PDF herunterladen
Semin Reprod Med 2012; 30(02): 077-083
DOI: 10.1055/s-0032-1307415
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Consequences of Superovulation and ART Procedures

Rachel Weinerman
1   Department of Obstetrics and Gynecology, NYU School of Medicine, New York
,
Jamie Grifo
2   NYU Fertility Center, New York, New York
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
27. April 2012 (online)

    Lizenzen und Reprints

Abstract

Superovulation procedures and assisted reproductive technologies (ART) have provided the means for significant improvement in infertility care. Although generally safe, these procedures are associated with complications that, albeit rare, can have significant morbidity. Complications from superovulation include ovarian hyperstimulation syndrome, thromboembolism, and adnexal torsion. Complications from oocyte retrieval include infection, bleeding, bowel injury, and anesthetic complications. Early pregnancy complications from in vitro fertilization include multiple gestations, ectopic pregnancy, and heterotopic pregnancy. Stimulation, retrieval, and transfer techniques can be modified to minimize these risks and prevent complications. Further research in the field is needed to continue to improve the safety of superovulation and ART.

Keywords

Superovulation - IVF - OHSS - ectopic pregnancy - complications
 

  • References

  • 1 Nygren KG, Sullivan E, Zegers-Hochschild F , et al. International Committee for Monitoring Assisted Reproductive Technology (ICMART) world report: assisted reproductive technology 2003. Fertil Steril 2011; 95 (7) 2209-2222 , 2222, e1–e17
    CrossrefPubMedGoogle Scholar
  • 2 Vloeberghs V, Peeraer K, Pexsters A, D'Hooghe T. Ovarian hyperstimulation syndrome and complications of ART. Best Pract Res Clin Obstet Gynaecol 2009; 23 (5) 691-709
    CrossrefPubMedGoogle Scholar
  • 3 Zivi E, Simon A, Laufer N. Ovarian hyperstimulation syndrome: definition, incidence, and classification. Semin Reprod Med 2010; 28 (6) 441-447
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 4 Golan A, Ron-el R, Herman A, Soffer Y, Weinraub Z, Caspi E. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv 1989; 44 (6) 430-440
    CrossrefPubMedGoogle Scholar
  • 5 Agents stimulating gonadal. Report of a WHO scientific group function in the human. World Health Organ Tech Rep Ser 1973; 514: 1-30
    PubMedGoogle Scholar
  • 6 Nastri CO, Ferriani RA, Rocha IA, Martins WP. Ovarian hyperstimulation syndrome: pathophysiology and prevention. J Assist Reprod Genet 2010; 27 (2–3) 121-128
    CrossrefPubMedGoogle Scholar
  • 7 Papanikolaou EG, Tournaye H, Verpoest W , et al. Early and late ovarian hyperstimulation syndrome: early pregnancy outcome and profile. Hum Reprod 2005; 20 (3) 636-641
    CrossrefPubMedGoogle Scholar
  • 8 Practice Committee of American Society for Reproductive Medicine. Ovarian hyperstimulation syndrome. Fertil Steril 2008; 90 (5, Suppl) S188-S193
    PubMedGoogle Scholar
  • 9 Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil Steril 1992; 58 (2) 249-261
    PubMedGoogle Scholar
  • 10 Neulen J, Yan Z, Raczek S , et al. Human chorionic gonadotropin-dependent expression of vascular endothelial growth factor/vascular permeability factor in human granulosa cells: importance in ovarian hyperstimulation syndrome. J Clin Endocrinol Metab 1995; 80 (6) 1967-1971
