can early onset severe OHSS hurt implantation?
1 Replies
Sherri - May 9

I'm 40.5, just had first failed IVF. I only did the IVF for the PGD....b/c I get preggo naturally fast but lose them (4 known trisomy 13). Have 3.5 year old conceived in third cycle no intervention, and 10 month old conceived first inject/IUI cycle. I felt that b/c of my age I would go right to IVF with PGD to get last kid.

48 eggs retrieved after stimming 8ish days (150 Gonal-F, 75 Menopur). E2 at trigger day 3300, 36 follies visualized on ultrasound.

PGD and transfer information below:
20 embryos biopsied for PGD (7 were normal on the 9 chromosomes tested but not all arrived at blast stage on day 5)

12 total blastocysts on day 5 (4 were normal)

4 normal blastocysts on day 5:
1) One at hatching stage (advanced stage)
2) One beginning to hatch (relatively advanced stage)
3) One cavitating (early developmental stage)
4) One early cavitating (early developmental stage)

3 normal embryos not quite at blast stage on day 5

***Transferred top 3 blasts (1,2, & 3)***

At transfer, 5dpo, (e2=2800 & progesterone=200)
Day after transfer, hospitalized for severe/critical OHSS...3 liters fluid drained from pelvic cavity, and following blood tests abnormal (hematocrit, electrolytes, white blood cells, liver, kidney) Symptoms started to appear after early onset.

Day after transfer none of sufficient quality to freeze

I know your first reaction will be to go to donor egg, but I would like to try once more given my response and a few normals via PGD. Just wondering if there is some chance here that the early onset OHSS hurt my chances....

Could you offer any ideas for me for next time? Drug change, trial of Metformin? My RE didn't even test me for PCOS b/c I am avg to thin, have clockwork cycles and definitely ovulating.


Barry Jacobs, M. D. - May 10

I think that I might have slowed your stimulation before you developed so many follicles. Second, if you had become pregnant, your hyperstimulation would probably have been worse, longer. I would have frozen all embryos and transferred them later, after your ovaries had returned to normal. Finally, it is not likely that the hyperstimulation impaired implantation.
Good luck.



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