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Genetic predictors of ovarian hyperstimulation syndrome in women undergoing in vitro fertilization

Nature Clinical Practice Endocrinology & Metabolism volume 2, pages 590–591 (2006)Cite this article

The controlled ovarian hyperstimulation used before in vitro fertilization (IVF) endeavors to induce the development of multiple dominant follicles in order to produce several oocytes and increase the pregnancy rate. Exogenous gonadotropins are commonly used in hyperstimulation protocols; however, large interindividual variability in the ovarian response to follicle-stimulating hormone (FSH) is observed, which ranges from extremely low to excessive. Factors including patient age, early follicular phase FSH levels, number of antral follicles, ovarian volume, and the presence of polycystic ovaries can be helpful when selecting the optimal starting dose of FSH, which, in turn, can determine the final outcome. Unfortunately, no test can fully predict the ovarian response to stimulation, and treatment is usually determined empirically or adjusted after previous attempts.

Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of ovarian stimulation treatments observed in patients with an excessive response to FSH. Severe forms of OHSS occur in ∼1% of IVF cycles, and are characterized by massive ovarian enlargement, with multiple cysts that result in the formation of ascites, pleural and/or pericardial effusion, hypovolemia, hemoconcentration, and hydroelectrolytic disorders. Life-threatening complications of OHSS include renal failure, adult respiratory distress syndrome, and thromboembolic phenomena.1 Human chorionic gonadotropin (hCG) has a crucial role in the development of OHSS as severe forms of OHSS are seen only in cycles in which exogenous hCG (administered to induce ovulation or as a luteal phase support) or pregnancy-derived hCG is present. Risk factors, such as the presence of polycystic ovaries, have been identified in the development of iatrogenic OHSS, but the syndrome is far from being predictable, especially in the pregnancy-associated forms.1 Nearly all cases of OHSS arise as a complication of therapies to induce ovulation; however, rarely, spontaneous forms of the syndrome have been reported, mostly during pregnancy.2

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Acknowledgements

Supported by the Interuniversity Attraction Poles of the Belgian Federal Office for Scientific, Technical and Cultural Affairs, and grants from the Fonds pour la Recherche Scientifique Médicale, the Fonds National de la Recherche Scientifique and Fondation Erasme.

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Authors and Affiliations

  1. Fertility Clinic, Erasme Hospital, and Assistant Researcher in the Laboratory of Research on Human Reproduction, Free University Brussels,

    Anne Delbaere, Gilbert Vassart & Sabine Costagliola

  2. Institut de Recherche Interdisciplinaire, Free University Brussels,

    Anne Delbaere, Gilbert Vassart & Sabine Costagliola

  3. Fonds National de la Recherche Scientifique, the Institut de Recherche Interdisciplinaire, Brussels, Belgium

    Anne Delbaere, Gilbert Vassart & Sabine Costagliola

  4. a Postdoctoral Fellow at the Babraham Institute, Cambridge, UK

    Guillaume Smits

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  1. Anne Delbaere
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  2. Guillaume Smits
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  4. Sabine Costagliola
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Correspondence to Gilbert Vassart.

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Delbaere, A., Smits, G., Vassart, G. et al. Genetic predictors of ovarian hyperstimulation syndrome in women undergoing in vitro fertilization. Nat Rev Endocrinol 2, 590–591 (2006). https://doi.org/10.1038/ncpendmet0319

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