Ovarian hyperstimulation and how to prevent it
Unita Zupanc (SI), Vesna Pavlović (RS), Milivoje Pavlović (RS), Sašo Stojkoski (SI)
[Zupanc] Hospital Celje, Slovenia, [Pavlović] Hospital Stari Grad, Belgrade, [Pavlović] Hospital Stari Grad, Belgrade, [Stojkoski] Hospital Slovenska Bistrica, Slovenia
Introduction:There is an extremely significant difference in opinions regarding how many embryos have to be left in process of stimulated ovulation with using Folliculometry or with IVF/ET.Goal:To show that the opinions of 20 year ago and today do not differ regarding how many embryos should be left after stimulated ovulation.And that the opinion on number of embryos that are being used in IVF/ET has changed.Case study:After one year of attempting to stay pregnant and not succeeding a 30 years old patient starts with testing.The applied stimulation used:clomifene citrate 2x1 in between 5-9 day of cyclus with Folliculometry.On one leading folikul of 19 mm there was effected ovulation with 2 amp Pregnyla of 5000U and it was setup when the couple should have sexual relation.On the 27th day of the cycle the patient comes with pain in lower part of stomach, on ultrasound it is visible one ovarium folicul 25mm and more smaller ones along with liquid.Discussion:Taking into consideration that the above case study was performed 20 year ago when there was no pre-stimulation of ovulation with oral contraceptives, and although the weakest protocol of stimulation was applied (Clomifen citrat from 5-9 day of the cycle) it still came to hyper stimulation.After that several changes were applied to the protocol of application of stimulated ovulation.The changes that were made after the testing lead to a conclusion that that it is better to make begin by analyzing the patients hormonal structure first and then to take it from the basic level.After this is done the decision which is the preferable stimulation method that should be decided.Conclusion:All parameters of the application of stimulation of ovulation should be taken into consideration,then the correctly prescribed therapy should be applied in order to avoid hyper stimulation which could lead to a very serious problem.