    CrossrefPubMedGoogle Scholar
  • 11 Griesinger G. Ovarian hyperstimulation syndrome prevention strategies: use of gonadotropin-releasing hormone antagonists. Semin Reprod Med 2010; 28 (6) 493-499
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 12 D'Angelo A, Brown J, Amso NN. Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev 2011; 6 (6) CD002811
    PubMedGoogle Scholar
  • 13 D'Angelo A, Amso N. Embryo freezing for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev 2007; 3 (3) CD002806
    PubMedGoogle Scholar
  • 14 Youssef MA, Al-Inany HG, Evers JL, Aboulghar M. Intra-venous fluids for the prevention of severe ovarian hyperstimulation syndrome. Cochrane Database Syst Rev 2011; 2 (2) CD001302
    PubMedGoogle Scholar
  • 15 Rosenwaks Z, Benadiva C. An eye to the future. Semin Reprod Med 2010; 28 (6) 540
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 16 Bodri D, Guillén JJ, Galindo A, Mataró D, Pujol A, Coll O. Triggering with human chorionic gonadotropin or a gonadotropin-releasing hormone agonist in gonadotropin-releasing hormone antagonist-treated oocyte donor cycles: findings of a large retrospective cohort study. Fertil Steril 2009; 91 (2) 365-371
    CrossrefPubMedGoogle Scholar
  • 17 Galindo A, Bodri D, Guillén JJ, Colodrón M, Vernaeve V, Coll O. Triggering with HCG or GnRH agonist in GnRH antagonist treated oocyte donation cycles: a randomised clinical trial. Gynecol Endocrinol 2009; 25 (1) 60-66
    CrossrefPubMedGoogle Scholar
  • 18 Engmann L, DiLuigi A, Schmidt D, Nulsen J, Maier D, Benadiva C. The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. Fertil Steril 2008; 89 (1) 84-91
    CrossrefPubMedGoogle Scholar
  • 19 Smitz JE, Thompson JG, Gilchrist RB. The promise of in vitro maturation in assisted reproduction and fertility preservation. Semin Reprod Med 2011; 29 (1) 24-37
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 20 Källén B. Maternal morbidity and mortality in in-vitro fertilization. Best Pract Res Clin Obstet Gynaecol 2008; 22 (3) 549-558
    CrossrefPubMedGoogle Scholar
  • 21 Aurousseau MH, Samama MM, Belhassen A, Herve F, Hugues JN. Risk of thromboembolism in relation to an in-vitro fertilization programme: three case reports. Hum Reprod 1995; 10 (1) 94-97
    CrossrefPubMedGoogle Scholar
  • 22 Braat DDM, Schutte JM, Bernardus RE, Mooij TM, van Leeuwen FE. Maternal death related to IVF in the Netherlands 1984–2008. Hum Reprod 2010; 25 (7) 1782-1786
    CrossrefPubMedGoogle Scholar
  • 23 Chan WS. The 'ART' of thrombosis: a review of arterial and venous thrombosis in assisted reproductive technology. Curr Opin Obstet Gynecol 2009; 21 (3) 207-218
    CrossrefPubMedGoogle Scholar
  • 24 Gelbaya TA. Short and long-term risks to women who conceive through in vitro fertilization. Hum Fertil (Camb) 2010; 13 (1) 19-27
    CrossrefPubMedGoogle Scholar
  • 25 Hurwitz A, Milwidsky A, Yagel S, Adoni A. Early unwinding of torsion of an ovarian cyst as result of hyperstimulation syndrome. Fertil Steril 1983; 40 (3) 393-394
    PubMedGoogle Scholar
  • 26 Gorkemli H, Camus M, Clasen K. Adnexal torsion after gonadotrophin ovulation induction for IVF or ICSI and its conservative treatment. Arch Gynecol Obstet 2002; 267 (1) 4-6
