Risks and complications associated with ovarian stimulation for fertility treatment

Baumgarten, Miriam N. (2018) Risks and complications associated with ovarian stimulation for fertility treatment. PhD thesis, University of Nottingham.

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Abstract

Almost all fertility treatment involves ovarian stimulation. This can be in the form of ovulation induction in women with anovulation or controlled ovarian stimulation for in vitro fertilisation treatment. The stepwise approach to fertility treatment in most cases it will be safe and successful. In certain cases, it might be however ineffective or related with adverse health outcomes for the woman causing significant distress for the couple and the treating clinicians.

Fertility treatment could be perceived as a paradox, as healthy women undergo treatment ‘willingly’, with often no cause identified of their failed conceptions. Exposure to assisted reproduction can therefore result in these healthy women being admitted to hospital suffering from complications of fertility treatment.

In this thesis of the genetic make-up of women, who had ovulation induction with or without success, is evaluated. Aiming for potential prediction of response for future patients. In order to gain more insight in the pathophysiology of ovarian overresponse, the ovarian renin angiotensin system was assessed during stimulation for IVF. The use of a dopamine agonist to alleviate or prevent OHSS was studied. And any assisted reproductive treatment adverse outcome rates after a salpingectomy prior to treatment were investigated.

The studies presented in this thesis utilized various research modalities, including systematic literature reviews, three-dimensional ultrasound, single nucleotide polymorphism analysis and polymerase chain reactions.

When OHSS develops dopamine agonists provide limited symptomatic relieve, but causes no harm. Salpingectomy prior to ovarian stimulation with potential harm to the ovarian blood supply does not influence the overall treatment outcome. Serum renin levels during ovarian stimulation might be able to differentiate which women become symptomatic of OHSS, but is a difficult test to implement in daily practice. For ovulation induction the use of genotyping of CYP450 might allow adjusting the dose needed to prevent unwanted response.

We need to remain critical of our practise. Registration and evaluation of complications will allow achievement of safer and better fertility treatment in the future. The overall conclusion is that the next trial should focus on the patient group found to be at risk of overresponse and randomise them to an antagonist protocol with agonist trigger and modified luteal support. Controlled ovarian stimulation should be in conjunction with a national complication registration to have a real picture of the risks associated with fertility treatment.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Broughton-Pipkin, F.
Jayaprakasan Kanna, M.
Thornton, J.G.
Keywords: Ovarian stimulation; Fertility treatment; Health outcomes; OHSS; Ovarian overresponse; Dopamine agonists; Modified luteal support
Subjects: W Medicine and related subjects (NLM Classification) > WP Gynecology
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 53238
Depositing User: Baumgarten, Miriam
Date Deposited: 02 Apr 2019 09:29
Last Modified: 07 May 2020 14:03
URI: http://eprints.nottingham.ac.uk/id/eprint/53238

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