@2024 Afarand., IRAN
ISSN: 2251-8215 Sarem Journal of Reproductive Medicine 2017;1(4):145-152
ISSN: 2251-8215 Sarem Journal of Reproductive Medicine 2017;1(4):145-152
The Efficacy of Mannitol Therapy in the Management of Moderate and Severe Forms of Ovarian Hyperstimulation Syndrome: A New Application
ARTICLE INFO
Article Type
Original ResearchAuthors
Saremi A.T. (*)Namdar Khanzadeh M. (1)
Shami M. (2)
Mohammad Aliha F. (2)
Pooladi A. (1)
(*) Sarem Fertility & Infertility Research Center (SAFIR) and Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran
(1) “Sarem Fertility & Infertility Research Center (SAFIR)” and “Sarem Cell Research Center (SCRC)” , Sarem Women’s Hospital, Tehran, Iran
(2) Sarem Fertility & Infertility Research Center (SAFIR), Sarem Women’s Hospital, Tehran, Iran
Correspondence
Article History
Received: April 3, 2016Accepted: October 20, 2016
ePublished: November 15, 2017
ABSTRACT
Aims
Ovarian hyperstimulation syndrome (OHSS) is an important complication of assisted reproductive technique (ART) following ovulation stimulation. Based on the disease pathophysiology and the mechanisms of drug effectiveness, mannitol was selected as an alternative for albumin. The objective of this study was to evaluate the efficacy of mannitol therapy in the management of moderate and severe forms of OHSS.
Materials & Methods This interventional non-experimental study was conducted on patients with moderate and severe OHSS over a period of 19 years (1994-2013). A total of 6970 women entered the ovarian stimulation protocol for IVF. All patients at risk for OHSS received a preventive dose of mannitol. If the patients developed signs of moderate/severe OHSS, they included in the study. Mannitol therapy was started daily or twice a day using doses ranged between 1 to 1.5 g/kg/dose. Patients were monitored according to the standard protocols. Data were analyzed by SPSS 19 software.
Findings OHSS developed in 1737 (24.92%) women. Mild OHSS was found in 1360 (78.30%), moderate in 338 (19.46%), and severe in 39 (2.24%) patients. A significant weight loss (p=0.024) was found after mannitol therapy. The correction of mean intake/output (I/O) balance of fluids (p=0.009) showed significant difference before and after mannitol therapy. Mean duration of hospitalization was 4.72±2.24 days, and the mortality rate was 0.0%.
Conclusion Mannitol therapy is an effective protocol in the management of moderate and severe forms of OHSS.
Materials & Methods This interventional non-experimental study was conducted on patients with moderate and severe OHSS over a period of 19 years (1994-2013). A total of 6970 women entered the ovarian stimulation protocol for IVF. All patients at risk for OHSS received a preventive dose of mannitol. If the patients developed signs of moderate/severe OHSS, they included in the study. Mannitol therapy was started daily or twice a day using doses ranged between 1 to 1.5 g/kg/dose. Patients were monitored according to the standard protocols. Data were analyzed by SPSS 19 software.
Findings OHSS developed in 1737 (24.92%) women. Mild OHSS was found in 1360 (78.30%), moderate in 338 (19.46%), and severe in 39 (2.24%) patients. A significant weight loss (p=0.024) was found after mannitol therapy. The correction of mean intake/output (I/O) balance of fluids (p=0.009) showed significant difference before and after mannitol therapy. Mean duration of hospitalization was 4.72±2.24 days, and the mortality rate was 0.0%.
Conclusion Mannitol therapy is an effective protocol in the management of moderate and severe forms of OHSS.
CITATION LINKS
[1]Aboulghar M. Symposium: Update on prediction and management of OHSS. Reprod Biomed Online. 2009;19(1):33-42.
[2]Tang H, Hunter T, Hu Y, Zhai SD, Sheng X, Hart RJ. Cabergoline for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2012;(2):CD008605.
[3]Prakash A, Mathur R. Ovarian Hyperstimulation Syndrom. Obstet Gynecol. 2013;15:31-5.
[4]Matorras R, Andres M, Mendoza R, Prieto B, Pijoan JI, Exposito A. Prevention of ovarian hyperstimulation syndrome in GnRH agonist IVF cycles in moderate risk patients: Randomized study comparing hydroxyethyl starch versus cabergoline and hydroxyethyl starch. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):439-43.
[5]Aboulghar MA, Mansour RT, Serour GI, et al. Ovarian Hyperstimulation syndrome: Modern consepts in pathophysiology and management. Middle East Fertil Soc J. 1996;1:3-16.
[6]Schrenker J, Weinsten D. Ovarian Hyperstimulation syndrome: A current survey. Fertil Steril. 1978;30(3):255-68.
