How useful is  Glucocorticoid Administration at OPU to prevet OHSS??

Rizk (1993) has found no protective effect of intravenous glucocorticoid. They considerd that the  pathophysiology suggest the involvement of an inflammatory mechanism during the development of the fluid leakage associated with the syndrome. Therefore, investigators hypothesized that glucocorticoids could possibly prevent OHSS in patients at high risk. Tan et al. (1992) also in a prospective randomized trial investigated the usefulness of glucocorticoids in the reduction of the rate of OHSS. Thirty-one patients, who were stimulated with hMG and who were desensitized with GnRH agonists and developed more than 20 follicles > 12 mm and/or had serum estradiol of > 10 000 pmo1/1 on the day of hCG administration, were recruited. The patients were randomized into two groups.

Group A (n= 17) were administered intravenous hydrocortisone immediately after transvaginal ultrasound oocyte recovery. Prednisolone 10 mg three times daily was given for five days, starting on the day of oocyte recovery, followed by prednisolone 10 mg twice daily for three days and 10 mg once daily for two days.

Group B (n =14) did not have any intravenous or oral gluco­corticoid treatment. Luteal phase support was given in the form of intra­muscular Gestone 100 mg/day. Seven of the 17 patients (41.2%) who received glucocorticoids developed OHSS compared with six of the 14 patients (42.9%) who did not. The authors concluded that the administration of glucocorticoids to high-risk patients did not diminish the risk of developing OHSS.

But can glucocorticoid administration prior to OPU say commencing from day 6 of COH reported that methylprednisolone 16 mg/day, starting on the 6th day of controlled ovarian hyperstimulation and tapered to day 13 after embryo transfer, was effective in reducing OHSS significantly to 10%, compared with 43.9% in the control group.