The Diagnosis and Management of Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian stimulation (COS) as part of assisted reproductive technologies (ART). While the safety and efficacy of ART is well established, physicians should always be aware of the risk of OHSS in patients undergoing COS, as it can be fatal. This article will briefly present the pathophysiology of OHSS, including the key role of vascular endothelial growth factor (VEGF), to provide the foundation for an overview of current techniques for the prevention of OHSS. Risk factors and predictive factors for OHSS will be presented, as recognizing these risk factors and individualizing the COS protocol appropriately is the key to the primary prevention of OHSS, as the benefits and risks of each COS strategy vary among individuals. Individualized COS (iCOS) could effectively eradicate OHSS, and the identification of hormonal, functional and genetic markers of ovarian response will facilitate iCOS. However, if iCOS is not properly applied, various preventive measures can be instituted once COS has begun, including cancelling the cycle, coasting, individualizing the human chorionic gonadotropin trigger dose or using a gonadotropin-releasing hormone (GnRH) agonist (for those using a GnRH antagonist protocol), the use of intravenous fluids at the time of oocyte retrieval, and cryopreserving/vitrifying all embryos for subsequent transfer in an unstimulated cycle. Some of these techniques have been widely adopted, despite the scarcity of data from randomized clinical trials to support their use.

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“…A recent review of the clinical aspects of OHSS provides detailed recommendations for management according to patient diagnosis and risk [79]. …”

Section: Introductionmentioning

confidence: 99%

Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment

Fiedler

Ezcurra

2012

Reprod Biol Endocrinol

117

137

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“…The goal of treatment is to preserve intravascular blood volume. Guidelines and most studies (Sansone et al ., 2011; RCOG, 2016; Shmorgun et al ., 2011; Vandoorne et al ., 2010) recommend use of macromolecules like albumin to maintain this intravascular fluid. Albumin is a blood-derived plasma expander, and it has been suggested that the binding and transport properties of human albumin result in binding and inactivation of the vasoactive intermediates responsible for the pathogenesis of OHSS.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound examination showed comparable ovarian size (75x48x51mm for the right ovary and 71x57x63mm for the left ovary), but significant ascites in the Douglas pouch (81x27x12mm), in the Retzius space (72x73x57mm) and around the liver (95x43mm). According to the SOGC-CFAS clinical practice guidelines (Shmorgun et al ., 2011), the OHSS was classified as severe, based on hemoconcentration, hyponatremia, elevated liver enzymes, presence of significant ascites, pleural effusion and clinical symptoms.…”

Section: Case Reportmentioning

confidence: 99%

Unsuspected adverse effect of albumin in severe ovarian hyperstimulation syndrome: a case report

Darii

Pavlovic

Doroftei

et al. 2019

JBRA Assisted Reproduction

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Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complications of in vitro fertilization (IVF). We present a case of OHSS maintained and aggraved by albumin administration. A 29-year-old woman with severe OHSS was treated with albumin perfusion according to the guidelines. The albumin was administered in order to maintain intravascular oncotic pressure and to reverse the shift of fluid from the intravascular to the third space, but this therapeutic measure resulted in inadvertent maintenance of the syndrome. The treatment of OHSS is a delicate balance between invasive approaches, such as paracentesis, administration of colloids and minimal therapeutic intervention, particularly during pregnancy.

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“…This subsequently leads to an increase in LH, FSH, testosterone, oestradiol and progesterone levels (figure 1). 2 This is in contrast to the iatrogenic ovarian hyperstimulation syndrome seen in women who have undergone supraphysiological ovarian stimulation with exogenous gonadotropins causing vasoactive peptides release from granulosa cells of the hyperstimulated ovaries 3. In these adult cases, the hyperstimulation is iatrogenic and does not result from a lack of response to the physiological negative feedback of gonadotropins on pituitary hormone secretion.…”

Section: Introductionmentioning

confidence: 99%

Atypical case of preterm ovarian hyperstimulation syndrome

2017

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Preterm ovarian hyperstimulation syndrome is a rare syndrome in which preterm infant girls have hypogastric, upper leg and labial swelling accompanied by elevated serum oestradiol levels and ovarian follicular cysts on ultrasound. Our case is an infant born at 23 weeks gestational age who at 30 weeks postconceptional age (PCA) developed elevated 17-hydroxyprogesterone on her newborn screen with associated clitoromegaly and a ventral groove on the inferior aspect of the erectile tissue. An initial pelvic ultrasound at 32 weeks PCA demonstrated a normal appearing uterus, but the ovaries were not visualised. At 39 weeks PCA, follicular ovarian cysts were noted bilaterally (31×26×21 mm on left and 38×25×36 mm on right). Without treatment, oestradiol and testosterone levels began normalising by 42 weeks PCA. After this point, the right ovarian cysts had resolved and the left ovarian cyst continued to diminish in size.

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The Diagnosis and Management of Ovarian Hyperstimulation Syndrome

Cited by 45 publications

References 32 publications

Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment

Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment

Unsuspected adverse effect of albumin in severe ovarian hyperstimulation syndrome: a case report

Atypical case of preterm ovarian hyperstimulation syndrome

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