Dual renin-angiotensin blockage and total embryo cryopreservation is not a risk-free strategy in patients at high risk for ovarian hyperstimulation syndrome

Objective: To evaluate the effectiveness and safety of dual renin-angiotensin system (RAS) blockage together with total embryo cryopreservation for: prevention of ovarian hyperstimulation syndrome (DHSS) in overstimulated patients undergoing IVF. Design: Retrospective case series. Setting: A private tertiary care-hospital assisted reproduction program. Patient(s): Ten women at high risk for OHSS (mean E-2 level 9401 +/- 585 pg/mL on the day of hCG administration). Intervention(s): Cancellation of ET and dual RAS blockage with an angiotensin receptor blocker (candesartan cilexetil) and an angiotensin-converting enzyme inhibitor (enalapril) starting from day I after oocyte retrieval. Embryos were cryopreserved and transferred in subsequent cycles. Main Outcome Measure(s): Development of DHSS and pregnancy and live birth rates after frozen-thawed ETs. Result(s): While eight women did not develop DHSS, two women (20%) developed severe OHSS requiring hospitalization. Subsequent frozen-thawed ETs resulted in an 80% clinical pregnancy rate and 40% live birth rate. Conclusion(s): Dual RAS blockage with total embryo cryopreservation is a relatively new strategy that was proposed for use in patients at high risk for OHSS. It should be stressed that complete elimination of the syndrome is not possible with this treatment. Subsequent pregnancy rates with the transfer of frozen-thawed embryos are high.