George T. Lainas, Efstratios M. Kolibianakis, Tryfon G. Lainas, Ioannis Z. Zorzovilis, Efthymia Alexopoulou, Christos A. Venetis, Basil C. Tarlatzis, Ioannis A. Sfontouris
To assess ultrasound and haematological changes in ovarian hyperstimulation syndrome (OHSS) during the early luteal phase in women at high risk for developing OHSS.
This is a retrospective cohort study of 319 women undergoing in-vitro fertilisation (IVF), at high risk for OHSS following human chorionic gonadotrophin (hCG) triggering of final oocyte maturation. Patients were treated with GnRH agonist or antagonist protocol and were monitored for 5 days post oocyte retrieval. Severe OHSS was diagnosed in the presence of at least moderate ascites and two or more of the following: maximal ovarian diameter (MOD) (>100 mm), haematocrit (Ht)>45%, white blood cell count (WBC)>15,000/mm3, hydrothorax, dyspnea, or oliguria. Outcome measures included changes in Ht, ascites grade, WBC, MOD, as well as the associations between these changes during the early luteal phase.
Changes in ascites grade, Ht, and WBC indicated a significant increase (p<0.001) of values during the early luteal phase, both in patients who developed or did not develop severe OHSS. MOD was significantly (p=0.001) increased only in patients who developed severe OHSS. Both time and development or not of severe OHSS were significantly associated with ascites grade, or Ht, or WBC or MOD, in multivariable analysis, however, there was also a significant interaction between time and development of severe OHSS for all of the above variables (p<0.001).
In the present study, the values of ascites grade, Ht and WBC were significantly increased with time, within the study observation period in all high risk for OHSS women, in line with the pathophysiology of the syndrome. Our data support the use of maximal ovarian diameter in the diagnosis of severe OHSS, and provide novel evidence for the role of Ht change (cHt) as a patient-specific haemoconcentration marker during OHSS development.