Overview
Ovarian hyperstimulation syndrome (OHSS) is a serious complication associated with assisted reproductive technology (ART), characterized by ovarian enlargement, ascites, pleural effusion, and potentially life-threatening complications like thromboembolism and multiorgan failure 15.Diagnosis
Key Symptoms: Ovarian enlargement, ascites, pleural effusion, abdominal pain, nausea, vomiting, weight gain, and in severe cases, dyspnea and hypotension 15.
Recommended Tests:
- Laboratory: Elevated hematocrit, low serum albumin, elevated white blood cell count 1.
- Imaging: Ultrasound to assess ovarian volume and presence of ascites 1.
Grading: Typically classified as mild, moderate, or severe based on clinical and laboratory criteria 1.Management
First-Line Treatments:
- Volume Replacement: Use of crystalloids or colloids to maintain intravascular volume 15.
- Antiemetics: For symptom management of nausea and vomiting 1.
Adjunctive Treatments:
- Human Chorionic Gonadotropin (hCG) Blockers: Drugs like danazol or cabergoline to reduce hCG effects 1.
- Surgical Intervention: Reserved for ovarian torsion or rupture 5.
- Supportive Care: Management of thromboembolic risk with anticoagulation, respiratory support, and renal/hepatic support as needed 13.Special Populations
Pregnancy: Specific management strategies may vary; close monitoring and individualized care are crucial 1.
Pediatrics: OHSS in preterm infants can present with high estradiol levels and requires careful monitoring and hormonal therapy like medroxyprogesterone acetate 7.
Comorbidities: Patients with pre-existing conditions like renal or hepatic dysfunction require heightened vigilance and multidisciplinary care, especially in severe cases 3.Key Recommendations
Identify High-Risk Patients: Implement risk stratification to identify individuals at higher risk for OHSS and tailor stimulation protocols accordingly (Evidence: Strong 1).
Optimize Stimulation Protocols: Adjust gonadotropin dosages and monitor closely to prevent excessive ovarian stimulation (Evidence: Strong 1).
Early Intervention: Initiate preventive measures and early treatment protocols for suspected OHSS to mitigate severity (Evidence: Moderate 13).
Multidisciplinary Approach: Employ a team approach involving reproductive endocrinologists, intensivists, and other specialists for severe cases (Evidence: Expert opinion 3).References
1 . Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertility and sterility 2024. link
2 Wittels KA, Mayes KD, Eyre A. Ovarian Hyperstimulation Syndrome: A Simulation Case for Emergency Medicine Residents. MedEdPORTAL : the journal of teaching and learning resources 2022. link
3 Kasaven LS, Goumenou A, Adegoke K. Multiorgan failure associated with severe ovarian hyperstimulation syndrome due to inadequate protocol optimisation: a rare but avoidable complication. BMJ case reports 2018. link
4 Wang R, Yan Y, Zhan S, Song L, Sheng W, Song X et al.. Diagnosis of ovarian vein syndrome (OVS) by computed tomography (CT) imaging: a retrospective study of 11 cases. Medicine 2014. link
5 Varma TR, Patel RH. Ovarian hyperstimulation syndrome. A case history and review. Acta obstetricia et gynecologica Scandinavica 1988. link
6 Moodley TR, Pillay M. Ovarian hyperstimulation syndrome. A case report. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1985. link
7 Sedin G, Bergquist C, Lindgren PG. Ovarian hyperstimulation syndrome in preterm infants. Pediatric research 1985. link