Consensus statement on prevention and detection of ovarian hyperstimulation syndrome

Abstract

OHSS is a serious condition for which there are a number of proven preventative strategies. OHSS is an area requiring ongoing research and development of a universally agreed definition will allow development of optimal prevention strategies and facilitate improved early detection of women at risk.

Prevention and management of ovarian hyperstimulation syndrome

“…The only other smaller RCT (n=145) similarly reported a reduction in OHSS with aspirin [15]. To date there has not been widespread adoption of aspirin, with some, but not all recent guidelines supporting its use due to the limited evidence base [1,2].…”

“…A wide range of alternative strategies including administration of luteal antagonist, letrozole, methyprednisolone, ketocanazole administration have been reported as being associated with a reduction in OHSS but the data on these treatments is limited [1,2]. Witholding FSH for up to 4 days (coasting), has not been associated wth a reduced risk of OHSS in RCTs [1,2].…”

“…Unfortunately failure to comprehensively adopt these strategies, means that ovarian hyperstimulation syndrome (OHSS) is a potentially lethal iatrogenic complication of the early luteal phase and/or early pregnancy after ovarian stimulation [1][2][3]. OHSS has historically been classified on severity (mild, moderate, severe, critical) ( Table 1) and by timing early (<9days) or late.…”

“…Focus has however shifted to moderate or severe OHSS which affects 2-3% of patients, as milder forms may develop in 20-30% of all in-vitro fertilisation (IVF) cycles, and it is the moderate/severe OHSS which incurs risk of acute renal insufficiency, acute respiratory distress syndrome and venous thromboembolism [4]. Given the multiple classification systems available and potential for ascertainment bias, an objective reproducible pathway for OHSS classification has now been proposed for use in clinical trial reporting ( Figure 1, Table 2), which complements existing clinical guidelines [1][2][3][4].…”

“…It is this induction by hCG that ensures OHSS is primarily self-limiting in those who are not pregnant but also why it may persist into the first trimester due to ongoing stimulation of the ovaries. Recognition of the critical contribution of hCG and VEGF to the pathogenesis of OHSS has facilitated successful treatment modification incorporating gonadotrophin antagonist control, agonist triggering and novel dopamine agonist preventative measures [1,2]. The current review aims to summarise the latest evidence on the identification of patients at risk of OHSS, preventative measures and the treatment of OHSS.…”