[7]Tollan A, Holst N, Forsdahl F, Fadnes HO, Oian P, Maltau JM. Transcapillary fluid dynamics during overian stimulationfor in vitro fertilization. Am J Obstet Gynecol. 1990;162(2):554-8.
[8]Rizk B, Aboulghar M, Smitz J, Ron-El R. The role of vascular endothelial growth factor and interleukins in the pathogenesis of severe ovarian hyperstimulation syndrome. Hum Reprod Update. 1997;3(3):255-66.
[9]Levin ER, Rosen GF, Cassidenti DL, Yee B, Meldrum D, Wisot A, et al. Role of vascular endothelial cell growth factor in Ovarian Hyperstimulation Syndrome. J Clin Invest. 1998;102(11):1978-85.
[10]Shweiki D, Itin A, Neufeld G, Gitay-Goren H, Keshet E. Patterns of expression of vascular endothelial growth factor (VEGF) and VEGF receptors in mice suggest a role in hormonally regulated angiogenesis. J Clin Invest. 1993;91(5):2235-43.
[11]Agrawal R, Conway GS, Sladkevicius P, Payne NN, Bekir J, Campbell S, et al. Serum vascular endothelial growth factor (VEGF) in the normal menstrual cycle: Association with changes in ovarian and uterine Doppler blood flow. Clinical Endocrinol. 1999;50(1):101-6.
[12]McClure N, Healy DL, Rogers PA, Sullivan J, Beaton L, Haning RV Jr, et al. Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome. Lancet. 1994;344(8917):235-6.
[13]Brinsden PR. Textbook of in vitro fertilization and assisted reroduction: Informa healthcare. Milton Park: Taylor & Francis; 2007. p. 688.
[14]Chen C, Chen H, Lu H, Chen S, Ho H, YS Y. Value of serum and follicular fluid cytokine profile in the prediction of moderate to severe ovarian hyperstimulation syndrome. Hum Reprod. 2000;15(5):1037-42.
[15]Navot D, Margalioth EJ, Laufer N, Birkenfeld A, Relou A, Rosler A, et al. Direct correlation between plasma renin activity and severity of the ovarian hyperstimulation syndrome. Fertil Steril. 1987;48(1):57-61.
[16]Nastri CO, Ferriani RA, Rocha IA, Martins WP. Ovarian hyperstimulation syndrome: Pathophysiology and prevention. J Assist Reprod Genet. 2010;27(2-3):121-8.
[17]Asch RH, Ivery G, Goldsman M, Frederick JL, Stone SC, Balmaceda JP. The use of intravenous albumin in patients at high risk for severe ovarian hyperstimulation syndrome. Hum Reprod. 1993;8(7):1015-20.
[18]Shalev E, Giladi Y, Matilsky M, Ben-Ami M. Decreased incidence of severe ovarian hyperstimulation syndrome in high risk in-vitro fertilization patients receiving intravenous albumin: A prospective study. Hum Reprod. 1995;10(6):1373-6.
[19]Isik AZ, Gokmen O, Zeyneloglu HB, Kara S, Keles G, Gulekli B. Intravenous albumin prevents moderate-severe ovarian hyperstimulation in in-vitro fertilization patients: A prospective, randomized and controlled study. Eur J Obstet Gynecol Reprod Biol. 1996;70(2):179-83.
[20]Kissler S, Neidhardt B, Siebzehnrubl E, Schmitt H, Tschaikowsky K, Wildt L. The detrimental role of colloidal volume substitutes in severe ovarian hyperstimulation syndrome: A case report. Eur J Obstet Gynecol Reprod Biol. 2001;99(1):131-4.
[21]Practice Committee of American Society for Reproductive Medicine. Ovarian hyperstimulation syndrome. Fertil Steril. 2008;90(Suppl 5):S188-93.
[22]Youssef MA, Van Wely M, Hassan MA, Al-Inany HG, Mochtar M, Khattab S, et al. Can dopamine agonists reduce the incidence and severity of OHSS in IVF/ICSI treatment cycles? A systematic review and meta-analysis. Hum Reprod Update. 2010;16(5):459-66.
[23]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:CD001302.
[24]Bellver J, Munoz EA, Ballesteros A, Soares SR, Bosch E, Simon C, et al. Intravenous albumin does not prevent moderate-severe ovarian hyperstimulation syndrome in high-risk IVF patients: A randomized controlled study. Hum Reprod. 2003;18(11):2283-8.
[25]Venetis CA, Kolibianakis EM, Toulis KA, Goulis DG, Papadimas I, Tarlatzis BC. Intravenous albumin administration for the prevention of severe ovarian hyperstimulation syndrome: A systematic review and metaanalysis. Fertil Steril. 2011;95(1):188-96.
