A case of severe ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is the serious physiological complication in patients undergoing controlled ovarian hyperstimulation. In a recently concluded treatment cycle of 28 women at the fertility management unit at the University Hospital of the West Indies, one patient developed symptoms and signs of severe ovarian hyperstimulation syndrome. Administration of human chorionic gonadotrophin (HCG) had a direct influence on the development of the syndrome. High risk cases, such as young patients, particularly those with polycystic ovaries or those with serum oestradiol levels >10,000 pmol/l and a large number of follicles, must be identified. Preventative measures include cylce cancellation, reduction of HCG dosage, egg retrieval and cryopreservation of embryos rather than embryo transfer.(Au)

The inaugural in vitro fertilisation cycle in Jamaica: an overview

INTRODUCTION: At the Fertility Management Unit, an assisted reproduction technology service was established in June 2000. Twenty-eight couples were enrolled for treatment, which was carried out in collaboration with staff of the Midland Fertility Service, United Kingdom, and a local team of doctors, nurses and embryologist. The main Pre-treatment diagnoses were tubal factors in eight (28.5 percent) women and oligospermia in eight males (28.5 percent). The mean age of the women was 34.1 years (range 27 to 41 years). METHODS: All patients under the "long protacol" with down regulations of the hypothalamo-pituitary-ovarian axis, using subcutaneous injections of the gonadotrophin releasing hormone agonist (Buserelin), followed by stimulation with the human menopausal gonadotrophin (Pergonal), for ovulation induction. Monitoring of the response was by use of transvaginal ultrasound at the end of down regulation, day 5 of stimulation and from day 9 until the follicles were determined to be ready for retrieval. Oestradiol levels were measured and human chorionic gonadotrophin (Profasi) was given to mature the oocytes. Oocyte recovery was by transvaginal ultrasound-guided needle aspiration of the follicles 35 hours later. Two days after egg recovery and fertilisation, embryos were transferred back to the patient. There were 24 transfers of 1, 2 or 3 embryos. Fertilised embryos not transferred were cryopreserved at -70 degree celcius. Ten women received human chorionic gonadotrophin (HCG) on the day of transfer and 2, 4 and 6 days later, for luteal phase support, and 24 women received progesterone pessaries. RESULTS: All women responded and came to oocyte recovery. There were 3 cases of ovarian hyperstimulation syndrome (OHSS), one severe and 2 mild. Ten couples had intracytoplasmic sperm injection (ICSI) as planned. Two percutaneous epididymal sperm aspirations were necessary due to aspermia, so these had ICSI as well. Standard in vitro firtilzation procedures were used in 16 cases. Twenty-five patients (89.3 percent) had fertilised oocytes. Three couples had no fertilisations. The patient with severe OHSS had numerous fertilisations but no embryos were transferred to the patient. Five patients (20.8 percent) had "chemical" pregnancies. Three pregnancies have continued, 2 twins and one singleton. The pregnancy rate for viable pregnancies is therefore 12.5 percent. CONCLUSION: In vitro fertilization had been successfully achieved (Au)