The adjunctive use of metformin is associated with decreased OHSS rates in PCOS patients (342). Cabergoline, a dopamine agonist that inhibits VEGF production, decreased OHSS rates when given at 0.5 mg daily for 7 or 8 days following retrieval. Long-term use of cabergoline may be associated with valvular heart disease (351,401,402). Albumin given at oocyte retrieval does not appear to decrease subsequent rates of OHSS (401).
Cryopreservation of all embryos without transfer will prevent late onset OHSS (402), but pregnancy outcomes vary for frozen/thaw transfers and early onset OHSS may still occur (401,402). More information on embryo crypreservation can be found in the “Process of Assisted Reproductive Technologies” section.
In vitro oocyte maturation completely obviates the need to stimulate the ovaries with gonadotropins. During in vitro oocyte maturation cycles, immature follicles are aspirated following hCG administration, and the retrieved oocytes are grown in vitro until mature. Mature oocytes are then fertilized by insemination or ICSI. Randomized trials are still needed to further evaluate this technique (403).
Risk of Cancer after Infertility by itself is a predisposing factor for ovarian cancer and breast cancer (404,405).
Fertility Therapy Although treatments that promote incessant ovulation and elevated estrogen levels offer biologic plausibility for further increased cancer risk, data regarding the impact of infertility therapy on neoplasias have been inconsistent and conﬂicting (406). A retrospective cohort study of women in the United States found no association between prior use of clomiphene or gonadotropins and subsequent development of ovarian or breast cancer, although the authors suggested that very high doses or long duration of administration may warrant closer attention (404,405). A large British cohort of women with ovulatory disorders who were given ovulation-stimulation drugs did not find evidence to suggest causation for cancer of the breast, ovary, colon, skin, or thyroid. However, there was a dose–response relationship between the development of uterine cancer and prior use of clomiphene, particularly with a lifetime exposure of 2,250 mg or more (406).
Stress Stress, as manifested by anxiety or depression, is thought to be increased among women experiencing infertility (407). Stress is the most common reason for patients, even those with insurance coverage, to terminate fertility treatment (408). However, it is not clear whether stress worsens infertility, nor is there clear evidence that psychological treatment improves fertility (407). If psychological disorders are present, treatment should be offered regardless of fertility status.