The Ovarian Hyperstimulation Syndrome

Pride, Sheila M.; James, Christopher; Yuen, Basil Ho

doi:10.1055/s-2007-1021446

Cited by 48 publications

(15 citation statements)

References 77 publications

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“…The incidence is 0.2–0.4% in in vitro fertilization cycles and 10–12% in severe OHSS 2 . Severe OHSS is reported to account for 0.56–6.5% of all cases of OHSS 1 . Seventy‐four percent of cases of thromboembolism following ovulation induction were associated with OHSS 3 .…”

Section: Discussionmentioning

confidence: 99%

“…2 Severe OHSS is reported to account for 0.56-6.5% of all cases of OHSS. 1 Seventy-four percent of cases of thromboembolism following ovulation induction were associated with OHSS. 3 Thromboembolism in the jugular vein occurs on average 43 Ϯ 30 days after ovulation induction.…”

Section: Discussionmentioning

confidence: 99%

“…Deep vein thrombosis (DVT) in the upper extremity and jugular veins is comparatively common (up to 10%) after severe ovarian hyperstimulation syndrome (OHSS). It has been surmised that the underlying hypercoagulable state characteristic of OHSS, due to high serum levels of estrogen and hemoconcentration, contributes to the development of DVT 1,2 . Nevertheless, thromboembolic events in OHSS, even during anticoagulation treatment, do not necessarily result in termination of the pregnancy.…”

Section: Introductionmentioning

confidence: 99%

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Severe ovarian hyperstimulation syndrome in a twin pregnancy after intracytoplasmic sperm injection

Cupisti¹,

Mueller²,

Strauß

et al. 2007

J of Obstet and Gynaecol

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A 35-year-old woman developed bilateral jugular thrombosis in the seventh gestational week in a twin pregnancy after severe ovarian hyperstimulation syndrome (OHSS) and intracytoplasmic sperm injection (ICSI). Due to progressive thrombosis and further complications despite anticoagulation therapy, the pregnancy was terminated in the ninth gestational week. Thromboembolic events are a serious complication associated with OHSS after assisted reproduction techniques. In these cases, a pregnancy can usually be protected by administering anticoagulation therapy, but our case shows that there may be exceptions to this. Screening for thrombophilia should be considered in patients who are at risk for OHSS and deep vein thrombosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Severe ovarian hyperstimulation syndrome in a twin pregnancy after intracytoplasmic sperm injection

Cupisti¹,

Mueller²,

Strauß

et al. 2007

J of Obstet and Gynaecol

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“…Presumably, VEGF produced in the ovary acts locally, spills into the peritoneal cavity, and is also secreted into the blood. It has been shown that some women who develop OHSS have elevated levels of VEGF in their blood (51,52), although the source of the VEGF is not clear, since vascular smooth muscle cells potently produce this growth factor. We found that ovarian FF contained the VEGF165 isoform by immunoblot.…”

Section: Discussionmentioning

confidence: 99%

Role of Vascular Endothelial Cell Growth Factor in Ovarian Hyperstimulation Syndrome

Levin

Rosen

Cassidenti

et al. 1999

Obstetrical & Gynecological Survey

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Controlled ovarian hyperstimulation with gonadotropins is followed by Ovarian Hyperstimulation Syndrome (OHSS) in some women. An unidentified capillary permeability factor from the ovary has been implicated, and vascular endothelial cell growth/permeability factor (VEGF) is a candidate protein. Follicular fluids (FF) from 80 women who received hormonal induction for infertility were studied. FFs were grouped according to oocyte production, from group I (0-7 oocytes) through group IV (23-31 oocytes). Group IV was comprised of four women with the most severe symptoms of OHSS. Endothelial cell (EC) permeability induced by the individual FF was highly correlated to oocytes produced ( r 2 ϭ 0.73, P Ͻ 0.001). Group IV FF stimulated a 63 Ϯ 4% greater permeability than FF from group I patients ( P Ͻ 0.01), reversed 98% by anti-VEGF antibody. Group IV fluids contained the VEGF165 isoform and significantly greater concentrations of VEGF as compared with group I (1,105 Ϯ 87 pg/ml vs. 353 Ϯ 28 pg/ml, P Ͻ 0.05). Significant cytoskeletal rearrangement of F-actin into stress fibers and a destruction of ZO-1 tight junction protein alignment was caused by group IV FF, mediated in part by nitric oxide. These mechanisms, which lead to increased EC permeability, were reversed by the VEGF antibody.

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“…On the molecular levels a variety of factors have been investigated including the ovarian rennin–angiotensin system, prostaglandins, histamine, prolactin, and vascular endothelial factor 19–26 . Estradiol levels have been correlated with the development of OHSS but administration of high doses of estradiol cannot induce the syndrome in an animal model 27 . In addition, a severe form of OHSS has been reported in a patient with 17–20 desmolase deficiency and very low estradiol levels 28,29 .…”

Section: Pathophysiology and Involved Factorsmentioning

confidence: 99%

Prevention and Management of Ovarian Hyperstimulation Syndrome

Vlahos

Gregoriou

2006

Annals of the New York Academy of Sciences

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The Ovarian Hyperstimulation Syndrome (OHSS) represents one of the biggest nightmares of all physicians involved in Assisted Reproductive Technologies (ART). Every year, several hundreds of women are hospitalized and to date several deaths have been reported. The pivotal event in the development of OHSS is the disruption of capillary integrity that results in leakage of intravascular fluid and proteins into third space. On the molecular level, human chorionic godadotropin (HCG) either exogenous or endogenous, functions as the triggering point for the production of vascular endothelial growth factor (VEGF) that is the main mediator to increase permeability on the vascular bed. Spontaneous OHSS has also been reported, either due to inappropriate activation of a mutant FSH receptor or due to very high levels of HCG during pregnancy. The available evidence on the several preventive and therapeutic approaches with special attention to level 1 evidence when available is also presented. OHSS is a self-resolving condition and the main role of the physician is to correct and maintain the intravascular volume, to support renal function and respiration and prevent thrombotic events. An algorithm on the management of OHSS on an outpatient basis and in the hospital is based on the previous mentioned principles.

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The Ovarian Hyperstimulation Syndrome

Cited by 48 publications

References 77 publications

Severe ovarian hyperstimulation syndrome in a twin pregnancy after intracytoplasmic sperm injection

Severe ovarian hyperstimulation syndrome in a twin pregnancy after intracytoplasmic sperm injection

Role of Vascular Endothelial Cell Growth Factor in Ovarian Hyperstimulation Syndrome

Prevention and Management of Ovarian Hyperstimulation Syndrome

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