Review of clinical course and treatment of ovarian hyperstimulation syndrome (OHSS)

Abstract

The ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy. This complication is unusual as it is not the consequence of a treatment which is vital or mandatory for the patient's health. Nevertheless, it can be accompanied by severe morbidity and may even be fatal. Data pertaining to the clinical course and consequences of OHSS in women and its treatment were searched using Medline, Current Contents and PubMed. To date, only a few studies have collected a large number of cases of OHSS. The clinical course of OHSS may involve, according to its severity and the occurrence of pregnancy, electrolytic imbalance, neurohormonal and haemodynamic changes, pulmonary manifestations, liver dysfunction, hypoglobulinaemia, febrile morbidity, thromboembolic phenomena, neurological manifestations and adnexal torsion. Treatment of the acute phase relies only on an empirical and symptomatic approach. The general approach will be adapted to the levels of severity. Specific approaches such as paracentesis, pleural puncture, surgical approach of OHSS and specific medication during OHSS were evaluated sporadically. More adequate treatment methods would require a better understanding of the underlying pathophysiological mechanisms, to promote an aetiological therapeutic approach. Properly conducted studies, including large numbers of patients are required in order to determine the best method of prevention and management.

Ovarian hyperstimulation syndrome after gonadotropin-releasing hormone agonist triggering and “freeze-all”: in-depth analysis of genetic predisposition

“…While its general incidence is approximately 2 to 3 % per cycle [2,1], OHSS can occur in up to a third of all cases of high-risk patients [3,4], notably those with a previous history of OHSS or polycystic ovary morphology (PCOM)/polycystic ovary syndrome (PCOS). In its severe form, this syndrome has the potential to cause serious morbidity or mortality, mainly due to the increased occurrence of ovarian torsion and thromboembolism [5].…”

Severe Ovarian Hyperstimulation Syndrome Complicated by <i>Stenotrophomonas maltophilia</i> Peritonitis: A Case Report and Literature Review

“…Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Proteus mirabilis and Proteus vulgaris have been reported to be the most common pathogens in such cases (1,19,30). However, our patient developed bacterial peritonitis secondary to Stenotrophomonas maltophilia, a very uncommon pathogen.…”

“…Abdominal distension, abdominal discomfort, nausea, vomiting and diarrhea are common clinical features of this syndrome (19). These symptoms result as a consequence of ovarian stimulation, which results in ovarian enlargement and the accumulation of exudative ascites (20).…”

Derrame pleural secundário à hiperestimulação ovariana

“…In addition, ascites, progressive ovarian enlargement, and paralytic ileus contribute to a worsening of respiratory distress. (9) The abdominal discomfort commonly reported by patients is not necessarily due to ascites, but to the volume of each hyperstimulated ovary, which can be over 500 cm 3 , as occurred in one of the three cases described herein. Ascites formation is not related to rupture or extravasation of the enlarged ovaries but rather to the mechanisms of increased capillary permeability.…”