Complications of controlled stimulation: what can be prevented and avoided

In her second lecture Nataliia Vladykina turns to the complications of stimulation — "every reproductive specialist's bogeyman." Her thesis: complications happen to everyone, they are rare, but to avoid even the rare ones you must speak about them openly.

She begins with the non-standard response to stimulation — the most frequent topic of questions. Three sources of such a situation: iatrogenic influence (long use of combined pills, agonists, treating endometriosis before stimulation), biological ageing and a genetic factor.

A separate point is the difference between a polymorphism and a mutation: a mutation practically switches off the possibility of stimulation, whereas polymorphisms only alter the response — some suppress it, others make it hyper. Hence an unexpected hypo- or hyper-response in a seemingly "predictable" patient; unified protocols do not work here.

Empty follicle syndrome is more often false: the patient did not administer the trigger correctly (wrong day, agonist not reconstituted). Hence the importance of trigger control: an ovulation or pregnancy test the next day, video and messages. The true syndrome is linked to an individual response to the trigger — re-aspiration at 40-42 hours instead of 36.

Resistant follicle syndrome — when a patient was mistakenly taken for stimulation: normal/raised AMH and antral follicles with high FSH and LH. The gold standard is genotyping: for some mutations only IVM is possible, for others moderate stimulation.

Ovarian torsion is a rare but unpleasant complication; predisposing factors are rapid follicle growth and multifollicular ovaries. A key point: Doppler is wrong up to 60% of the time (arterial flow persists in torsion), so a diagnosis by "flow present" is unreliable.