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Comparison of cabergoline and intravenous albumin in the prevention of ovarian hyperstimulation syndrome: a randomized clinical trial
Tehraninejad ES, Hafezi M, Arabipoor A, Aziminekoo E, Chehrazi M, Bahmanabadi A
Journal of Assisted Reproduction and Genetics. 2012;29((3):):259-64.
Abstract
PURPOSE To compare the efficacy of cabergoline (Cb2) and intravenous human albumin (HA) in the prevention of ovarian hyperstimulation syndrome. METHODS In this randomized controlled trial study, 138 women who were at high risk for developing OHSS were randomly allocated into two groups. In Group one, 20 gr of HA 20% was infused over 1 h. Group two received 0.5 mg per day of Cb2 orally for 7 days, starting on oocyte pickup day. All patients were visited seven and 14 days after oocyte retrieval to determine early clinical or ultrasound evidence of OHSS. RESULTS Moderate OHSS was observed in 33 versus 14 cases in the HA and Cb2 groups, respectively, which was significantly different. The number of severe OHSS cases in the HA group was significantly higher than in the Cb2 group (P?0.001). CONCLUSIONS Prophylactic oral low dose cabergoline was more effective and less costly than intravenous human albumin in the prevention of OHSS in high-risk patients.
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2.
Intravenous albumin administration for the prevention of severe ovarian hyperstimulation syndrome: a systematic review and metaanalysis
Venetis CA, Kolibianakis EM, Toulis KA, Goulis DG, Papadimas I, Tarlatzis BC
Fertility & Sterility. 2011;95((1):):188-196.e3.
Abstract
OBJECTIVE To reappraise the currently available evidence, providing the answer to the following question: does intravenous albumin administration reduce the risk of severe ovarian hyperstimulation syndrome (OHSS) occurrence following ovarian stimulation with gonadotrophins and GnRH analogues for IVF in high-risk patients? DESIGN Systematic review and metaanalysis. SETTING University-based hospital. INTERVENTION(S): Intravenous albumin administration in high-risk patients for prevention of severe OHSS occurrence. MAIN OUTCOME MEASURE(S): Severe OHSS occurrence. RESULT(S): Eight eligible randomized controlled trials were identified (n=1,199 patients) that offered data for statistical pooling. No statistically significant difference in the occurrence of severe OHSS in patients who received intravenous albumin (n=595) and those who did not (n=604; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.52-1.22) was detected. Moreover, no statistically significant differences were present regarding the probability of pregnancy (OR, 0.83; 95% CI, 0.64-1.07) and first trimester pregnancy loss (OR, 1.44; 95% CI, 0.73-2.85) between patients who received intravenous albumin and those who did not. CONCLUSION(S): Based on the currently best available evidence, intravenous albumin administration in high-risk patients does not appear to reduce the occurrence of severe OHSS. This finding should be considered when implementing strategies for severe OHSS prevention.
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3.
Administration of intravenous albumin around the time of oocyte retrieval reduces pregnancy rate without preventing ovarian hyperstimulation syndrome: a systematic review and meta-analysis
Jee BC, Suh CS, Kim YB, Kim SH, Choi YM, Kim JG, Moon SY
Gynecologic & Obstetric Investigation. 2010;70((1):):47-54.
Abstract
BACKGROUND/AIM: The aim of this meta-analysis was to evaluate whether IV albumin infusion around the time of oocyte retrieval prevents ovarian hyperstimulation syndrome (OHSS) and affects the pregnancy rate. METHODS A meta-analysis of data from 9 randomized controlled trials including 1,613 women at high risk for developing OHSS in in vitro fertilization cycles was performed. RESULTS The combined incidence of severe OHSS was 6.0% in the IV albumin group and 7.9% in saline or no treatment groups. These rates were statistically not different (RR = 0.80, 95% CI = 0.57-1.12). Treatment with IV albumin significantly lowered the pregnancy rates (RR = 0.85, 95% CI = 0.74-0.98). CONCLUSIONS The combined data presented in this meta-analysis do not support a benefit for IV albumin around the time of oocyte retrieval in preventing OHSS and even showed a deleterious effect on the pregnancy rate.
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4.
A randomized controlled study of human serum albumin and serum substitute supplement as protein supplements for IVF culture and the effect on live birth rates
Meintjes M, Chantilis SJ, Ward DC, Douglas JD, Rodriguez AJ, Guerami AR, Bookout DM, Barnett BD, Madden JD
Human Reproduction. 2009;24((4):):782-9.
