Spontaneous ovarian hyperstimulation syndrome caused by a follicle-stimulating hormone-secreting pituitary macroadenoma in an early pubertal girl.

UNLABELLED: Gonadotroph adenomas are difficult to diagnose since they usually show as nonsecreting tumors or produce biologically inactive hormones with no clinical effects and classically grow silent until neurological symptoms appear. Presentation with bilateral ovarian masses and ovarian hyperstimulation has been described in fertile years. Gonadotroph adenomas are extremely infrequent in children. We report a 13-year-old postmenarcheal girl referred to our hospital with 6 months of amenorrhea, abdominal palpable mass presumptive of bilateral ovarian tumors. The patient had Tanner IV breast development and a large abdominal mass occupying the whole low hemiabdomen. Laboratory evaluation revealed high estradiol levels with suppressed luteinizing hormone and inappropriately high follicle-stimulating hormone (FSH) levels. Pelvic ultrasound showed enlarged ovaries containing multiple giant cysts. An MRI revealed a pituitary macroadenoma. Transsphenoidal resection of the adenoma was performed with an uneventful postoperative course. Immunohistologic examination only showed staining for FSH, thus confirming pituitary secreting FSH adenoma. Hormonal laboratory levels normalized and ovarian masses showed marked involution 1 month after surgery. Three months later the MRI showed tumor disappearance. CONCLUSION: The presence of bilateral ovarian tumors requires a careful endocrine and neurological evaluation to exclude the presence of an FSH-producing tumor in order to avoid unnecessary ovarian surgery.

[Severe ovarian hyperstimulation syndrome treatment by decompressive paracentesis and self-transfusion of ascitis fluid]. / Tratamiento del síndrome de hiperestimulación ovárica grave mediante paracentesis descompresiva y autotransfusión de líquido de ascitis.

BACKGROUND: The ovarian hyperstimulation syndrome is a serious complication in patients who undergo controlled ovarian stimulation and for that reason all clinicians who prescribe ovulation inducing agents must be prepared to recognize and manage ovarian hyperstimulation syndrome, to prevent severe and ocasionally mortal complications. OBJECTIVE: To communicate the experience in the treatment of ovarian hyperstimulation syndrome as a complication in patients who undergo controlled ovarian stimulation. PATIENTS AND METHODS: In the present study seven patients who developed severe ovarian hyperstimulation syndrome were included, and were treated by ultrasound guided paracentesis and self-transfusion of the ascitic fluid. RESULTS: In all patients we observed a clinical improvement immediately after the drainage of ascitic fluid no hematological or infectious disease were observed after the self-transfusion. We observed a reduction in hemoglobin of 20.9% and 22.2% in the hematocrit after paracentesis and self-transfusion, meanwhile we observed an increase of 55.5% in the albumin level. Any patient developed hemodynamic disturbance after paracentesis after drainage of great volume in the paracentesis (mean of 4453.4 mL per patient). CONCLUSIONS: The drainage of ascitis by paracentesis and self-transfusion of the fluid is a good therapeutic option in patients with severe ovarian hyperstimulation syndrome in combination with intravenous fluids and administration of human albumin 25%.

Successful ongoing pregnancies after vitrification of oocytes.

OBJECTIVE: To demonstrate the efficiency of vitrifying mature human oocytes for different clinical indications. DESIGN: Descriptive case series. SETTING: Cryobiology laboratory, Centro Colombiano de Fertilidad y Esterilidad-CECOLFES LTDA. (Bogotá, Colombia). PATIENT(S): Oocyte vitrification was offered as an alternative management for patients undergoing infertility treatment because of ovarian hyperstimulation syndrome, premature ovarian failure, natural ovarian failure, male factor, poor response, or oocyte donation. Mature oocytes were obtained from 33 donor women and 40 patients undergoing infertility treatment. INTERVENTION(S): Oocytes were retrieved by ultrasound-guided transvaginal aspiration and vitrified with the Cryotops method, with 30% ethylene glycol, 30% dimethyl sulfoxide, and 0.5 mol/L sucrose. Viability was assessed 3 hours after thawing. The surviving oocytes were inseminated by intracytoplasmic sperm injection. Fertilization was evaluated after 24 hours. The zygotes were further cultured in vitro for up to 72 hours until time of embryo transfer. MAIN OUTCOME MEASURE(S): Recovery, viability, fertilization, and pregnancy rates. RESULT(S): Oocyte vitrification with the Cryotop method resulted in high rates of recovery, viability, fertilization, cleavage, and ongoing pregnancy. CONCLUSION(S): Vitrification with the Cryotop method is an efficient, fast, and economical method for oocyte cryopreservation that offers high rates of survival, fertilization, embryo development, and ongoing normal pregnancies, providing a new alternative for the management of female infertility.