[26]An SJ, Jee BC, Suh CS, Kim SH, Choi YM, Moon SY. Administration of intravenous albumin around the time of oocyte retrieval to prevent ovarian hyperstimulation syndrome: A meta-analysis. Fertility Steril. 2008;90 Suppl:S244-S5.
[27]Kearsley MW, Kearsly MW, Deis RC, Malcom WM. Sweeteners and sugar alternatives in food technology, 2nd Edition. New Jersey: Blackwell publishing; 2006. pp. 249-61.
[28]American Pharmacist Associaton. Drug infomation handbook: Comprehensive resource for all clinicians and healthcare professionals. Ohio: Lexicomp; 2012. 2387p.
[29]Gao MZ, Zhao XM, Sun ZG, Hong Y, Zhao LW, Zhang HQ. Endocrine gland-derived vascular endothelial growth factor concentrations in follicular fluid and serum may predict ovarian hyperstimulation syndrome in women undergoing controlled ovarian hyperstimulation. Fertil Steril. 2011;95(2):673-8.
[30]Aboulghar M. Treatment of ovarian hyperstimulation syndrome. Semin Reprod Med. 2010;28(6):532-9.
[31]Saremi A, Alam M, Motaghi M. Administration of mannitol to prevent severe ovarian hyperstimulation syndrome : A randomized controlled trial. Middle East Fertil Soc J. 2003;8(2):159-63.
[32]E Busso C, Soares SR, Pellicer A. Pathogenesis of ovarian hyperstimulation syndrome [Internet]. Alphen aan den Rijn: Wolters Kluwer Health. 1987. [updated Apr 2013; cited 2014 Jun 14]. Avilable from: https://www.uptodate.com/contents/pathogenesis-clinical-manifestations-and-diagnosis-of-ovarian-hyperstimulation-syndrome.
[2]Tang H, Hunter T, Hu Y, Zhai SD, Sheng X, Hart RJ. Cabergoline for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2012;(2):CD008605.
[3]Prakash A, Mathur R. Ovarian Hyperstimulation Syndrom. Obstet Gynecol. 2013;15:31-5.
[4]Matorras R, Andres M, Mendoza R, Prieto B, Pijoan JI, Exposito A. Prevention of ovarian hyperstimulation syndrome in GnRH agonist IVF cycles in moderate risk patients: Randomized study comparing hydroxyethyl starch versus cabergoline and hydroxyethyl starch. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):439-43.
[5]Aboulghar MA, Mansour RT, Serour GI, et al. Ovarian Hyperstimulation syndrome: Modern consepts in pathophysiology and management. Middle East Fertil Soc J. 1996;1:3-16.
[6]Schrenker J, Weinsten D. Ovarian Hyperstimulation syndrome: A current survey. Fertil Steril. 1978;30(3):255-68.
[7]Tollan A, Holst N, Forsdahl F, Fadnes HO, Oian P, Maltau JM. Transcapillary fluid dynamics during overian stimulationfor in vitro fertilization. Am J Obstet Gynecol. 1990;162(2):554-8.
[8]Rizk B, Aboulghar M, Smitz J, Ron-El R. The role of vascular endothelial growth factor and interleukins in the pathogenesis of severe ovarian hyperstimulation syndrome. Hum Reprod Update. 1997;3(3):255-66.
[9]Levin ER, Rosen GF, Cassidenti DL, Yee B, Meldrum D, Wisot A, et al. Role of vascular endothelial cell growth factor in Ovarian Hyperstimulation Syndrome. J Clin Invest. 1998;102(11):1978-85.
[10]Shweiki D, Itin A, Neufeld G, Gitay-Goren H, Keshet E. Patterns of expression of vascular endothelial growth factor (VEGF) and VEGF receptors in mice suggest a role in hormonally regulated angiogenesis. J Clin Invest. 1993;91(5):2235-43.
[11]Agrawal R, Conway GS, Sladkevicius P, Payne NN, Bekir J, Campbell S, et al. Serum vascular endothelial growth factor (VEGF) in the normal menstrual cycle: Association with changes in ovarian and uterine Doppler blood flow. Clinical Endocrinol. 1999;50(1):101-6.
[12]McClure N, Healy DL, Rogers PA, Sullivan J, Beaton L, Haning RV Jr, et al. Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome. Lancet. 1994;344(8917):235-6.
[13]Brinsden PR. Textbook of in vitro fertilization and assisted reroduction: Informa healthcare. Milton Park: Taylor & Francis; 2007. p. 688.
[14]Chen C, Chen H, Lu H, Chen S, Ho H, YS Y. Value of serum and follicular fluid cytokine profile in the prediction of moderate to severe ovarian hyperstimulation syndrome. Hum Reprod. 2000;15(5):1037-42.
