Ovarian Hyperstimulation Syndrome – It’s Time to Reverse the Trend
By Dr. Geeta Nargund | BioNews | Dec. 5, 2016
In this commentary, Dr. Geeta Nargund at CREATE Fertility, discusses the increase in ovarian hyperstimulation syndrome (OHSS) reported by fertility clinics in the United Kingdom.
In the author’s opinion, a report published by the Human Fertilization and Embryology Authority (HFEA) “obfuscates” real data – a 40 percent rise in hospital admissions with severe OHSS. She suggests the HFEA prioritize this “alarming statistic” and focus on reversing the trend, offering the following recommendations: a reduced dose of stimulation followed by GnRH agonist to trigger ovulation, with an option of cryopreservation of all embryos; and abandoning the use of the “long downregulation” protocol, employed in many IVF treatment cycles, and a switch to antagonist cycles.
In line with others in the field, Nargund also emphasizes the need for informed consent – placing the responsibility for this on providers – and rigorous documentation of the effects of stimulation protocols (including the drugs and dosages used).
Professor Michele Goodwin at the University of Minnesota and Judy Norsigian have described the “raw and debilitating physical, emotional and spiritual challenges created by deeply personal and life-altering procedures” experienced by some women seeking ART and support the need for additional regulation. In addition to the invasive processes involved in conception, the ethical quandary created by a recommendation for fetal reduction and the emotional toll on women and couples may be profound and is incompletely studied. Professor Goodwin asserts there is a “much needed public discourse that could also become the clarion call for regulation of a field of medicine that has thus far unsuccessfully regulated itself.”
A transaction once shrouded in secrecy, the Internet now hosts a thriving and competitive marketplace for donors, largely supplanting leaflets on college bulletin boards and ads in campus newspapers, the traditional methods of recruiting fertile young women. Payment varies, currently starting at about $3,500 per cycle and sometimes 
Perinatal risks that may be associated with assisted reproductive technology (ART) and ovulation induction include multifetal gestations, prematurity, low birth weight, small for gestational age, perinatal mortality, cesarean delivery, placenta previa, abruptio placentae, preeclampsia, and birth defects. Although these risks are much higher in multifetal gestations, even singletons achieved with ART and ovulation induction may be at higher risk than singletons from naturally occurring pregnancies.
This report provides an overview of recent scientific literature on the long-term health effects of ovarian stimulation and egg retrieval, a specific component of ART used during in vitro fertilization (IVF), egg donation, and egg freezing. It is not a complete literature review but, as described, “an overall assessment of what is and what is not currently known, followed by recommendations for how to improve the information available about this aspect of reproductive health care.”
This opinion piece, published on WBUR’s CommonHealth Blog, outlines the authors’ key concerns related to egg retrieval, both for infertility treatment and research.