Abstract
BACKGROUND It has been speculated that the addition of proteins more complex than human serum albumin (HSA) to culture media may improve IVF outcomes. Whether the expense, labor and risk of adding additional human-derived protein to IVF media are warranted is a question unanswered. METHODS In a randomized controlled trial with couples undergoing routine IVF or ICSI, 528 patients were assigned to one of two treatment groups. Embryos were cultured in either media supplemented with HSA as a solitary protein supplement or in media supplemented with HSA+serum substitute supplement (SSS) from the 2PN stage until the time of embryo transfer. Clinical end-points monitored included implantation (total 1151 embryos) and live birth rates (total 528 patients). RESULTS The transfer of embryos cultured in HSA+SSS resulted in higher embryo implantation (289/571, 50. 6% versus 254/580, 43. 8%; difference 6. 8% with 95% CI 1. 0-12. 7, P = 0. 042) and live birth rates (167/266, 62. 8% versus 142/262, 54. 2%; difference 8. 6% with 95% CI 0. 1-17. 3, P = 0. 043) when compared with those of women whose embryos were cultured with HSA as the sole protein supplement. CONCLUSIONS SSS added to commercial HSA-supplemented embryo culture media resulted in an overall increase in implantation and live birth rates. It remains uncertain whether the use of human-derived blood products in culture media and the requirement for ultra-rigorous quality control measures make these findings applicable to the average IVF laboratory. Protein enrichment of media may significantly improve the blastocyst implantation rate, creating opportunities to transfer single blastocysts without compromising the live birth rate. The study was registered at clinicaltrials. gov. NCT00708383.
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5.
Hyaluronic acid versus albumin in human embryo transfer medium
Mahani IM, Davar R
Eastern Mediterranean Health Journal. 2007;13((4):):876-80.
Abstract
We compared the implantation and pregnancy rate through in vitro fertilization (IVF) using hyaluronic acid and albumin as transfer medium in 60 women randomly allocated to 2 groups. In treatment group A (n = 30), embryos were transferred to medium supplemented with hyaluronic acid. In the control group B (n = 30), embryos were transferred to medium containing albumin. There were no significant differences between the groups in terms of mean age of the females, mean duration of infertility and mean number of embryos. The pregnancy rate in groups A and B were 81. 8% and 71. 4% respectively, a non-statistically significant difference. Hyaluronic acid can successfully replace albumin as transfer medium.
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6.
Human albumin does not prevent ovarian hyperstimulation syndrome in assisted reproductive technology program: a prospective randomized placebo-controlled double blind study
Isikoglu M, Berkkanoglu M, Senturk Z, Ozgur K
Fertility and Sterility. 2007;88((4):):982-5.
Abstract
We aimed to clarify the efficiency of IV human albumin in the prevention of ovarian hyperstimulation syndrome (OHSS). We found that human albumin at the described strength does not seem to either prevent or reduce the incidence of severe OHSS in high risk patients undergoing intracytoplasmic sperm injection (ICSI).
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7.
Changes in acid-base balance following bolus infusion of 20% albumin solution in humans
Bruegger D, Jacob M, Scheingraber S, Conzen P, Becker BF, Finsterer U, Rehm M
Intensive Care Medicine. 2005;31((8):):1123-7.
Abstract
OBJECTIVE To evaluate changes in acid-base balance following bolus infusions of a 20% albumin solution. DESIGN AND SETTING Randomized prospective study in a university hospital. PATIENTS AND PARTICIPANTS Two groups of eight patients each undergoing gynecological surgery. INTERVENTIONS Patients were randomly assigned to receive either 0. 9% saline or lactated Ringer's solution. At the end of surgery two boluses of 0. 5 g/kg body weight of a 20% albumin solution were administered. Arterial blood gases, electrolytes, and total protein were measured. The strong ion difference and the amount of weak plasma acid were calculated. pH and titratable acidity of the 20% albumin solution were determined. MEASUREMENTS AND RESULTS The infusion of a 20% albumin solution resulted in a significant decrease in pH from 7. 284 to 7. 262 in the saline group and from 7. 422 to 7. 394 in the Ringer's group. In both groups the 20% albumin solution caused an increase in strong ion difference and an increase in the amount of weak plasma acid. The observed changes in serum bicarbonate concentration were in good agreement with the changes in strong ion difference and the amount of weak plasma acid. The 20% albumin solution possessed a pH of 6. 95 and a titratable acidity of 8. 5 [corrected] mEq/l. CONCLUSIONS According to the Stewart approach, the observed changes in acid-base balance are the net result of the two opposing effects of the strong ion difference and the amount of weak plasma acid. Alternatively, the acidifying effect of the 20% albumin solution may stem from the titratable acid content of the solution.
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8.
