Salama Khalid M, Abo Ragab Hesham M, El Sherbiny Mohammed F, Morsi Ali A, Souidan Ibrahim I
Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt.
BMC Womens Health. 2017 Nov 13;17(1):108. doi: 10.1186/s12905-017-0466-z.
Ovarian hyperstimulation syndrome (OHSS) is an important condition with considerable morbidity and a small risk of mortality and most commonly results as an iatrogenic condition following follicular stimulation of the ovaries. We aimed to evaluate safety and efficacy of 3-day cetrotide therapy started on day of oocyte retrieval (Day-0) in women at high-risk for development of ovarian hyperstimulation syndrome (OHSS) after GnRH agonist induction protocol.
Forty-eight women fulfilling inclusion criteria underwent ultrasound scanning for maximal ovarian diameter (MOD) estimation and ascites grading. Patients underwent embryo freezing, but the study group received 3-day Cetrotide sc injection (0.25 mg/day) started on Day-0. Serum E2, pain scores and MOD were checked daily. Hematocrite value (Ht%), total leucocytic count (TLC), gastrointestinal (GI) manifestations and ascites grading were re-evaluated on Day-3, 6 and 8.
Sequential serum E2 levels decreased significantly in both groups with significantly lower levels in the study group. Sequential MOD estimates showed non-significant difference between the two groups and versus Day-0 estimates. On Day-2, pain scores showed progressive significant decrease compared to Day-0 scores in both groups with significantly lower scores in the study group. On Day-3; four control patients still had vomiting and by Day-6, 6 of the control patients still had GI manifestations with significant difference versus the study group. Compared to Day-0 estimates, Ht% and TLC were significantly lower on Day-3, 6 and 8 in the study group, but only on Day-8 in the control group. Day-3 and Day-8 ascites grading in both groups was significantly lower compared to respective Day-0 grading with significant difference in favor of the study group. Six patients required hospitalization, but without mortalities. Day-3 E2 levels in the study group showed positive significant correlation with clinical and other laboratory data and ascites grading, while the correlation was non-significant with MOD.
The 3-day cetrotide therapy starting after oocyte retrieval with embryo transfer freezing could be an appropriate management policy for women received GnHR-agonist induction protocol and were at high-risk for OHSS. Sequential E2 serum levels could predict outcome more perfectly than sequential MOD estimates.
Trial registration ( clinicaltrial.gov registration) NCT02823080 (retrospective) Initial Release 21-6-2016 Last Release 3-1-2017 Unique Protocol ID: Benha U Secondary IDs: kmsalama.
卵巢过度刺激综合征（OHSS）是一种重要病症，具有较高的发病率和较低的死亡风险，最常见的是在卵泡刺激卵巢后作为医源性病症出现。我们旨在评估在卵母细胞取出日（第0天）开始的3天西曲瑞克治疗对接受促性腺激素释放激素（GnRH）激动剂诱导方案后有卵巢过度刺激综合征（OHSS）发生高风险女性的安全性和有效性。
48名符合纳入标准的女性接受超声扫描以估计最大卵巢直径（MOD）并进行腹水分级。患者进行胚胎冷冻，但研究组从第0天开始接受3天的西曲瑞克皮下注射（0.25毫克/天）。每天检查血清雌二醇（E2）、疼痛评分和MOD。在第3、6和8天重新评估血细胞比容值（Ht%）、白细胞总数（TLC）、胃肠道（GI）表现和腹水分级。
两组的连续血清E2水平均显著下降，研究组水平显著更低。连续的MOD估计显示两组之间以及与第0天的估计相比无显著差异。在第2天，两组的疼痛评分与第0天相比均呈逐渐显著下降，研究组评分显著更低。在第3天，4名对照组患者仍有呕吐症状，到第6天，6名对照组患者仍有胃肠道表现，与研究组有显著差异。与第0天的估计相比，研究组在第3、6和8天的Ht%和TLC显著更低，但对照组仅在第8天显著更低。两组在第3天和第8天的腹水分级与各自第0天的分级相比均显著更低，有利于研究组的差异显著。6名患者需要住院治疗，但无死亡病例。研究组第3天的E2水平与临床及其他实验室数据和腹水分级呈显著正相关，而与MOD的相关性不显著。
对于接受GnHR激动剂诱导方案且有OHSS高风险的女性，在卵母细胞取出后进行胚胎移植冷冻并开始3天的西曲瑞克治疗可能是一种合适的管理策略。连续的血清E2水平比连续的MOD估计能更完美地预测结果。
试验注册（clinicaltrial.gov注册）NCT02823080（回顾性）初始发布日期2016年6月21日 最后发布日期2017年1月3日 唯一方案识别码：Benha U 二级识别码：kmsalama
