|
Ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy comprise a series of iatrogenically induced complications in patients undergoing therapeutic induction of ovulation. The narrow range of therapeutic agents and the occasional unpredictable ovarian response make the entire prevention of OHSS more difficult, especially in patients with polycystic ovarian disease(PCOD). To evalutate the usefulness of selective oocyte retrieval(SOR) in patients who had responded exceptionally well to controlled ovarian hyperstimulation(COH), SOR was performed in 16 clomid-resistant PCOD patients from Octorber, 1989 to September, 1991.On the day of hCG injection, serum estradiol level was 5176.2±2179.0 pg/ml(2018∼9700pg/ml)and the number of follicles demonstrated in ultrasonographic monitoring was 17.3±6.0(10∼30). The number of oocytes retrieved transvaginally was 14.7±7.4(4∼27) and the number of remaining intact follicles was 3.8±0.3(3∼4). After SOR and intrauterine insemination(IUI), conceptions were achieved in 7 patients including 1 chemical pregnancy and 1 spontaneous abortion at 8 weeks gestation with the pregnancy rate per cycle of 43.8%. Five patients had given birth to 4 normal singletons and 1 twin at term. Among 16 patients, mild OHSS occurred in 3 patients (18.8%) and severe OHSS in 1 patient (6.3%). All the cases of OHSS were pregnant cases. These data suggest that SOR is one of the valuable solution to the sudden multiple follicular development with a high risk to OHSS during COH with the preservation of the possibility of pregnancy, especially in patients with PCOD. Moreover, as the oocytes retrieved were fertilized in vitro and the embryos cryopreserved, SOR avoids wasting supernumerary oocytes.
|