Incidences and risk factors of moderate-to-severe ovarian hyperstimulation syndrome and severe hemoperitoneum in 1,435,108 oocyte retrievals.
RESEARCH QUESTION
What are the risk factors affecting the incidences of moderate-to-severe ovarian hyperstimulation syndrome (OHSS) and severe hemoperitoneum in assisted reproductive technology (ART) treatment cycles?


DESIGN
A retrospective cohort study was conducted on 1,435,108 oocyte retrieval cycles among Japanese ART registry data between 2007 and 2015. The study included 11,378 cycles with moderate-to-severe OHSS, 1182 cycles with severe hemoperitoneum, including 27 cycles with both conditions, and 1,422,575 cycles without moderate-to-severe OHSS and severe hemoperitoneum.


RESULTS
The incidences of moderate-to-severe OHSS and severe hemoperitoneum were 0.79% and 0.08%, respectively, and decreased by 0.57-fold and 0.29-fold from 2007 to 2015, respectively. In cycles with OHSS and cycles with hemoperitoneum women were younger (odds ratios [OR] 0.91 and 0.95, respectively) and had more retrieved oocytes (OR 1.09 and 1.01, respectively) compared with cycles without both complications. The use of a gonadotrophin-releasing hormone (GnRH) agonist protocol for ovarian stimulation was the highest risk factor in cycles with OHSS and hemoperitoneum (OR 1.83 and 1.24, respectively), followed by GnRH antagonist protocol (reference), gonadotrophin with or without oral medicine (OR 0.45 and 0.56, respectively) and natural or oral medicine (OR 0.02 and 0.19, respectively). In fresh embryo transfer, clinical pregnancy was associated with an increased risk of OHSS and hemoperitoneum (OR 1.19 and 2.34, respectively).


CONCLUSIONS
The highest risk factors affecting OHSS and hemoperitoneum were the use of a GnRH agonist protocol and clinical pregnancy following fresh embryo transfer. The incidences of OHSS and hemoperitoneum have decreased yearly with a reduction of GnRH agonist use and fresh embryo transfer.
['Kuroda|Keiji|K|', 'Nagai|Saki|S|', 'Ikemoto|Yuko|Y|', 'Matsumura|Yuko|Y|', 'Ochiai|Asako|A|', 'Nojiri|Shuko|S|', 'Itakura|Atsuo|A|', 'Sugiyama|Rikikazu|R|']
D000328:Adult D005260:Female D006465:Hemoperitoneum D006801:Humans D015994:Incidence D007564:Japan D054315:Oocyte Retrieval D016471:Ovarian Hyperstimulation Syndrome D010062:Ovulation Induction D012189:Retrospective Studies D012307:Risk Factors
Risk factor Ovarian hyperstimulation syndrome Hemoperitoneum Assisted reproductive technology Complication Ovarian stimulation