Staff Members - Benha University
Sequential E2 levels not ovarian maximal diameter estimates were correlated with outcome of cetrotide therapy for management of women at high-risk of ovarian hyperstimulation syndrome: a randomized controlled study
• 2017
Publication Information
Authors
Khalid M. Salama*
, Hesham M. Abo Ragab, Mohammed F. El Sherbiny, Ali A. Morsi and Ibrahim I. Souidan
Keywords
Not Available
Journal
Not Available
Publisher
Not Available
Volume
Not Available
Issue
Not Available
Pages
Not Available
publication.type
International
Paper Link
Not Available
Supplementary Materials
Not Available
Abstract
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
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