Ismail, Maryama

Abstract Objective To assess the relationship between ovarian hyperstimulation syndrome (OHSS) and adverse outcomes using population-based data in the United States. The hypothesis is that patients with OHSS were more likely to deliver preterm and more likely to have hypertensive disorders. Methods This retrospective cohort study identified 94 patients with OHSS and 183 matched referents in eight counties in Minnesota. Data were collected regarding pregnancy history, infertility treatment, and pregnancy outcomes. Using the Rochester Epidemiology Project, study subjects were identified from female patients, aged 18 to 49 years, who were diagnosed with infertility from January 2, 1995 to December 1, 2017, and had a pregnancy greater than 20 weeks' gestation. The primary outcome was preterm delivery or hypertensive disorder of pregnancy incidence in the OHSS group when compared with control patients. Chi-squared test, t test, and multivariate logistic models were used where appropriate. Results Patients with OHSS were more likely to deliver preterm (odds ratio, 2.14; 95% confidence interval, 1.26–3.65; P < 0.01), and their neonates were more likely to be small for gestational age (odds ratio, 4.78; 95% confidence interval, 1.61–14.19; P < 0.01). No significant differences between the groups were observed in any other outcome. Patients with OHSS are more likely to deliver preterm if they undergo fresh transfer compared with a freeze all and subsequent frozen transfer (odds ratio, 3.03, 95% confidence interval, 1.20–7.66, P = 0.02). Conclusion OHSS may lead to preterm birth and small-for-gestational-age neonates, which changes patient counseling and leads to arranging specialized obstetrical care for these patients with OHSS.

INTRODUCTION: The incidence of ovarian hyperstimulation syndrome (OHSS) after assisted reproduction is approximately 3%. The outcomes of pregnancy in immediate versus delayed pregnancy has not been previously studied. METHODS: A retrospective cohort study was conducted using the Rochester Epidemiology Project Database. Residents of Olmsted County and the surrounding 9 counties with OHSS were identified between 1995 and 2017. Patients were included if they had a pregnancy lasting ≥20 weeks gestation after the diagnosis of OHSS. Background data and pregnancy outcomes were collected. Data were then analyzed using a combination of t-test and Chi squared test. Women with OHSS and same cycle pregnancy were compared to those with subsequent cycle pregnancy. RESULTS: 85 women with OHSS were analyzed, 47 with same-cycle pregnancies and 38 with subsequent cycle pregnancies. Background data did not differ between the two groups for infertility cause, body mass index, gestational age, parity, or number of embryos transferred. OHSS treatment modalities (paracentesis, thoracentesis, hospitalization and medical treatment) did not differ between groups. Patients with same-cycle pregnancies had neonates delivered at 35.6 weeks compared to 38.3 weeks with delayed pregnancies (p=0.0006). Patients with same cycle pregnancies also had lower birth weights compared to patients with delayed pregnancies (3201 g v 2628 g, p=0.003). Incidence of hypertensive disorders, diabetes, placental abruption, thromboembolism, intrauterine fetal death, intrauterine growth restriction, and 1 and 5 minute Apgar scores did not differ between the two groups. CONCLUSION: The data gives new insight into the risk of same-cycle pregnancies in patients with OHSS. Larger studies are needed to confirm the data.