Ovarian hyperstimulation syndrome: an analysis of patient characteristics in the Asian population

Rajesh H, Lee WY, Fook-Chong S, Yu SL
Correspondence: Dr Hemashree Rajesh, hemashreerajesh@yahoo.com

ABSTRACT
Introduction We aimed to identify the variables associated with ovarian hyperstimulation in Asian patients and compare them with western standards.
Methods This is a retrospective case record analysis of 79 patients with ovarian hyperstimulation at a tertiary restructured hospital.
Results Gonadotropin doses resulting in hyperstimulation did not vary between long and antagonist cycles in women less than 35 years with polycystic ovaries (PCO). Mean oestradiol levels at hyperstimulation were not different between PCO and non-PCO patients in a long cycle. Hyperstimulation was mostly due to higher starting doses. Total follicle counts of more than 20 on Day 5–7 after stimulation may be predictive of subsequent hyperstimulation. Hyperstimulation tended to be more severe in lean PCO patients, and prophylactic albumin helped to reduce its severity.
Conclusion Gonadotropin doses at stimulation should start at 150 iu or less in women below 35 years of age, with a step up of 37.5 iu, as necessary. Transfer should be abandoned in the presence of high oestradiol levels (more than 5,000 pg/ml), when the total number of intermediate and large follicle count exceeds 30 on the day of oocyte retrieval, or when more than 19 eggs are retrieved.Variables in the Asian population appear to be similar to those in the western population.

Keywords: oestradiol level, follicle count, gonadotropin dose, in vitro fertilisation, ovarian hyperstimulation syndrome
Singapore Med J 2011; 52(3): 168-174