| Review title and comparison intervention/control | Assumed risk with comparator | Corresponding risk with intervention | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments |
| D'Angelo 2007 | Embryo freezing for preventing ovarian hyperstimulation syndrome (Embryo freezing vs fresh transfer) | Overall OHSS: 60 per 1000 | Overall OHSS: 125 per 1000 (62 to 240) | OR 1.12 (0.01 to 2.29) | 125 (1 study) | Low | Imprecision, number of events < 300 Evidence based on a single open‐label study with insufficient methodological details provided |
| D'Angelo 2007 | Embryo freezing for preventing ovarian hyperstimulation syndrome (Embryo freezing vs intravenous albumin) | Moderate or severe OHSS: 77 per 1000 | Moderate or severe OHSS: 308 per 1000 (41 to 824) | OR 5.33 (0.51 to 56.24) | 26 (1 study) | Very low | Imprecision, number of events < 300 Evidence based on a single open‐label trial |
| D'Angelo 2011 | Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome | Moderate or severe OHSS: 265 per 1000 | Moderate or severe OHSS: 58 per 1000 (11 to 241) | OR 0.17 (0.03 to 0.88) | 68 (1 study) | Very low | Imprecision, number of events < 300 Evidence based on a single conference abstract
Insufficient methodological details provided |
| Tang 2016 | Dopamine agonists for preventing ovarian hyperstimulation syndrome | Moderate or severe OHSS: 286 per 1000 | Moderate or severe OHSS: 97 per 1000 (71 to 135) | OR 0.27 (0.19 to 0.39) | 2091 (16 studies)) | Moderate | Imprecision, number of events < 300 Lack of details for allocation concealment and blinding, selective reporting |
| Youssef 2016b | Volume expanders for the prevention of ovarian hyperstimulation syndrome (human albumin vs placebo/no treatment) | Moderate or severe OHSS: 122 per 1000 | Moderate or severe OHSS: 85 per 1000 (61 to 177) | OR 0,67 (0.47 to 0.95) | 1452 (7 studies) | Very low | Imprecision, number of events < 300 Lack of details on allocation concealment and selective reporting |
| Youssef 2016b | Volume expanders for the prevention of ovarian hyperstimulation syndrome (HES vs placebo) | Moderate or severe OHSS: 164 per 1000 | Moderate or severe OHSS: 50 per 1000 (23 to 104) | OR 0.27 (0.12 to 0.59 | 272 (2 studies) | Very low | Imprecision, number of events < 300 Lack of details on allocation concealment and selective reporting |
| Youssef 2016b | Volume expanders for the prevention of ovarian hyperstimulation syndrome (mannitol vs placebo) | Moderate or severe OHSS: 517 per 1000 | Moderate or severe OHSS: 289 per 1000 (191 to 407) | OR 0.38 (0.22 to 0.64) | 226 (1 study) | Low | Imprecision, number of events < 300 Lack of details on allocation concealment and selective reporting |
| Youssef 2016 | Recombinant versus urinary human chorionic gonadotrophin for final oocyte maturation triggering in IVF and ICSI cycles (r‐hCG vs u‐hCG) | Overall OHSS: 27 per 1000 | Overall OHSS:40 per 1000 (15 to 102) | OR 0.39 (0.25 to 0.61) | 374 (3 studies) | Moderate | Imprecision, number of events < 300 One of the trials lacked methodological details on randomisation, allocation concealment and blinding |
| Youssef 2016 | Recombinant versus urinary human chorionic gonadotrophin for final oocyte maturation triggering in IVF and ICSI cycles (r‐LH vs u‐hCG) | Overall OHSS: 10 per 1000 | Overall OHSS: 17 per 1000 (11 to 84) | OR 1.76 (0.37 to 8.45) | 417 (3 studies) | Low | Imprecision, number of events < 300 One of the trials lacked adequate methodological details |
| Youssef 2014 | Gonadotropin‐releasing hormone agonist versus hCG for oocyte triggering in antagonist‐assisted reproductive technology | Overall OHSS: 5 per 1000 | Overall OHSS: 1 per 1000 (0 to 2) | OR 0.15 (0.05 to 0.47) | 989 (9 studies) | Moderate | Imprecision, number of events < 300 All studies at high risk of bias in 1 or more domains None clearly reported blinded outcome assessment |
| Tso 2014 | Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome. | Overall OHSS: 270 per 1000 | Overall OHSS: 97 per 1000 (62 to 153) | OR 0.29 (0.18 to 0.49) | 798 (8 studies) | Moderate | Imprecision, number of events < 300 |
| Pouwer 2015 | Long‐acting FSH versus daily FSH for women undergoing assisted reproduction (low dose) | Overall OHSS: 47 per 1000 | Overall OHSS: 57 per 1000 (26 to 125) | RR 1.22 (0.56 to 2.66) | 645 (3 studies) | Moderate | Imprecision, number of events < 300 |
