Pregnancy after ovarian hyperstimulation syndrome 卵巢过度刺患者的妊娠结果

分类:医学文献 22 0

High pregnancy rates, ranging between 34% and 88%, have been reported in women with ovarian hyperstimulation syndrome (OHSS). In 1967, Rabau et al. were among the first to report a 42% pregnancy rate in patients with OHSS (1), which was confirmed subsequently by most authors who found higher pregnancy rates in in vitro fertilization (IVF) patients in whom OHSS developed compared to IVF patients that did not develop OHSS (2). The largest difference for pregnancy rates between OHSS patients and non-OHSS patients is 73% versus 14%. (3). The authors concluded that the severity of OHSS is related to the probability of conception and with a higher rate of multiple gestation pregnancy (MGP).


Mathur and Jenkins (4) debated whether OHSS was associated with a poor obstetric outcome and reviewed forty-one IVF pregnancies complicated by moderate or severe OHSS over a three-year period. They observed no difference in the miscarriage rates between the pregnant OHSS patients and the group of 501 contemporary clinical pregnant patients resulting from IVF procedures without OHSS. They suggest that the higher miscarriage rate other studies report might be attributed to a higher incidence of multiple gestation pregnancy or greater severity of OHSS.


The risk of miscarriage is apparently higher in patients with severe OHSS than in IVF patients without OHSS. Most authors have found miscarriage rates in women with OHSS ranging between 27% and 40% (5), with only a few authors finding no difference (6). These high miscarriage rates are thought to have been caused by the excessively high serum estradiol levels, high cytokine production, and excessive rennin-angiotensin activity, which are all characteristic of OHSS.


One of the largest studies on pregnancy outcome after OHSS is that of Abramov et al. (7), who reviewed all patients hospitalized between 1987 and 1996 in a multicenter study in Israel. Overall they found higher pregnancy rates, miscarriages, multiple gestation pregnancies, gestational diabetes, placental abruption, preterm birth and low birth weight in IVF patients with OHSS compared with IVF patients without OHSS. A high number (2902) of their patients were hospitalized for OHSS management and of these patients, 209 were severe or critical and 163 were IVF patients. Most were young (mean age: 29 years) and healthy women with a mean of 4.4 years of infertility duration. The clinical pregnancy rate was 73% including 42% singletons, 34% twins, 17% triplets, and 7% quadruplets. The pregnancy loss rate was 30%, of which 25% were early pregnancy losses and 4.8% were late miscarriages. Fetal reduction was performed in 25% of multiple gestation pregnancies in addition to the occurrence of spontaneous reduction or vanishing twins in 18%, with threatened miscarriage in 18%. Premature rupture of membranes occurred in 18% of patients compared with 5% occurrence in other IVF patients. Pregnancy-induced hypertension occurred in 13% of OHSS patients compared with 6% in the general IVF population, and gestational diabetes occurred in 6% versus 0.8%. The mean gestational age was 37 weeks for singletons, 35 for twins, and 34 for triplets. Preterm birth occurred in 28% of the singleton pregnancies, 50% of the twin pregnancies, and 100% of triplet pregnancies. The rate of Cesarean section delivery was 44%.




1. Rabau E, David A, Serr DM, Mashiach S, Lunenfeld B. Human menopausal gonadotrophins for anovulation and sterility. Results of 7 years of treatment. Am J Obstet Gynecol 1967; 98: 92-98.

2. Delvigne A, Demoulin A, Smitz J, et al. The ovarian hyperstimulation syndrome in in-vitro fertilization: a Belgian multicentric study. I. Clinical and biological features. Hum Reprod 1993; 8: 1353-1360.

3.Raziel A, Schacter M, Friedler S, Ron-El R. Outcome of IVF pregnancies following severe OHSS. Reprod Biomed Online 2009; 19: 61-65.

4. Mathur RS, Jenkins JM. Is ovarian hyperstimulation syndrome associated with a poor obstetric outcome? Brit J Obstet Gynaecol 2000; 107: 943-946.

5. Chen CD, Wu MY, Chao KH, et al.. Serum estradiol level and oocyte number in predicting severe ovarian hyperstimulation syndrome. J Formos Med Assoc 1997; 96: 829-834.

6. Mathur R, Akande A, Keay SD, Hunt LP, Jenkins JM. Distinction between early and late ovarian hyperstimulation syndrome. Fertil Steril 2000; 73: 901-907.

7. Abramov Y, Elchalal U, Schenker JG. Obstetric outcome of in-vitro fertilized pregnancies complicated by severe ovarian hyperstimulation syndrome: a multicenter study. Fertil Steril 1998; 70: 1070-1075.

3. The amount of payment in this agreement is 9999 in US dollar. 5000 of this fee is due and payable when this agreement is signed; the balance shall be due and payable on the day when fetal heartbeat is detected.

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