Comment: The quality of evidence is downgraded by study limitations (poor reporting and failure to blind outcome assessment), by imprecision (wide confidence intervals and few outcome events), and by indirectness (no data on live birth).
A Cochrane review [Abstract] 1 included 9 RCTs involving 1 867 high-risk women undergoing ovarian hyperstimulation. There was a decrease in the incidence of severe ovarian hyperstimulation syndrome (OHSS) with administration of human albumin, hydroxyethyl starch (HES) or mannitol compared to placebo or no treatment (table T1). There was no evidence of statistical difference in the pregnancy rate wtih mannitol or HES, but a clear decrease with human albumin (table T1 ). There were no data on live birth rate. Adverse effects were rare.
| Outcome | Relative effect(95% CI) | Risk with placebo / no treatment | Corresponding risk - Intervention (95% CI) | №of participants(studies) |
|---|---|---|---|---|
| Albumin: Moderate or severe OHSS | OR 0.67(0.47 to 0.95) | 122 / 1000 | 85 / 1000(61 to 117) | 1452(7) |
| Albumin: Pregnancy rate | OR 0.72(0.55 to 0.94) | 396 / 1000 | 321 / 1000(265 to 381) | 1069(7) |
| HES: Moderate or severe OHSS | OR 0.27(0.12 to 0.59) | 164 / 1.000 | 50 / 1000(23 to 104) | 272(2) |
| HES: Pregnancy rate | OR 1.20(0.49 to 2.93) | 120 / 1.000 | 141 / 1000(63 to 286) | 168(1) |
| Mannitol: Moderate or severe OHSS | OR 0.38(0.22 to 0.64) | 517 / 1000 | 289 / 1000(191 to 407) | 226(1) |
| Mannitol: Pregnancy rate | OR 0.85(0.47 to 1.55) | 276 / 1000 | 245 / 1000(152 to 371) | 226(1) |
Primary/Secondary Keywords