| Pouwer 2015 | Long‐acting FSH versus daily FSH for women undergoing assisted reproduction (medium dose) | Overall OHSS: 63 per 1000 | Overall OHSS: 60 per 1000 (45 to 85) | RR 0.96 (0.68 to 1.35) | 3075 (5 studies) | Low | Imprecision, number of events < 300 Confidence intervals compatible with clinically meaningful benefit in either arm or with no effect, plus high risk of attrition bias in 2 studies |
| Pouwer 2015 | Long‐acting FSH versus daily FSH for women undergoing assisted reproduction (high dose) | Overall OHSS: 0 per 1000 | Overall OHSS: 0 per 1000 (0 to 0) | RR 1.73 (0.09 to 32.75) | 33 (1 study) | Very low | Imprecision, number of events < 300 High risk of attrition bias |
| Gibreel 2012 | Clomiphene citrate in combination with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilisation (clomiphene + gonadotropins vs gonadotropins) | Overall OHSS: 50 per 1000 | Overall OHSS:12 per 1000 (5 to 27) | OR 0.23 (0.1 to 0.52) | 1559 (5 studies) | Low | Imprecision, number of events < 300 Very wide 95% confidence interval crossing the threshold points of appreciable benefit or harm, which is 25% |
| Allersma 2013 | Natural cycle IVF for subfertile couples (natural cycle vs conventional IVF) | Overall OHSS: 67 per 1000 | Overall OHSS: 13 per 1000 (1 to 393) | OR 0.10 (0.01 to 4.06) | 60 (1 study) | Very low | Imprecision, number of events < 300 Only 1 study reporting on OHSS Allocation concealment method not reported |
| van der Linden 2015 | Luteal phase support for ART cycles (hCG versus placebo/no treatment) | Overall OHSS: 41 per 1000 | Overall OHSS: 155 per 100 (76 to 292) | OR 4.28 (1.191 to 9.6) | 387 (1 study) | Low | Imprecision, number of events < 300 Poor reporting of study methods |
| van der Linden 2015 | Luteal phase support for ART cycles (progesterone vs hCG regimens) | Overall OHSS: 126 per 1000 | Overall OHSS: 72 per 1000 (31 to 162) | OR 0.54 (0.22 to 1.34) | 615 (4 studies) | Low | Imprecision, number of events < 300 Poor reporting of study methods |
| van der Linden 2015 | Luteal phase support for ART cycles (progesterone + GnRH agonist) | Overall OHSS: 50 per 1000 | Overall OHSS: 50 per 1000 (17 to 137) | OR 1.00 (0.33 to 3.01) | 300 (1 study) | Very low | Imprecision, number of events < 300 Poor reporting of study methods |
| van der Linden 2015 | Luteal phase support for ART cycles (progesterone vs progesterone + oestrogens) | Overall OHSS: 39 per 1000 | Overall OHSS: 22 per 1000 (8 to 62) | OR 0.56 (0.2 to 1.63) | 461 (2 studies) | Low | Imprecision, number of events < 300 Poor reporting of study methods |
| Al‐Inany 2016 | Gonadotrophin‐releasing hormone antagonists for assisted reproductive technology (GnRH antagonist vs GnRH agonist) | Overall OHSS: 114 per 1000 | Overall OHSS: 73 per 1000 (62 to 85) | OR 0.61
(0.51 to 0.72) | 7944 (36 studies) | Moderate | Methodological limitations including poor allocation concealment and lack of blinding |
| Yossry 2006 | In vitro fertilisation versus tubal reanastomosis (sterilisation reversal) for subfertility after tubal sterilisation (IVF vs tubal reanastomosis) | NA | NA | NA | NA | NA | Empty review |
| Pandian 2015 | In vitro fertilisation for unexplained subfertility (IVF vs IUI + gonadotropins/clomiphene citrate) | Overall OHSS: 58 per 1000 | Overall OHSS: 66 per 1000 (26 to 158) | OR 1.15 (0.43 to 3.06) | 324 (2 studies) | Low | Imprecision, number of events < 300 Only 2 studies on OHSS reported |
| Albuquerque 2013 | Depot versus daily administration of gonadotrophin releasing hormone agonist protocols for pituitary desensitization in assisted reproduction cycles (depot vs daily gonadotropins) | Overall OHSS: 3 per 100 | Overall OHSS: 2 per 100
(1 to 6) | OR 0.84
(0.29 to 2.42) | 570 (5 studies) | Low | Most studies were classified as at unclear risk of bias for all domains Imprecision, number of events < 300
Studies were insufficient to assess publication bias |
| van Wely 2011 | Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles (rFSH vs HMG/HMG‐HP) | Overall OHSS: 17 per 1000 | Overall OHSS: 17 per 1000 (10 to 28) | OR 1.00 (0.58 to 1.71) | 3197 (11 studies) | High | Imprecision, number of events < 300 |
| van Wely 2011 | Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles (rFSH vs FSH‐P) | Overall OHSS: 28 per 1000 | Overall OHSS:49 per 1000 (25 to 95) | OR 1.79 (0.89 to 3.62) | 1490 (6 studies) | Higha | Imprecision, number of events < 300 |