    CrossrefPubMedGoogle Scholar
  • 27 Roest J, Mous HV, Zeilmaker GH, Verhoeff A. The incidence of major clinical complications in a Dutch transport IVF programme. Hum Reprod Update 1996; 2 (4) 345-353
    CrossrefPubMedGoogle Scholar
  • 28 Schenker JG, Ezra Y. Complications of assisted reproductive techniques. Fertil Steril 1994; 61 (3) 411-422
    PubMedGoogle Scholar
  • 29 Aragona C, Mohamed MA, Espinola MS , et al. Clinical complications after transvaginal oocyte retrieval in 7,098 IVF cycles. Fertil Steril 2011; 95 (1) 293-294
    CrossrefPubMedGoogle Scholar
  • 30 Howe RS, Wheeler C, Mastroianni Jr L, Blasco L, Tureck R. Pelvic infection after transvaginal ultrasound-guided ovum retrieval. Fertil Steril 1988; 49 (4) 726-728
    PubMedGoogle Scholar
  • 31 Dicker D, Ashkenazi J, Feldberg D, Levy T, Dekel A, Ben-Rafael Z. Severe abdominal complications after transvaginal ultrasonographically guided retrieval of oocytes for in vitro fertilization and embryo transfer. Fertil Steril 1993; 59 (6) 1313-1315
    PubMedGoogle Scholar
  • 32 Klemetti R, Sevón T, Gissler M, Hemminki E. Complications of IVF and ovulation induction. Hum Reprod 2005; 20 (12) 3293-3300
    CrossrefPubMedGoogle Scholar
  • 33 Rísquez F, Confino E. Can Doppler ultrasound-guided oocyte retrieval improve IVF safety?. Reprod Biomed Online 2010; 21 (4) 444-445
    CrossrefPubMedGoogle Scholar
  • 34 Sequeira PM. Anesthesia for in vitro fertilization. Int Anesthesiol Clin 2003; 41 (2) 95-105
    CrossrefPubMedGoogle Scholar
  • 35 The ESHRE Capri Workshop Group. Multiple gestation pregnancy. Hum Reprod 2000; 15 (8) 1856-1864
    CrossrefPubMedGoogle Scholar
  • 36 Grifo JA, Flisser E, Adler A , et al. Programmatic implementation of blastocyst transfer in a university-based in vitro fertilization clinic: maximizing pregnancy rates and minimizing triplet rates. Fertil Steril 2007; 88 (2) 294-300
    CrossrefPubMedGoogle Scholar
  • 37 Scotland GS, McLernon D, Kurinczuk JJ , et al. Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon. BJOG 2011; 118 (9) 1073-1083
    CrossrefPubMedGoogle Scholar
  • 38 Wang YA, Kovacs G, Sullivan EA. Transfer of a selected single blastocyst optimizes the chance of a healthy term baby: a retrospective population based study in Australia 2004-2007. Hum Reprod 2010; 25 (8) 1996-2005
    CrossrefPubMedGoogle Scholar
  • 39 Guerif F, Frapsauce C, Chavez C, Cadoret V, Royere D. Treating women under 36 years old without top-quality embryos on day 2: a prospective study comparing double embryo transfer with single blastocyst transfer. Hum Reprod 2011; 26 (4) 775-781
    CrossrefPubMedGoogle Scholar
  • 40 Schoolcraft WB, Treff NR, Stevens JM, Ferry K, Katz-Jaffe M, Scott Jr RT. Live birth outcome with trophectoderm biopsy, blastocyst vitrification, and single-nucleotide polymorphism microarray-based comprehensive chromosome screening in infertile patients. Fertil Steril 2011; 96 (3) 638-640
    CrossrefPubMedGoogle Scholar
  • 41 Racowsky C, Ohno-Machado L, Kim J, Biggers JD. Is there an advantage in scoring early embryos on more than one day?. Hum Reprod 2009; 24 (9) 2104-2113
    CrossrefPubMedGoogle Scholar
