Curr Health Sci J, vol. 39, no. 3, 2013

Principles of Diagnosis and Management in the Ovarian Hyperstimulation Syndrome

[Updates]

ALINA ONOFRIESCU1, A. LUCA2, A.BORS3, M.HOLICOV2, M. ONOFRIESCU2, CARMEN VULPOI4

1Department of Diabetology, University of Medicine and Pharmacy of Iasi; 2Department of Obstetrics and-Gynecology, University of Medicine and Pharmacy of Iasi; 3Fertility Reproductive Medical Center Omini Clinic Iasi; 4Department of Endocrinology, University of Medicine and Pharmacy of Iasi


Abstract:

Ovarian hyperstimulation syndrome (OHSS) is the most serious consequence of ovulation induction and in vitro fertilisation (IVF), potentially resulting in death in its extreme manifestation. How best to manage this condition has been the subject of considerable study, with primary emphasis on risk recognition before commencing the IVF stimulation sequence. The exact etiology of OHSS remains unknown. The aim of this guideline is to provide clinicians with up-to-date information about the diagnosis and treatment of OHSS, based upon the best available evidence. This guideline covers outpatient management, criteria for hospital admission and basic inpatient management. Intensive care management of OHSS is not covered in detail. OHSS is an exaggerated response to ovulation induction with FSH and HCG. OHSS is a self-limiting disorder with a broad spectrum of clinical manifestations related to increased capillary permeability and fluid retention mediated by many inflammatory mediators including vascular endothelium growth factor. OHSS is a systemic disease resulting from vasoactive products released by hyperstimulated ovaries. The pathophysiology of OHSS is characterized by increased capillary permeability, leading to leakage of fluid from the vascular compartment, with third space fluid accumulation and intravascular dehydration. Severe manifestations include a tendency to develop thrombosis, renal and liver dysfunction and acute respiratory distress syndrome (ARDS), causing serious morbidity. The role of this guideline is to outline the risk factors, clinical features and appropriate management of severe OHSS. The guidelines also aim at assisting the determination of the appropriate site of care.


Keywords:
Ovarian hyperstimulation, risk factors, polycystic ovaries syndrome



Corresponding:
Alina Onofriescu, MD, PhD Student, Department of Diabetology, University of University of Medicine and Pharmacy of Iasi , 16 Universitatii Street, 700115, Iasi, Romania, amarige_u82@yahoo.com


DOI 10.12865/CHSJ.39.03.12 - Download PDF