[15]Navot D, Margalioth EJ, Laufer N, Birkenfeld A, Relou A, Rosler A, et al. Direct correlation between plasma renin activity and severity of the ovarian hyperstimulation syndrome. Fertil Steril. 1987;48(1):57-61.
[16]Nastri CO, Ferriani RA, Rocha IA, Martins WP. Ovarian hyperstimulation syndrome: Pathophysiology and prevention. J Assist Reprod Genet. 2010;27(2-3):121-8.
[17]Asch RH, Ivery G, Goldsman M, Frederick JL, Stone SC, Balmaceda JP. The use of intravenous albumin in patients at high risk for severe ovarian hyperstimulation syndrome. Hum Reprod. 1993;8(7):1015-20.
[18]Shalev E, Giladi Y, Matilsky M, Ben-Ami M. Decreased incidence of severe ovarian hyperstimulation syndrome in high risk in-vitro fertilization patients receiving intravenous albumin: A prospective study. Hum Reprod. 1995;10(6):1373-6.
[19]Isik AZ, Gokmen O, Zeyneloglu HB, Kara S, Keles G, Gulekli B. Intravenous albumin prevents moderate-severe ovarian hyperstimulation in in-vitro fertilization patients: A prospective, randomized and controlled study. Eur J Obstet Gynecol Reprod Biol. 1996;70(2):179-83.
[20]Kissler S, Neidhardt B, Siebzehnrubl E, Schmitt H, Tschaikowsky K, Wildt L. The detrimental role of colloidal volume substitutes in severe ovarian hyperstimulation syndrome: A case report. Eur J Obstet Gynecol Reprod Biol. 2001;99(1):131-4.
[21]Practice Committee of American Society for Reproductive Medicine. Ovarian hyperstimulation syndrome. Fertil Steril. 2008;90(Suppl 5):S188-93.
[22]Youssef MA, Van Wely M, Hassan MA, Al-Inany HG, Mochtar M, Khattab S, et al. Can dopamine agonists reduce the incidence and severity of OHSS in IVF/ICSI treatment cycles? A systematic review and meta-analysis. Hum Reprod Update. 2010;16(5):459-66.
[23]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:CD001302.
[24]Bellver J, Munoz EA, Ballesteros A, Soares SR, Bosch E, Simon C, et al. Intravenous albumin does not prevent moderate-severe ovarian hyperstimulation syndrome in high-risk IVF patients: A randomized controlled study. Hum Reprod. 2003;18(11):2283-8.
[25]Venetis CA, Kolibianakis EM, Toulis KA, Goulis DG, Papadimas I, Tarlatzis BC. Intravenous albumin administration for the prevention of severe ovarian hyperstimulation syndrome: A systematic review and metaanalysis. Fertil Steril. 2011;95(1):188-96.
[26]An SJ, Jee BC, Suh CS, Kim SH, Choi YM, Moon SY. Administration of intravenous albumin around the time of oocyte retrieval to prevent ovarian hyperstimulation syndrome: A meta-analysis. Fertility Steril. 2008;90 Suppl:S244-S5.
[27]Kearsley MW, Kearsly MW, Deis RC, Malcom WM. Sweeteners and sugar alternatives in food technology, 2nd Edition. New Jersey: Blackwell publishing; 2006. pp. 249-61.
[28]American Pharmacist Associaton. Drug infomation handbook: Comprehensive resource for all clinicians and healthcare professionals. Ohio: Lexicomp; 2012. 2387p.
[29]Gao MZ, Zhao XM, Sun ZG, Hong Y, Zhao LW, Zhang HQ. Endocrine gland-derived vascular endothelial growth factor concentrations in follicular fluid and serum may predict ovarian hyperstimulation syndrome in women undergoing controlled ovarian hyperstimulation. Fertil Steril. 2011;95(2):673-8.
[30]Aboulghar M. Treatment of ovarian hyperstimulation syndrome. Semin Reprod Med. 2010;28(6):532-9.
[31]Saremi A, Alam M, Motaghi M. Administration of mannitol to prevent severe ovarian hyperstimulation syndrome : A randomized controlled trial. Middle East Fertil Soc J. 2003;8(2):159-63.
[32]E Busso C, Soares SR, Pellicer A. Pathogenesis of ovarian hyperstimulation syndrome [Internet]. Alphen aan den Rijn: Wolters Kluwer Health. 1987. [updated Apr 2013; cited 2014 Jun 14]. Avilable from: https://www.uptodate.com/contents/pathogenesis-clinical-manifestations-and-diagnosis-of-ovarian-hyperstimulation-syndrome.