Síndrome de hiperestímulo ovariano: fisiopatologia, abordagem clínica, prevenção e tratamento / Ovarian hyperstimulation syndrome: physiopathology, management, prevention and treatment

A síndrome de hiperestímulo ovariano é uma importante complicação das técnicas de reprodução assistida devido a sua grande morbidade. O mecanismo patogênico básico é o aumento da permeabilidade capilar levando ao extravasamento de líquidos do espaço intravascular para o extravascular, com desenvolvimento de ascite e outros tipos de sufusões, além de hemoconcentração e hipovolemia. A fisiopatologia ainda é motivo de controvérsia. Evidências recentes apontam para o papel de vários mediadores neste processo, sendo que o vascular endothelial growth factor vem sendo envolvido como principal responsável pelo desenvolvimento da síndrome do hiperestímulo ovariano. O presente estudo tem como objetivo revisar sua fisiopatologia e avaliar os recentes avanços descritos na literatura sobre a profilaxia e tratamento da síndrome de hiperestímulo ovariano

[Efficacy of simultaneous use of cryopreserved semen, controlled ovarian hyperstimulation and intrauterine insemination in the treatment of sterility caused by hypergonadotropic azoospermia]. / Eficacia del uso simultáneo de semen criopreservado, hiperestimulación ovárica controlada e inseminaciones intrauterinas para el tratamiento de la esterilidad causada por azoospermia hipergonadotrópica.

The purpose of the present study is to determine the efficacy of an artificial intrauterine insemination program with frozen donor sperm and controlled ovarian hyperstimulation as an alternative therapy for infertility cause by hypergonadotropic azoospermia. Two hundred forty three insemination cycles with frozen donor sperm were analyzed. Clomiphene citrate, pure FSH, recombinant FSH or human menopausal gonadotropins were utilized for ovulation induction; human corionic gonadotropin (hCG), 10,000 IU, was administered when one or more dominant follicles with diameter > or = 16 mm were present; intrauterine insemination was performed 36 hours after the hCG injection. The pregnancy rate per cycle was 19.9%, and the cumulative pregnancy rate was 59.3%. It is concluded that intrauterine insemination with frozen donor sperm and ovulation induction is a good alternative for male factor infertility with no available treatment.

Experiencias en fertilización in vitro (FIV) y transferencia embrionaria / Experiences in vitro fertilization and embrionary transference

Las indicaciones de FIV están bien definidas y cada vez son más las parejas que deben recurrir a ella para solucionar su problema de infertilidad (1). El alto costo que implica un tratamiento de FIV, junto al hecho de que las pacientes deben viajar a alguno de los centros ubicados en Santiago, nos motivó a crear la Unidad de Medicina Reproductiva en Clínica Reñaca, de Viña del Mar, como programa periférico de la Unidad de Medicina Reproductiva de Clínica las Condes. Está demostrado que la efectividad de los centros pequeños dedicados a FIV es menor que la de los grandes centros (1,2). Nuestros objetivos al crear esta unidad, fueron ofrecer un servicio del más alto nivel ofrecido por un equipo de gran experiencia, reduciendo los costos a través de procedimientos simplificados y ambulatorios, pero manteniendo resultados aceptables

[Integral treatment of severe ovarian hyperstimulation syndrome by means of autotransfusion of ascitic fluid and intravenous infusion of albumin]. / "Tratamiento integral del síndrome de hiperestimulación ovárica severo mediante autotransfusión de ascitis e infusión intravenosa de albúmina".

Severe ovarian hyperstimulation syndrome (OHSS) is a potential life-threatening condition relationated with ovulation induction. It affects multiple systems. Little is known about it's pathophysiology. The treatment available consists in the correction of fluid, electrolyte and hematologic imbalances. In other hand, is mandatory the prevention of embolic phenomena. Ascitic fluid aspiration result in dramatic improvement of symptoms. The purpose of this study was to assess the effect of autotransfusion of ascitic fluid obtained by paracentesis and the intravenous infusion of albumin for the treatment of severe from of the OHSS.

