The Methods Used to Avoid Ovarian Hyperstimulation Syndrome Do Not Negatively Effect Pregnancy Success Rates Following In vitro Fertilization in Young Women with High Anti-Mullerian Hormone Levels

Author(s): Brooke Neumann, Jerome H Check, Michael Sobel, Carrie Wilson, Donna Summers

Objective:

To determine if two methods to avoid the ovarian hyperstimulation syndrome (OHSS) in young women undergoing in-vitro fertilization embryo transfer with high serum antimullerian hormone (AMH) levels, namely deferring fresh embryo transfer (ET) in favor of subsequent frozen ET (FET) and substituting leuprolide acetate for human chorionic gonadotropin (hCG) to advance meiosis, negatively affects pregnancy outcome.

Material and Method:

Retrospective comparison of frequency of using these two techniques to avoid OHSS in women aged <35 for women with normal ovarian reserve (serum AMH 1 to <5 ng/ml) and high-responders defined as those likely to stimulate a high number of dominant follicles (20 or more) or attaining serum estradiol (E2) levels on day of trigger shot of >4000 pg/ ml based on serum AMH >5 ng/ml. Live delivered pregnancy rates (LDPRs) were determined according to the pregnancy rate per transfer and per given oocyte harvest (i.e. counting subsequent FET cycles if the first transfer did not work as long as they did not go through another oocyte retrieval). Only one live delivery per patient was included.

Results:

For the majority of women, there was no adverse effect on LDPR in the high AMH group when choosing leuprolide acetate to advance meiosis vs hCG. Only a minority of women used leuprolide in the normal oocyte reserve group which did not negatively affect pregnancy outcomes either. Deferring fresh ET was more common in the high AMH group than the normal group, but it had no negative impact on pregnancy outcome.

Conclusion:

Since there were not any patients that developed severe OHSS requiring hospitalization, physicians should not be afraid to use GNRHa vs hCG in controlled ovarian hyperstimulation (COH) as it not only helps to avoid severe OHSS, but also has no negative impact on pregnancy rates in patients undergoing IVF.