Preprint Review Version 2 Preserved in Portico This version is not peer-reviewed

Beyond the Umbrella: A Systematic Review of the Interventions for Prevention of and Reduction in the Incidence and Severity of Ovarian Hyperstimulation Syndrome in Patients Who Undergo In Vitro Fertilization Treatments

Stefano Palomba
* ORCID logo ,
Flavia Costanzi
,
Scott M. Nelson
,
Aris Besharat
,
Donatella Caserta
,
Peter Humaidan
Version 1 : Received: 4 August 2023 / Approved: 4 August 2023 / Online: 4 August 2023 (11:19:48 CEST)
Version 2 : Received: 11 August 2023 / Approved: 11 August 2023 / Online: 11 August 2023 (11:11:59 CEST)

A peer-reviewed article of this Preprint also exists.

Palomba, S.; Costanzi, F.; Nelson, S.M.; Besharat, A.; Caserta, D.; Humaidan, P. Beyond the Umbrella: A Systematic Review of the Interventions for the Prevention of and Reduction in the Incidence and Severity of Ovarian Hyperstimulation Syndrome in Patients Who Undergo In Vitro Fertilization Treatments. Int. J. Mol. Sci. 2023, 24, 14185. Palomba, S.; Costanzi, F.; Nelson, S.M.; Besharat, A.; Caserta, D.; Humaidan, P. Beyond the Umbrella: A Systematic Review of the Interventions for the Prevention of and Reduction in the Incidence and Severity of Ovarian Hyperstimulation Syndrome in Patients Who Undergo In Vitro Fertilization Treatments. Int. J. Mol. Sci. 2023, 24, 14185.

Abstract

Ovarian hyperstimulation syndrome (OHSS) is the main severe complication of the ovarian stimulation for in vitro fertilization (IVF) cycles. The aim of the current study was to identify the interventions for prevention of and reduction in the incidence and severity of OHSS in patients who undergo IVF not included in systematic reviews with meta-analysis of randomized controlled trials (RCTs), assess and grade their efficacy and evidence base. The best available evidence for each specific intervention was identify, analyzed in terms of safety/efficacy ratio and of risk of bias, and graded using Oxford Centre for Evidence-Based Medicine (CEBM) hierarchy of evidence. A total of 15 interventions to prevent OHSS were included in the final analysis. In IVF population not at high risk for OHSS, follitropin delta for ovarian stimulation may reduce the incidence of early OHSS and/or preventive interventions for early OHSS. In high-risk patients, inositol pretreatment, ovulation triggering with low doses of urinary hCG, and the luteal phase administration of GnRH antagonist may reduce the OHSS risk. In conclusion, even if not supported by systematic reviews with homogeneity of the RCTs, several treatments/strategies to reduce the incidence and severity of OHSS have shown to be promising.

Keywords

assisted reproductive technologies; ART; complications; in vitro fertilization; ovarian hyperstimulation syndrome; OHSS; systematic review

Subject

Medicine and Pharmacology, Reproductive Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Comments (1)

Comment 1
Received: 11 August 2023
Commenter: Stefano Palomba
Commenter's Conflict of Interests: Author
Comment: The new version includes a section on vitamin D supplementation
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