"Tratamiento integral del síndrome de hiperestimulación ovárica severo mediante autotransfusión de ascitis e infusión intravenosa de albúmina" / Whole treatment of the severe ovarian hyperstimulation syndrome by means of autotransfusión of ascitic fluid and intravenous infusion of albumin

La forma severa del síndrome de hiperestimulación ovárica (SHEO) es un proceso grave que puede poner en peligro la vida y se produce ocasionalmente como consecuencia de la inducción de la ovulación. El padecimiento afecta a múltiples sistemas, pero se conoce poco sobre su fisiopatología. El tratamiento consiste en la corrección del desequilibrio hidroelectrolitico, las alteraciones hematológicas y en la prevención de los fenómenos embólicos. La aspiración de líquido produce mejoría notoria en la sintomatología. En este trabajo se evalúa el efecto de la autotransfusión de ascitis y la infusión intravenosa de albúmina en el tratamiento de la forma severa del SHEO

[Severe ovarian hyperstimulation syndrome: an intensive care disease]. / El sindrome de hiperestimulación ovárica severa; una patología de cuidados intensivos.

Ovarian hyperstimulation syndrome is a severe and potentially fatal iatrogenic disease that affects 2% of women subjected to pharmacological induction of ovulation. The newest data on the clinical picture, risk factors, pathophysiology and management of this disease, are reviewed.

Síndrome de hiperestimulaçäo Ovariana / The ovarian hyperstimulation syndrome

A Síndrome de Hiperestimulaçäo Ovariana (SHO) é uma complicaçäo relativamente freqüente em ciclos de reproduçäo assistida, podendo representar um risco de vida para algumas pacientes. Várias pesquisas vêm sendo realizadas com o objetivo de esclarecer a fisiopatologia desta síndrome, permitindo assim uma prevençäo mais eficaz e um tratamento adequado dessas pacientes. A identificaçäo das formas graves é de fundamental importância para que se evite maiores complicaçöes.

[The ovarian hyperstimulation syndrome. Institutional experience]. / Síndrome de hiperestimulación ovárica. Experiencia institucional.

Thirty patients with OHS were analyzed; all of them had to be hospitalized. There was no difference as to sterility time and syndrome appearance. The use of menotropines caused more frequently the syndrome. There was multiple pregnancy in 33%. Abortion incidence was 16%. As the etiology is unknown there is not an adequate treatment, and care is for maintenance. Prevention is the best option.

[Ovarian hyperstimulation syndrome. Current concepts]. / Síndrome de hiperestimulación ovárica. Conceptos actuales.

The ovarian hyperstimulation syndrome is the most severe iatrogenic complication of ovarian stimulation. Currently, the number of women receiving drugs for ovulation induction has markedly increased with the advent of different medically assisted reproduction programs. Consequently, this potentially life-threatening situation has become a frequent clinical problem. Since its pathophysiology is poorly understood, it is the clinician's responsibility to ensure its accurate prevention, prediction and active management. Although severe and critical ovarian hyperstimulation syndrome may be not completely avoided, it is the responsibility of the clinician to be aware of an early recognition of high-risk factors and make a judicious prevention to reduce the complication and sequelae of this iatrogenic syndrome. The present work offers an overview of the current world literature on ovarian hyperstimulation syndrome.

[Treatment and prevention of the ovarian hyperstimulation syndrome]. / Tratamiento y profilaxis del síndrome de hiperestimulación ovárica.

Frequency and features of ovarian hyperstimulation syndrome (OHS) were reviewed in 41 women stimulated with human menopausal gonadotropin (HMG) during 130 cycles. There were 7 cases of OHS, since 17% of patients and 5.3% of cycles were affected; 3 cases were mild, 2 moderate and 2 severe. Of these 41 women, 21 pregnancies occurred (51%) and 19 newborns were healthy. The patients with OHS received 1060 +/- 235 (X +/- DE) UI of HMG and there was not a significative difference with the amount of HMG units in remaining subjects. Symptoms began 3-6 days after human chorionic gonadotropin (HCG) administration. Women with mild OHS were treated as out patients with bed rest and 100 mg indomethacin in suppositories two times a day. Moderate and severe OHS were hospitalized with bed rest; careful monitoring of fluid intake and output, weight and abdominal perimeter daily, as well as vital signs were withdrawn. Patients with severe OHS were treated in the intensive care unit for detection and management of complications. One patient was submitted to laparotomy because of a probably ovarian rupture, but it was discarded in the surgery. OHS remained between 6 and 8 days. Patients with OHS presented 3 pregnancies, 2 were twins and the other was ectopic. Emphasis was made in the prophylactic measures to avoid the OHS.

Síndrome da hiperestimulaçäo ovariana / Ovarian hyperstimulation syndrome

No presente trabalho os autores fazem uma revisäo sobre a Síndrome de Hiperestimulaçäo Ovariana (SHO), tecendo consideraçöes sobre classificaçäo, fisiopatologia, quadro clínico e laboratorial, tratamento e prevençäo