Efficacy and Pregnancy Rates of Administration of Prophylactic Albumin or Elective Cryopreservation of All Embryos for Prevention of Ovarian Hyperstimulation Syndrome in IVF-ET

Song, I O; Song, J H; Hong, S J; Yoo, K J; Baik, E C; Choi, B C; Koong, M K; Son, I P; Jun, J Y; Kang, I S; Park, I S

Abstract

Ovarian hyperstimulation syndrome (OHSS) is one of the well known complication of controlled ovarian hyperstimulation. Although there have been several protocols for prevention of OHSS, it has not been completely preventable until now. This study was performed to evaluate the efficacy of prophylactic administration of albumin on the day of oocyte retrieval or elective cryopreservation of all embryos for the prevention of OHSS in patients at high risk after ovarian stimulation for in vitro fertilization and to assess the impact of the two protocols of treatment on the pregnancy rates. We analyzed a total of 60 IVF-ET cycles in which the serum E2 concentration on the day of hCG administration was >4000 pg/ml and less than 15 oocytes were retrieved during the period of January 1995 to September 1997. The incidence of OHSS and pregnancy rates in 46 cycles in which fresh embryos transfer was done after prophylactic albumin (albumin group) were compared with 14 cycles in which embryo transfer was cancelled with cryopreservation of all embryos (cryopreservation group). Two to three months later, cryopreserved-thawed embryo transfer was done in artificially prepared cycle using estrogen and progesterone. There was no significant difference between the two groups in the mean age (31.1+/-0.6 vs 32.0+/-0.6, mean+/-SEM), total dosage of gonadotropin (21.1+/-1.3 vs 17.4+/-1.5 ampules), endometrial thickness on the day of hCG administration (10.5 +/-0.3 vs 11.4+/-0.5 mm), number of oocytes retrieved (24.9+/-0.9 vs 28.1+/-3.1), up number of fertilized oocytes (13.4+/-0.8 vs 14.8+/-1.1) and number of good embryos transfered (2.4+/-0.2 vs 2.6+/-0.5). However, mean serum E2 concentration on the day of hCG administration in the cryopreservation gro (8,507+/-747 pg/ml) was significantly higher (p<0.05) than albumin group (5,885+/-177 pg/ml). The average incidence of OHSS was similar in both groups (8.7% vs 14.3%; p>0.05). But, there was no severe OHSS (0/14) in cryopreservation group, whereas incidence of severe OHSS was 4.3% (2/46) in albumin group. The clinical pregnancy rate was significantly higher in cryopreservation group than in albumin group (64.3% vs 23.9%; p<0.05) These data suggest that administration of albumin may not reliably protect against the development of OHSS. However, withholding embryo transfer may reduce the incidence of severe OHSS even in cases with extremely high serum E2 level and yield significantly higher clinical pregnancy rate subsequent thawed embryo transfer cycle. Therefore, we suggest that cancellation of embryo transfer with cryopreservation of all embryos could be an effective alternative protocol to the administration of prophylactic albumin in patients at risk of developing severe OHSS.