Incidences and risk factors of moderate-to-severe ovarian hyperstimulation syndrome and severe hemoperitoneum in 1,435,108 oocyte retrievals

Keiji Kuroda; Saki Nagai; Yuko Ikemoto; Yuko Matsumura; Asako Ochiai; Shuko Nojiri; Atsuo Itakura; Rikikazu Sugiyama

doi:10.1016/j.rbmo.2020.09.001

Incidences and risk factors of moderate-to-severe ovarian hyperstimulation syndrome and severe hemoperitoneum in 1,435,108 oocyte retrievals

Reprod Biomed Online. 2021 Jan;42(1):125-132. doi: 10.1016/j.rbmo.2020.09.001. Epub 2020 Sep 3.

Authors

Keiji Kuroda¹, Saki Nagai², Yuko Ikemoto², Yuko Matsumura², Asako Ochiai², Shuko Nojiri³, Atsuo Itakura², Rikikazu Sugiyama⁴

Affiliations

¹ Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan; Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan. Electronic address: kuroda@sugiyama.or.jp.
² Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan.
³ Medical Technology Innovation Center, Juntendo University, Tokyo 113-8421, Japan; Clinical Research and Trial Center, Juntendo University Hospital, Tokyo 113-8421, Japan.
⁴ Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan.

PMID: 33051135
DOI: 10.1016/j.rbmo.2020.09.001

Abstract

Research question: What are the risk factors affecting the incidences of moderate-to-severe ovarian hyperstimulation syndrome (OHSS) and severe hemoperitoneum in assisted reproductive technology (ART) treatment cycles?

Design: A retrospective cohort study was conducted on 1,435,108 oocyte retrieval cycles among Japanese ART registry data between 2007 and 2015. The study included 11,378 cycles with moderate-to-severe OHSS, 1182 cycles with severe hemoperitoneum, including 27 cycles with both conditions, and 1,422,575 cycles without moderate-to-severe OHSS and severe hemoperitoneum.

Results: The incidences of moderate-to-severe OHSS and severe hemoperitoneum were 0.79% and 0.08%, respectively, and decreased by 0.57-fold and 0.29-fold from 2007 to 2015, respectively. In cycles with OHSS and cycles with hemoperitoneum women were younger (odds ratios [OR] 0.91 and 0.95, respectively) and had more retrieved oocytes (OR 1.09 and 1.01, respectively) compared with cycles without both complications. The use of a gonadotrophin-releasing hormone (GnRH) agonist protocol for ovarian stimulation was the highest risk factor in cycles with OHSS and hemoperitoneum (OR 1.83 and 1.24, respectively), followed by GnRH antagonist protocol (reference), gonadotrophin with or without oral medicine (OR 0.45 and 0.56, respectively) and natural or oral medicine (OR 0.02 and 0.19, respectively). In fresh embryo transfer, clinical pregnancy was associated with an increased risk of OHSS and hemoperitoneum (OR 1.19 and 2.34, respectively).

Conclusions: The highest risk factors affecting OHSS and hemoperitoneum were the use of a GnRH agonist protocol and clinical pregnancy following fresh embryo transfer. The incidences of OHSS and hemoperitoneum have decreased yearly with a reduction of GnRH agonist use and fresh embryo transfer.

Keywords: Assisted reproductive technology; Complication; Hemoperitoneum; Ovarian hyperstimulation syndrome; Ovarian stimulation; Risk factor.

MeSH terms

Adult
Female
Hemoperitoneum / epidemiology*
Hemoperitoneum / etiology
Humans
Incidence
Japan / epidemiology
Oocyte Retrieval / adverse effects*
Oocyte Retrieval / statistics & numerical data
Ovarian Hyperstimulation Syndrome / epidemiology*
Ovarian Hyperstimulation Syndrome / etiology
Ovulation Induction / adverse effects*
Ovulation Induction / statistics & numerical data
Retrospective Studies
Risk Factors