Ovarian hyperstimulation syndrome (OHSS)

It is day 7 after her trigger. She rings the unit at midnight: she cannot do up her trousers, she is breathless lying flat, and she has gained 3 kilograms in two days. The retrieval went well — 24 oocytes — and that is exactly the problem. OHSS is the price a fertile ovary can pay for a successful stimulation, and the registrar who understands the capillary-leak physiology and the prevention ladder is the one who keeps these patients out of intensive care.^[8][17]

Overview and definition

OHSS is a potentially life-threatening iatrogenic complication of ovarian stimulation in assisted reproduction, characterised by cystic ovarian enlargement and an acute shift of fluid from the intravascular space into the third space.^[9][10] The Cochrane prevention review frames the mechanism plainly: the syndrome is marked by enlarged ovaries and an acute fluid shift into the third space, producing bloating, an increased risk of venous thromboembolism and decreased organ perfusion.^[10]

Two numbers anchor the topic: most cases are mild, but moderate or severe OHSS appears in roughly 3% to 8% of IVF cycles.^[10] Severity, not ovarian size, is what matters — and severity is graded by the detectability of ascites and by end-organ compromise.^[2][3]

References18ShowHide

1. [1]Golan A, Ron-el R, Herman A, Soffer Y, Weinraub Z, Caspi E Ovarian hyperstimulation syndrome: an update review Obstet Gynecol Surv, 1989.PMID 2660037
2. [2]Golan A, Weissman A Symposium: Update on prediction and management of OHSS. A modern classification of OHSS Reprod Biomed Online, 2009.PMID 19573287
3. [3]Rizk B, Aboulghar M Modern management of ovarian hyperstimulation syndrome Hum Reprod, 1991.PMID 1806565
4. [4]Aboulghar MA, Mansour RT Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures Hum Reprod Update, 2003.PMID 12859048
5. [5]McClure N, Healy DL, Rogers PA, Sullivan J, Beaton L, Haning RV Jr, Connolly DT, Robertson DM Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome Lancet, 1994.PMID 7913160
6. [6]Abramov Y, Barak V, Nisman B, Schenker JG Vascular endothelial growth factor plasma levels correlate to the clinical picture in severe ovarian hyperstimulation syndrome Fertil Steril, 1997.PMID 9022600
7. [7]Mathur RS, Akande AV, Keay SD, Hunt LP, Jenkins JM Distinction between early and late ovarian hyperstimulation syndrome Fertil Steril, 2000.PMID 10785214
8. [8]Papanikolaou EG, Pozzobon C, Kolibianakis EM, Camus M, Tournaye H, Fatemi HM, Van Steirteghem A, Devroey P Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles Fertil Steril, 2006.PMID 16412740
9. [9]Practice Committee of the American Society for Reproductive Medicine Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline Fertil Steril, 2016.PMID 27678032
10. [10]Tang H, Mourad SM, Wang A, Zhai SD, Hart RJ Dopamine agonists for preventing ovarian hyperstimulation syndrome Cochrane Database Syst Rev, 2021.PMID 33851429
11. [11]Youssef MA, Van der Veen F, Al-Inany HG, Mochtar MH, Griesinger G, Nagi Mohesen M, Aboulfoutouh I, van Wely M Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology Cochrane Database Syst Rev, 2014.PMID 25358904
12. [12]D'Angelo A, et al. Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome Cochrane Database Syst Rev, 2017.PMID 28535578
13. [13]Al-Inany HG, Youssef MA, Ayeleke RO, Brown J, Lam WS, Broekmans FJ Gonadotrophin-releasing hormone antagonists for assisted reproductive technology Cochrane Database Syst Rev, 2016.PMID 27126581
14. [14]Humaidan P, et al. GnRHa trigger and individualized luteal phase hCG support according to ovarian response to stimulation: two prospective randomized controlled multi-centre studies in IVF patients Hum Reprod, 2013.PMID 23753114
15. [15]Corbett S, Shmorgun D, Claman P; Reproductive Endocrinology Infertility Committee The prevention of ovarian hyperstimulation syndrome J Obstet Gynaecol Can, 2014.PMID 25574681
16. [16]Ovarian Stimulation TEGGO; ESHRE Guideline Group on Ovarian Stimulation ESHRE guideline: ovarian stimulation for IVF/ICSI Hum Reprod Open, 2020.PMID 32395637
17. [17]Tan BK, Mathur R; British Fertility Society Policy and Practice Subcommittee Management of ovarian hyperstimulation syndrome guidelines. Produced on behalf of the BFS Policy and Practice Committee Hum Fertil (Camb), 2013.PMID 23705631
18. [18]Sachar P, et al. Young Ischemic Stroke in Association with Ovarian Hyperstimulation Syndrome J Stroke Cerebrovasc Dis, 2016.PMID 27396697