| van Wely 2011 | Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles (rFSH vs FSH‐HP) | Overall OHSS: 28 per 1000 | Overall OHSS: 31 per 1000 (20 to 48) | OR 1.11 (0.70 vs 1.75) | 3053 (14 studies) | Higha | Two additional trials excluded in sensitivity analyses because it was unclear if data were reported according to ITT analysis (those were included for "Overall OHSS") |
| van Wely 2011 | Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles (rec‐hCG vs u‐hCG) | Overall OHSS: 19 per 1000 | Overall OHSS: 22 per 1000 (16 to 30) | OR 1.18 (0.86 vs 1.61) | 7740 (32 studies) | Higha | Imprecision number of events < 300 |
| Martins 2013 | FSH replaced by low‐dose hCG in the late follicular phase versus continued FSH for assisted reproductive techniques (low‐dose hCG vs FSH in late follicular phase) | Overall OHSS: 3 per 100 | Overall OHSS: 1 per 100 (0 to 4) | OR 0.30 (0.06 to 1.59) | 351 (5 studies) | Very low | Imprecision, number of events < 300 Inconsistency, high risk of bias |
| Smulders 2010 | Oral contraceptive pill, progestogen or oestrogen pre‐ treatment for ovarian stimulation protocols for women undergoing assisted reproductive techniques (OAC plus antagonist vs antagonist) | Overall OHSS: 17 per 1000 | Overall OHSS: 25 per 1000 (5 to 133) | OR 1.5 (0.26 to 8.8) | 234 (1 study) | Very low | Single study reporting on OHSS Imprecision, number of events < 300 Wide confidence intervals that cross line of no effect High risk of attrition bias |
| Smulders 2010 | Oral contraceptive pill, progestogen or oestrogen pre‐ treatment for ovarian stimulation protocols for women undergoing assisted reproductive techniques (OAC plus antagonist vs agonist) | Overall OHSS: 55 per 1000 | Overall OHSS: 35 per 1000 (12 to 100) | OR 0.63 (0.21 to 1.92) | 290 (2 studies) | Very low | Imprecision, number of events < 300 One study at high risk of attrition bias |
| Kwan 2014 | Monitoring of stimulated cycles in assisted reproduction (IVF and ICSI) (transvaginal ultrasound + estradiol vs transvaginal ultrasound) | Overall OHSS: 36 per 1000 | Overall OHSS: 36 per 1000 (18 to 75) | OR 1.03 (0.48 to 2.20) | 781 (6 studies) | Low | Imprecision, number of events < 300 with wide confidence intervals Methods of randomisation inadequately described in 3 of 6 trials, allocation concealment inadequately described in all 6 trials and blinding inadequately described in 5 of 6 trials No definition of OHSS provided by authors of these 6 studies |
| Boomsma 2012 | Peri‐implantation glucocorticoid administration for assisted reproductive technology cycles (adjuvant glucocorticoids vs no glucocorticoids) | Overall OHSS: 194 per 1000 | Overall OHSS: 159 per 1000 (64 to 392) | OR 0.82 (0.33 to 2.02) | 151 (2 studies) | Low | Imprecision, number of events < 300 |
| Siristatidis 2016 | Aspirin for in vitro fertilisation (aspirin vs no treatment/placebo) | NA | NA | NA | NA | NA | Only 1 study reported on OHSS; no exact numbers or explanation of numerators/denominators given |
| Siristatidis 2009 | In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction (IVM vs conventional IVF) | NA | NA | NA | NA | NA | Empty review |
| Cheong 2013 | Acupuncture and assisted reproductive technology (acupuncture vs no acupuncture/sham acupuncture) | NA | NA | NA | NA | NA | No studies reported on OHSS |
| Mochtar 2007 | Recombinant luteinizing hormone (rLH) for controlled ovarian hyperstimulation in assisted reproductive cycles (combined rLH + FSH vs FSH ) | Overall OHSS: 20 per 1000 | Overall OHSS: 27 per 1000 (12 to 59) | OR 1.34 (0.58 to 3.09) | 986 (7 studies) | Low | Imprecision, number of events < 300 Some methodological details unclear |
| Duffy 2010 | Growth hormone for in vitro fertilization (growth hormone vs no treatment/placebo) | NA | NA | NA | NA | NA | Only 1 study reported on OHSS; however, no cases of OHSS were reported |
| Siristatidis 2015 | Gonadotropin‐releasing hormone agonist protocols for pituitary suppression in assisted reproduction (different protocols vs other protocol) | Overall OHSS: 20 per 1000 | Overall OHSS: 27 per 1000 (12 to 59) | OR 1.34 (0.58 to 3.09) | 986 (7 studies) | Low | Imprecision, number of events < 300 Some methodological details unclear |
| Showell 2013 | Antioxidants for female subfertility (antioxidants vs no treatment/placebo/other antioxidant) | NA | NA | NA | NA | NA | Although 3 studies reported on OHSS, no numbers were given, so effect size could not be calculated |
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