Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment.
Publication/Presentation Date
8-1-1992
Abstract
OBJECTIVE: To overview the world literature on ovarian hyperstimulation syndrome (OHSS) and modes of prevention and treatment of OHSS.
STUDY SELECTION: All the pertinent literature on OHSS, its prevention, and strategies for treatment were reviewed.
PREVENTION: Key to prevention is proper identification of the population at risk, which includes women with either the hormonal or the morphological signs of polycystic ovarian disease, high serum estradiol (E2) before human chorionic gonadotropin (hCG) administration (E2 greater than 4,000 pg/mL), multiple follicular response (greater than 35), younger age, and lean habitus. When a high risk situation is recognized, ovulatory dose of hCG may be reduced, avoided (with cycle cancellation), or substituted by gonadotropin-releasing hormone or its agonist. Luteal support with hCG is to be bypassed. To minimize risk of OHSS, endogenous pregnancy-drived hCG may be eluded by judicious cryopreservation of all embryos. Last, follicular aspiration will allow higher levels of E2 and larger number of follicles to be matured with lesser risk of OHSS than conventional ovulation induction without follicular aspiration.
TREATMENT: In-house for the severe and intensive care for the critical form. Meticulous fluid and electrolyte balance using both crystalloids and colloids (albumin) until hemoconcentration abates. Paracentesis is indicated for tight ascites, deteriorating kidney functions, and symptomatic relief. Diuretics may be prudently used once hemodilution is achieved. Dopamine drip may be used as a renal rescue, whereas heparin is indicated for thromboembolic phenomena and surgery reserved for abdominal catastrophies. Therapeutic interruption of an early gestation may be lifesaving when all other measures have failed.
CONCLUSIONS: Although severe and critical OHSS may not be completely avoided, early recognition of high-risk factors, judicious prevention schemes, and treatment strategies should reduce the complication and long-term sequelae of this iatrogenic syndrome.
Volume
58
Issue
2
First Page
249
Last Page
261
ISSN
0015-0282
Published In/Presented At
Navot, D., Bergh, P. A., & Laufer, N. (1992). Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertility and sterility, 58(2), 249–261. https://doi.org/10.1016/s0015-0282(16)55188-7
Disciplines
Medicine and Health Sciences
PubMedID
1633889
Department(s)
Department of Obstetrics and Gynecology
Document Type
Article