Background: Ovarian hyperstimulation syndrome (OHSS) is an important condition with considerable morbidity and a
small risk of mortality and most commonly results as an iatrogenic condition following follicular stimulation of the ovaries.
We aimed to evaluate safety and efficacy of 3-day cetrotide therapy started on day of oocyte retrieval (Day-0) in women
at high-risk for development of ovarian hyperstimulation syndrome (OHSS) after GnRH agonist induction protocol.
Methods: Forty-eight women fulfilling inclusion criteria underwent ultrasound scanning for maximal ovarian diameter
(MOD) estimation and ascites grading. Patients underwent embryo freezing, but the study group received 3-day Cetrotide
sc injection (0.25 mg/day) started on Day-0. Serum E2, pain scores and MOD were checked daily. Hematocrite value (Ht%),
total leucocytic count (TLC), gastrointestinal (GI) manifestations and ascites grading were re-evaluated on Day-3, 6 and 8.
Results: Sequential serum E2 levels decreased significantly in both groups with significantly lower levels in the study
group. Sequential MOD estimates showed non-significant difference between the two groups and versus Day-0
estimates. On Day-2, pain scores showed progressive significant decrease compared to Day-0 scores in both groups with
significantly lower scores in the study group. On Day-3; four control patients still had vomiting and by Day-6, 6 of the
control patients still had GI manifestations with significant difference versus the study group. Compared to Day-0
estimates, Ht% and TLC were significantly lower on Day-3, 6 and 8 in the study group, but only on Day-8 in the control
group. Day-3 and Day-8 ascites grading in both groups was significantly lower compared to respective Day-0 grading
with significant difference in favor of the study group. Six patients required hospitalization, but without mortalities. Day-3
E2 levels in the study group showed positive significant correlation with clinical and other laboratory data and ascites
grading, while the correlation was non-significant with MOD.
Conclusion: The 3-day cetrotide therapy starting after oocyte retrieval with embryo transfer freezing could be an
appropriate management policy for women received GnHR-agonist induction protocol and were at high-risk for OHSS.
Sequential E2 serum levels could predict outcome more perfectly than sequential MOD estimates.
Trial registration: Trial registration (clinicaltrial.gov registration) NCT02823080 (retrospective) Initial Release 21–6-2016 Last
Release 3–1-2017 Unique Protocol ID: Benha U Secondary IDs: kmsalama.
Keywords: Ovarian hyper stimulation syndrome, Cetrotide therapy, Embryo freezing |
