0.78, 95% CI = 0.44-1.39). CONCLUSIONS: Albumin appears to have no positive effect on OHSS or conception rates, while its use carries the risk of undesirable side effects, including exacerbation of ascites in OHSS, nausea, vomiting, febrile reaction, allergic reaction, anaphylactic shock and risk of virus and prion transmission. We suggest that this form of treatment should not be included in the prevention of OHSS.     

人工授精周期诱导排卵药物及方案的研究进展

诱导排卵联合宫腔内人工授精是广泛应用的一项辅助生育技术。诱导排卵目的是形成单一卵泡的发育成熟,尽可能地减少发生多胎妊娠和卵巢过度刺激综合征的风险。抗雌激素类和芳香化酶抑制剂因口服方便而广泛应用,单独使用妊娠率较低。促性腺激素类药物可以获得较高的临床妊娠率,采用小剂量递增的温和方案不但能够保证较高的单卵泡发育还能够明显的减少并发症的发生。关于促性腺激素促排卵治疗中卵巢反应预测因子还有待于进一步研究。     

体外受精—胚胎移植术后并发重度卵巢过度刺激综合征的观察与护理

目的:探讨体外受精—胚胎移植术(IVF-ET)后并发重度卵巢过度刺激综合征(OHSS)的护理。方法:选择重度OHSS住院患者40例,平均分为试验组与对照组,对照组采用常规护理,试验组在常规护理的基础上进行护理干预。结果:试验组干预后其SAS评分和SDS评分均明显优于对照组(P<0.05)。两组患者均预后良好,无严重并发症发生,试验组其住院时间明显少于对照组(P<0.05)。结论:严密观察IVF-ET并发OHSS患者的病情,并实施有效的护理干预措施可以有效的改善患者的心理状态,缩短治疗时间,改善患者预后。     

Anti-Müllerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology

BACKGROUND: Recently, a new marker, the anti-Müllerian hormone (AMH), has been evaluated as a marker of ovarian response. Serum AMH levels have been measured at frequent time-points during the menstrual cycle, suggesting the complete absence of fluctuation. The aim of this study was to evaluate whether serum AMH measurement on any day of the menstrual cycle could predict ovarian response in women undergoing assisted reproductive technology (ART). METHODS: This study included 48 women attending the IVF/ICSI programme. Blood withdrawal for AMH measurement was performed in all the patients independently of the day of the menstrual cycle. RESULTS: Women in the lowest AMH quartile (<0.4 ng/ml) were older and required a higher dose of recombinant FSH than women in the highest quartile (>7 ng/ml). All the cancelled cycles due to absent response were in the group of the lowest AMH quartile, whereas the cancelled cycles due to risk of ovarian hyperstimulation syndrome (OHSS) were in the group of the highest AMH quartile. This study demonstrated a strong correlation between serum AMH levels and ovarian response to gonadotrophin stimulation. CONCLUSION: For the first time, clinicians may have a reliable serum marker of ovarian response that can be measured independently of the day of the menstrual cycle.     

米索前列醇与HCG促排卵效果的临床比较研究

目的比较米索前列醇和人绒毛膜促性腺激素（HCG）这两种药物在临床的促排卵效果及妊娠结局。方法选取2009年4月-2011年4月在内蒙古妇幼保健医院生殖内分泌门诊就诊的Ⅱ型生殖内分泌异常的不育妇女90例,在月经周期第3日起开始口服来曲唑促排卵,连服5日,剂量为5mg/日。于月经周期的10日开始阴道B超监测卵泡,直至优势卵泡直径≥18mm,共85例。无卵巢高反应性者为A组,共70例,给予肌注HCG 6000U;出现卵巢高反应性或预测可能出现卵巢过度刺激综合征（OHSS）者为B组,共15例,给予口服米索前列醇0.2 mg。通过阴道B超监测排卵征象,测定基础体温及超声最终明确早孕。结果 HCG组与米索前列醇组排卵成功率与无显著性差异（P〉0.05）,两组的妊娠率亦无显著性差异（P〉0.05）。结论米索前列醇与HCG的临床促排卵效果无显著性差异,米索前列醇作用温和,对于促排卵过程中出现卵巢高反应性或过度刺激综合征倾向者,在HCG日应用米索前列醇诱发排卵,是较为理想的替代选择。     

拮抗剂方案中应用促性腺激素释放激素激动剂诱发卵母细胞成熟后不同黄体支持方案对妊娠结局的影响——一项提前终止的前瞻随机临床对照研究

目的 (1)在促性腺激素释放激素拮抗剂(GnRH-ant)方案中应用促性腺激素释放激素激动剂(GnRH-a)诱发卵母细胞最终成熟后,在黄体支持方案中比较孕激素+人绒毛膜促性腺激素(HCG)和孕激素+雌激素两种不同的黄体支持方案对妊娠结局的影响;(2)在GnRH-ant方案中比较添加高纯度人绝经期促性腺激素(HP-HMG)和添加人重组黄体生成素(rLH)对妊娠结局的影响.方法 前瞻随机对照的临床实验.对照组32例,添加rLH,GnRH-a诱发卵母细胞最终成熟后12h添加1,000 IU、35 h添加500 IU HCG,取卵后应用孕激素;实验Ⅰ组37例,添加HP-HMG,黄体支持方案同对照组;实验Ⅱ组33例,添加HP-HMG,取卵后应用孕激素和雌激素.结果 对照组、实验Ⅰ组和实验Ⅱ组的新鲜周期胚胎移植周期临床妊娠率分别是38.10％、23.08％和8.70％,实验Ⅱ组新鲜周期临床妊娠率明显低于本中心质控标准,该临床实验提前终止.对照组、实验Ⅰ组和实验Ⅱ组未妊娠者已有33例进行了冷冻胚胎移植周期,其临床妊娠率分别为50.00％,63.64％和57.14％.三组均无中重度卵巢过度刺激综合征(OHSS)发生.结论 拮抗剂方案中应用GnRH-a诱发卵母细胞成熟可以避免中重度OHSS的发生,且不影响胚胎质量.GnRH激动剂诱发卵母细胞成熟对黄体功能和内膜容受性存在不利影响,单纯补充雌孕激素无法替代HCG的作用.