Unit of Gynecology, Sant'Andrea Hospital, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy.
School of Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
Int J Mol Sci. 2023 Sep 16;24(18):14185. doi: 10.3390/ijms241814185.
Ovarian hyperstimulation syndrome (OHSS) is the main severe complication of ovarian stimulation for in vitro fertilization (IVF) cycles. The aim of the current study was to identify the interventions for the prevention of and reduction in the incidence and severity of OHSS in patients who undergo IVF not included in systematic reviews with meta-analyses of randomized controlled trials (RCTs) and assess and grade their efficacy and evidence base. The best available evidence for each specific intervention was identified, analyzed in terms of safety/efficacy ratio and risk of bias, and graded using the Oxford Centre for Evidence-Based Medicine (CEBM) hierarchy of evidence. A total of 15 interventions to prevent OHSS were included in the final analysis. In the IVF population not at a high risk for OHSS, follitropin delta for ovarian stimulation may reduce the incidence of early OHSS and/or preventive interventions for early OHSS. In high-risk patients, inositol pretreatment, ovulation triggering with low doses of urinary hCG, and the luteal phase administration of a GnRH antagonist may reduce OHSS risk. In conclusion, even if not supported by systematic reviews with homogeneity of the RCTs, several treatments/strategies to reduce the incidence and severity of OHSS have been shown to be promising.
卵巢过度刺激综合征(OHSS)是体外受精(IVF)周期中卵巢刺激的主要严重并发症。本研究旨在确定预防和减少未纳入系统评价的 IVF 患者 OHSS 发生率和严重程度的干预措施,这些系统评价是对随机对照试验(RCT)的荟萃分析,并评估和分级其疗效和证据基础。为每个特定干预措施确定了最佳可用证据,根据安全性/疗效比和偏倚风险进行分析,并使用牛津循证医学中心(CEBM)证据等级进行分级。共有 15 种预防 OHSS 的干预措施被纳入最终分析。在 IVF 人群中,对于 OHSS 风险较低的人群,促卵泡激素 delta 用于卵巢刺激可能会降低早期 OHSS 的发生率和/或早期 OHSS 的预防干预措施。对于高风险患者,预处理肌醇、低剂量尿 hCG 触发排卵和 GnRH 拮抗剂黄体期给药可能会降低 OHSS 风险。总之,尽管没有得到 RCT 同质性的系统评价支持,但已经显示出几种降低 OHSS 发生率和严重程度的治疗/策略具有很大的潜力。