2. PREVENTION OF SEVERE OHSS

3. 16 follicles 12 mature oocytes 14 oocytes Extras frozen if good 2 to 3 transferred 9 fertilize normally 5 divide normally 30-40% of couples 4 stop dividing & sperm Typical progression

4. OHSS is a serious complication of ovulation induction. In its severest forms, it is complicated by hemoconcentration, venous thrombosis, electrolyte imbalance and renal and hepatic failure. Shenker and Weinstein, 1978; Navot et al., 1992; Aboulghar et al., 1993

11. METFORMIN COCHRANE REVIEW, TSO ET AL., 2008

18. COCHRANE REVIEW, AL-INANY ET AL., 2011

19. GNRHAGONIST FOR TRIGGERRING OVULATION YOUSSEF ET AL., 2010

21. COCHRANE REVIEW, D’ANGELO E.AL. 2010 Coasting vs. no coasting

23. GnRH antagonist In a Cochrane review by Al-Inany et al (2011) comparing agonist and antagonist, significant difference in the incidence of OHSS was found.

24. WHY: (AL-INANY ET AL, 2010)

25. CANCELLATION FOR RISK OF OHSS

27. BUT NOT ALL DOCTORS WOULD GO FOR ANTAGONIST

31. OUR RESULTS Parameter Coasting (n = 96) Antagonist (n = 94) P-value Age (years) 30.0 ± 4.9 29.6 ± 4.6 NS Duration of infertility (years) 6.64 ± 4.45 7.07 ± 4.3 NS No. of HMG injections 30.52 ± 8.9 29.94 ± 8.8 NS Days of stimulation 1 9.1 ± 1.5 9.4 ± 1.5 NS Peak oestradiol (pg/ml) 5087 ± 1589 5305 ± 1680 NS Oestradiol on day of HCG (pg/ml) 2605 ± 790 2721 ± 699 NS Range of oestradiol on day of HCG (pg/ml) 1110–4136 1223–4093 NS Day of intervention 2.82 ± 0.97 1.74 ± 0.91 <0.0001 No. of oocytes 14.06 ± 5.20 16.5 ± 7.60 0.02 No. of MII oocytes 11.13 ± 4.60 13.14 ± 6.60 NS No. of fertilized oocytes 7.97 ± 3.80 9.14 ± 4.70 NS No. of high quality embryos 2.21 ± 1.10 2.87 ± 1.20 0.0001 No. of embryos transferred 2.83 ± 0.50 2.79 ± 0.40 NS No. of cryopreserved embryos 4.50 ± 3.93 5.77 ± 4.87 NS Clinical pregnancy (%) 46/96 (47.9) 52/94 (55.3) NS Multiple pregnancy (%) 15/46 (32.6) 17/52 (32.7) NS

35. RESULTS OF SEARCH 9/23 10 RCTs (n= 2048) 7 RCTs : HA vs. P 1 RCT : HES vs. P 2 RCTs :HA vs. HES vs. P No RCTs compared dextran or haemaccel vs placebo

36. IV FLUIDS VERSUS PLACEBO, SEVERE OHSS 18/23

37. AFTER OPU : DOPAMINE AGONIST : YOUSSEF ET AL., 2010

38. YOUSSEF ET AL., 2010

40. Conclusion OHSS is a preventable disease that should not be allowed to happen

42. THANK YOU Dr. Hesham Al-Inany MD, PhD e-mail : hesham@khosoba.com