Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparing the Effects of Intravenous Infusion of Calcium or Hydroxyethyl Starch as Preventive Therapies of Ovarian Hyperstimulation Syndrome in High-Risk Women in Isfahan City, Iran, during the Years 2006-2017: A Clinical Trial Study

Document Type : Original Article (s)

Authors
Fatemeh Mostajeran 1
Hatav Ghasemi-Tehrani 2
Afshan Farshadmehr 3
1 Professor, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Resident, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.22122/jims.v36i494.10411
Abstract
Background: Some of studies suggest that hydroxyethyl starch (HES) and calcium Infusion may be beneficial for women with a high risk of developing ovarian hyperstimulation syndrome (OHSS). This study aimed to compare the effects of intravenous infusion of calcium or hydroxyethyl starch in preventing OHSS in high-risk women.Methods: This clinical trial study was carried out on 100 women considered at risk of developing OHSS were divided in two equal groups. The first group received 10 mg of 10% calcium gluconate in 100 mg normal saline within 2 hours, and the dose was repeated at the third day of oocyte retrieval. In the second group, in a time of oocyte retrieval, 500 cc hydroxyethyl starch was administered by infusion, and it was repeated at second and third days of oocyte removal. Finally, incidence and intensity of OHSS was measured and compared between the two groups.Findings: OHSS was found in 21 patients (42%) in each group; but intensity of OHSS in hydroxyethyl starch group was higher (P = 0.024). There was no sever OHSS in calcium group, whereas in hydroxyethyl starch group, 3 patients (14%) had sever form OHSS.Conclusion: Calcium or hydroxyethyl starch infusion strategies were both effective in preventing OHSS, but the intensity of OHSS in calcium infusion was lower. Therefore, probably calcium infusion is a better novel therapy that may be used effectively in prevention of OHSS.
Keywords
Calcium
Hydroxyethylated starches
Ovarian hyperstimulation syndrome
  1. Practice Committee of American Society for Reproductive Medicine. Ovarian hyperstimulation syndrome. Fertil Steril 2008; 90(5): S188-S193.
  2. Abbara A, Islam R, Clarke SA, Jeffers L, Christopoulos G, Comninos AN, et al. Clinical parameters of ovarian hyperstimulation syndrome following different hormonal triggers of oocyte maturation in IVF treatment. Clin Endocrinol (Oxf) 2018; 88(6): 920-7.
  3. Gebril A, Hamoda H, Mathur R. Outpatient management of severe ovarian hyperstimulation syndrome: a systematic review and a review of existing guidelines. Hum Fertil (Camb) 2018; 21(2): 98-105.
  4. Delvigne A, Rozenberg S. Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): A review. Hum Reprod Update 2002; 8(6): 559-77.
  5. Yakovenko SA, Sivozhelezov VS, Zorina IV, Dmitrieva NV, Apryshko VP, Voznesenskaya JV. Prevention of OHSS by intravenous calcium.Hum Reprod.2009;24(Suppl 1):i61.
  6. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81(1): 19-25.
  7. Hardarson T, Hanson C, Sjogren A, Lundin K. Human embryos with unevenly sized blastomeres have lower pregnancy and implantation rates: indications for aneuploidy and multinucleation. Hum Reprod 2001; 16(2): 313-8.
  8. Dinarello CA, Gelfand JA, Wolff SM. Anticytokine strategies in the treatment of the systemic inflammatory response syndrome. JAMA 1993; 269(14): 1829-35.
  9. McClure N, Healy DL, Rogers PA, Sullivan J, Beaton L, Haning RV, Jr., et al. Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome. Lancet 1994; 344(8917): 235-6.
  10. Abramov Y, Barak V, Nisman B, Schenker JG. Vascular endothelial growth factor plasma levels correlate to the clinical picture in severe ovarian hyperstimulation syndrome. Fertil Steril 1997; 67(2): 261-5.
  11. Friedlander MA, Loret de Mola JR, Goldfarb JM. Elevated levels of interleukin-6 in ascites and serum from women with ovarian hyperstimulation syndrome. Fertil Steril 1993; 60(5): 826-33.
  12. Revel A, Barak V, Lavy Y, Anteby E, Abramov Y, Schenker JJ, et al. Characterization of intraperitoneal cytokines and nitrites in women with severe ovarian hyperstimulation syndrome. Fertil Steril 1996; 66(1): 66-71.
  13. Krasnow JS, Berga SL, Guzick DS, Zeleznik AJ, Yeo KT. Vascular permeability factor and vascular endothelial growth factor in ovarian hyperstimulation syndrome: a preliminary report. Fertil Steril 1996; 65(3): 552-5.
  14. Loret de Mola JR, Flores JP, Baumgardner GP, Goldfarb JM, Gindlesperger V, Friedlander MA. Elevated interleukin-6 levels in the ovarian hyperstimulation syndrome: ovarian immunohistochemical localization of interleukin-6 signal. Obstet Gynecol 1996; 87(4): 581-7.
  15. Asch RH, Li HP, Balmaceda JP, Weckstein LN, Stone SC. Severe ovarian hyperstimulation syndrome in assisted reproductive technology: definition of high risk groups. Hum Reprod 1991; 6(10): 1395-9.
  16. Lewit N, Kol S, Manor D, Itskovitz-Eldor J. Comparison of gonadotrophin-releasing hormone analogues and human chorionic gonadotrophin for the induction of ovulation and prevention of ovarian hyperstimulation syndrome: a case-control study. Hum Reprod 1996; 11(7): 1399-402.
  17. Youssef MA, Al-Inany HG, Evers JL, Aboulghar M. Intra-venous fluids for the prevention of severe ovarian hyperstimulation syndrome. Cochrane Database Syst Rev 2011; (2): CD001302.
  18. Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008; 358(2): 125-39.
  19. Gurgan T, Demirol A, Guven S, Benkhalifa M, Girgin B, Li TC. Intravenous calcium infusion as a novel preventive therapy of ovarian hyperstimulation syndrome for patients with polycystic ovarian syndrome. Fertil Steril 2011; 96(1): 53-7.
  20. El-Khayat W, Elsadek M. Calcium infusion for the prevention of ovarian hyperstimulation syndrome: a double-blind randomized controlled trial. Fertil Steril 2015; 103(1): 101-5.
  21. Gokmen O, Ugur M, Ekin M, Keles G, Turan C, Oral H. Intravenous albumin versus hydroxyethyl starch for the prevention of ovarian hyperstimulation in an in-vitro fertilization programme: a prospective randomized placebo controlled study. Eur J Obstet Gynecol Reprod Biol 2001; 96(2): 187-92.
  22. Navot D, Relou A, Birkenfeld A, Rabinowitz R, Brzezinski A, Margalioth EJ. Risk factors and prognostic variables in the ovarian hyperstimulation syndrome. Am J Obstet Gynecol 1988; 159(1): 210-5.
  23. Lewis CG, Warnes GM, Wang XJ, Matthews CD. Failure of body mass index or body weight to influence markedly the response to ovarian hyperstimulation in normal cycling women. Fertil Steril 1990; 53(6): 1097-9.
  24. Enskog A, Henriksson M, Unander M, Nilsson L, Brannstrom M. Prospective study of the clinical and laboratory parameters of patients in whom ovarian hyperstimulation syndrome developed during controlled ovarian hyperstimulation for in vitro fertilization. Fertil Steril 1999; 71(5): 808-14.
Journal of Isfahan Medical School
Volume 36, Issue 494 - Serial Number 494
July and August 2018
Pages 1037-1043

  • Receive Date 08 July 2018
  • Accept Date 06 April 2022