Intravenous albumin does not prevent moderate-severe ovarian hyperstimulation syndrome in high-risk IVF patients: a randomized controlled study
Bellver J, Muñoz EA, Ballesteros A, Soares SR, Bosch E, Simón C, Pellicer A, Remohí J
Human Reproduction (Oxford, England). 2003;18((11):):2283-8.
Abstract
BACKGROUND Intravenous albumin administration has been described for many years as a debatable, but probably useful preventive measure in ovarian hyperstimulation syndrome (OHSS). The present study details the largest randomized controlled trial to date of albumin infusion versus no treatment in IVF patients with a high risk of developing moderate to severe OHSS. METHODS Between March 1999 and February 2002, women undergoing IVF at the IVI Valencia with >20 retrieved oocytes were included. A total of 988 patients was initially enrolled. Immediately after oocyte retrieval, patients were allocated to two groups based on a computer randomization: the first group received 40 g human albumin; the second group received no treatment. Subjects were weighed and a blood analysis performed immediately after oocyte retrieval and again 7 days later. Women were monitored on an outpatient basis until menstruation, or until fetal heart activity was detected. Twelve subjects were excluded due to follow-up loss, leaving 976 women (377 of them oocyte donors), with 488 in each group. RESULTS No difference was found between the two groups in terms of patient characteristics and outcome. Moderate-severe and severe-only OHSS rates were similar. The incidence of haemoconcentration and liver and renal dysfunction at 7 days after oocyte retrieval was similar in the two groups. In women who developed moderate/severe (n = 66) or only severe (n = 46) OHSS, there was no difference based on prior albumin administration between blood parameters or body weight on the day of oocyte retrieval, 7 days later, and even when comparing variation between both measurements. Moreover, the number of patients with paracentesis, hospital admissions, complications and days of OHSS until resolution did not differ. CONCLUSIONS Albumin infusion on the day of oocyte retrieval is not a useful means of preventing the development of moderate-severe OHSS.
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9.
Hydroxyethylstarch versus human albumin for the treatment of severe ovarian hyperstimulation syndrome: a preliminary report
Abramov Y, Fatum M, Abrahamov D, Schenker JG
Fertility & Sterility. 2001;75((6):):1228-30.
Abstract
OBJECTIVE To compare the efficacy and safety of 6% hydroxyethylstarch and human albumin as colloid solutions for treatment of severe ovarian hyperstimulation syndrome (OHSS). DESIGN Controlled cohort study. SETTING Tertiary medical center. PATIENT(S): Sixteen patients with severe OHSS. INTERVENTION(S): Six percent hydroxyethylstarch (6 patients) and human albumin (10 patients). MAIN OUTCOME MEASURE(S): Urine output, number of abdominal and pleural drainage procedures, complications, duration of hospitalization, and perinatal outcome. RESULT(S): Patients who received 6% hydroxyethylstarch had higher urine output, needed fewer abdominal and pleural paracenteses, and had a shorter hospital stay than those who received human albumin. In each group, no adverse effects or congenital malformations were observed and the rates of miscarriage were similar. CONCLUSION(S): These results suggest that 6% hydroxyethylstarch may be superior to albumin as a colloid solution for the treatment of severe OHSS.
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10.
Intravenous albumin versus hydroxyethyl starch for the prevention of ovarian hyperstimulation in an in-vitro fertilization programme: a prospective randomized placebo controlled study
Gokmen O, Ugur M, Ekin M, Keles G, Turan C, Oral H
European Journal of Obstetrics, Gynecology, & Reproductive Biology. 2001;96((2):):187-92.
Abstract
A prospective randomized placebo controlled clinical trial was carried out on 250 patients (cycles) considered at risk of developing OHSS in an IVF programme. Criteria for inclusion were: estradiol value of more than 3000 pg/ml or the presence of more than 20 follicles on the day of hCG administration. Patients were randomized by using a random table to receive either 20% human albumin 50 ml (n: 82); 6% hydroxyethyl starch (200/0.5) 500 ml (n: 85) or a placebo of 500 ml 0.9% NaCl solution (n: 83) over 30 min during oocyte collection. Groups were similar with respect to patients' age, estradiol levels on hCG day, body mass index, number of oocytes retrieved, number of embryos transferred and pregnancies (P>0.05). There was no severe OHSS in patients who received albumin and HES while four patients who received placebo developed severe OHSS. On the other hand moderate OHSS was encountered in four patients in the albumin group; five patients receiving HES; and 12 patients receiving placebo. There was a statistically significant difference in the incidence of moderate, severe and overall OHSS among groups (P values of <0.05, <0.05, and <0.01, respectively). Both HES and albumin significantly reduced the incidence of moderate, severe and overall incidence of OHSS. It is concluded that hydroxyethyl starch is a cheaper and safer alternative to Human Albumin in OHSS prevention.