  • 42 Chang HJ, Suh CS. Ectopic pregnancy after assisted reproductive technology: what are the risk factors?. Curr Opin Obstet Gynecol 2010; 22 (3) 202-207
    CrossrefPubMedGoogle Scholar
  • 43 Tal J, Haddad S, Gordon N, Timor-Tritsch I. Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993. Fertil Steril 1996; 66 (1) 1-12
    PubMedGoogle Scholar
  • 44 Knutzen V, Stratton CJ, Sher G, McNamee PI, Huang TT, Soto-Albors C. Mock embryo transfer in early luteal phase, the cycle before in vitro fertilization and embryo transfer: a descriptive study. Fertil Steril 1992; 57 (1) 156-162
    PubMedGoogle Scholar
  • 45 Azem F, Yaron Y, Botchan A , et al. Ectopic pregnancy after in vitro fertilization-embryo transfer (IVF-ET): the possible role of the ET technique. J Assist Reprod Genet 1993; 10 (4) 302-304
    CrossrefPubMedGoogle Scholar
  • 46 Pope CS, Cook EK, Arny M, Novak A, Grow DR. Influence of embryo transfer depth on in vitro fertilization and embryo transfer outcomes. Fertil Steril 2004; 81 (1) 51-58
    PubMedGoogle Scholar
  • 47 Nazari A, Askari HA, Check JH, O'Shaughnessy A. Embryo transfer technique as a cause of ectopic pregnancy in in vitro fertilization. Fertil Steril 1993; 60 (5) 919-921
    PubMedGoogle Scholar
  • 48 Flisser E, Grifo JA. Is what we clearly see really so obvious? Ultrasonography and transcervical embryo transfer—a review. Fertil Steril 2007; 87 (1) 1-5
    CrossrefPubMedGoogle Scholar
  • 49 Ali CR, Khashan AS, Horne G, Fitzgerald CT, Nardo LG. Implantation, clinical pregnancy and miscarriage rates after introduction of ultrasound-guided embryo transfer. Reprod Biomed Online 2008; 17 (1) 88-93
    CrossrefPubMedGoogle Scholar
  • 50 Flisser E, Grifo JA, Krey LC, Noyes N. Transabdominal ultrasound-assisted embryo transfer and pregnancy outcome. Fertil Steril 2006; 85 (2) 353-357
    CrossrefPubMedGoogle Scholar
  • 51 Weinerman R, Mullin C. Use of ultrasound-guided embryo transfer reduces rates of extra-uterine pregnancies. Poster presented at: American Society for Reproductive Medicine Annual Meeting; October 19, 2011; Orlando, FL
    PubMedGoogle Scholar
  • 52 Keegan DA, Morelli SS, Noyes N, Flisser ED, Berkeley AS, Grifo JA. Low ectopic pregnancy rates after in vitro fertilization: do practice habits matter?. Fertil Steril 2007; 88 (3) 734-736
    CrossrefPubMedGoogle Scholar
  • 53 Milki AA, Jun SH. Ectopic pregnancy rates with day 3 versus day 5 embryo transfer: a retrospective analysis. BMC Pregnancy Childbirth 2003; 3 (1) 7-10
    CrossrefPubMedGoogle Scholar
  • 54 Rosman ER, Keegan DA, Krey L, Liu M, Licciardi F, Grifo JA. Ectopic pregnancy rates after in vitro fertilization: a look at the donor egg population. Fertil Steril 2009; 92 (5) 1791-1793
    CrossrefPubMedGoogle Scholar
  • 55 Donadio NF, Donadio N, Martins PT, Cambiaghi Cde G. Heterotopic gestation: diagnostic possibility after in vitro fertilization. A case report [in Portuguese]. Rev Bras Ginecol Obstet 2008; 30 (9) 466-469
    PubMedGoogle Scholar
  • 56 Maruotti GM, Sarno L, Morlando M, Sirico A, Martinelli P, Russo T. Heterotopic pregnancy: it is really a rare event? The importance to exclude it not only after in vitro fertilization but also in case of spontaneous conception. Fertil Steril 2010; 94 (3) e49 ; author reply e50
    CrossrefPubMedGoogle Scholar