Assisted Reproduction is constantly evolving, both in terms of safety and effectiveness. The progress made is related to the development of technology and the accumulation of knowledge and experience.

An example is Ovarian Hyperstimulation Syndrome during IVF. Not many years ago, the Syndrome was quite a common complication, with an incidence of about 5% of all Extracorporeal cycles. Its severe form was manifested in approximately 1% of women undergoing ovarian stimulation.
Today, thanks to the new protocols and strategies followed, the possibility of the occurrence of the severe form of the Syndrome, which is the one we are concerned about, has been eliminated.

What is ovarian hyperstimulation syndrome and when does it occur?

The exact cause of the Syndrome is not known. However, the triggering factor for its appearance is the last injection that takes place before egg retrieval. It is β-hCG, administered with Pregnyl or Ovitrelle formulations.

If the Syndrome occurs, the ovaries swell and fluid may leak into the abdomen or elsewhere. Common symptoms are abdominal bloating and pain, tendency to vomit, weight gain and in the most severe form of the syndrome, difficulty breathing and urinating and the appearance of blood clots. In particularly severe cases, the patient needs hospitalization for monitoring and treatment.

Predisposing factors for the manifestation of ovarian hyperstimulation syndrome

Those women who suffer from Polycystic Ovary Syndrome and/or have previously manifested Ovarian Hyperstimulation Syndrome are at greater risk. Also, women who during ovarian stimulation produce many follicles and show high levels of estradiol have an increased chance of developing the Syndrome.

With what strategy can the risk of ovarian hyperstimulation be reduced to zero?

In recent years, significant progress has been made in preventing the Syndrome. With the application of an alternative approach, which has to do with the use of a different protocol (antagonist protocol – GnRH antagonist), the chances of Polycystic Ovary Syndrome occurring are virtually zero.

The Assisted Reproduction Specialist has the responsibility to diagnose which women are at increased risk – among other things, by measuring estradiol, which in combination with other tests is a reliable predictor – in order to start the process with the antagonist protocol.

This approach gives the doctor the possibility to decide at the time of the injection for the final maturation of the follicles whether to proceed with β-hCG (Pregnyl or Ovitrelle) or with the preparation Arvekap 0.2 mg which eliminates the chances of the occurrence of the Syndrome. As the choice of Arvekap reduces the receptivity of the endometrium, it is combined with freezing all embryos (freeze all) and carrying out the embryo transfer the following month. It is important to point out that with modern methods of cryopreservation (vitrification), freezing does not degrade the quality of the embryos at all.

With the effective consideration of the risk factors, the correct diagnosis and the implementation of the appropriate strategy, it is not an exaggeration to say that Ovarian Hyperstimulation Syndrome should now be a historical and only reference.