Prevention and management of ovarian hyperstimulation syndrome

Abstract

Ovarian hyperstimulation syndrome (OHSS) is a serious iatrogenic complication of ovarian stimulation. It is feasible to identify patients at risk, modify stimulation strategies to ameliorate risk, and initiate out-patient treatments that alter disease pathophysiology to reduce disease severity. Mitigation of OHSS risk and severity, through innovative approaches prior to treatment, during treatment and after treatment should now be the standard care. This review summarizes recent developments and provides recommendations on the prevention and treatment of OHSS.3

Pregnancy-related complications and perinatal outcomes resulting from transfer of cryopreserved versus fresh embryos in vitro fertilization: a meta-analysis

“…First, previous studies have proven that the supraphysiologic levels of hormones such E 2 , P, and stress hormones (43,44) during the initial ovarian stimulation phase of IVF could lead to morphologic and biochemical modifications and consequently impaired endometrial receptivity with the use of fresh ET as well as affecting the early developing embryo (45), reducing the implantation rates and leading to increased risks of adverse perinatal outcomes (30,46). Next, there is still the increased risk for severe ovarian hyperstimulation syndrome (OHSS), which is a potentially life-threatening serious complication of ovarian stimulation in fresh cycles (47,48). FET can reduce the risk of OHSS without affecting endometrial receptivity after the use of GnRH agonist (49).…”

Sp1 regulates steroidogenic genes and LHCGR expression in primary human luteinized granulosa cells

“…The risk of OHSS complications is a significant clinical problem due to the increased demand for IVF treatments [40]. The main culprit leading to OHSS development are an exaggerated response to hCG leading to abnormally high levels of VEGF [41]. The release of VEGF from LGCs to circulation has been shown to increase capillary permeability and fluid retention [42][43][44].…”

Comparative analysis of abdominal fluid cytokine levels in ovarian hyperstimulation syndrome (OHSS)

“…Despite greater insights into the etiology of OHSS, the exact pathomechanism remains unclear. It has been hypothesized that local vasoactive mediators, such as vascular endothelial growth factor (VEGF), substances belonging to the renin-angiotensin system, and cytokines such as interleukin (IL)-6 and IL-8, play major roles in disease pathogenesis [5][6][7][8][9]. These factors can potentially induce fluid redistribution and massive extravasation, thereby resulting in a state of hypovolemic hyponatremia with hemoconcentration, as well as hypercoagulability [8,9].…”