Materiały źródłowe

• #1 Pathogenesis, clinical manifestations, and diagnosis of ovarian hyperstimulation syndrome – UpToDate

  https://www.uptodate.com/contents/pathogenesis-clinical-manifestations-and-diagnosis-of-ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian hyperstimulation (COH) for assisted reproduction technologies (ART). It occurs when the ovaries are hyperstimulated and enlarged due to fertility treatments (or rarely, mutations in the follicle-stimulating hormone [FSH] receptor), resulting in the shift of serum from the intravascular space to the third space, mainly to the abdominal cavity. In its severe form, OHSS is a life-threatening condition because it can cause venous or arterial thromboembolic events, including stroke and loss of perfusion of an extremity. […] The prevention and management of OHSS are discussed separately. (See „Prevention of ovarian hyperstimulation syndrome” and „Management of ovarian hyperstimulation syndrome”.) […] The incidence of moderate and severe OHSS while undergoing IVF has decreased in the last decade due to modern approaches in prevention strategies: use of gonadotropin-releasing hormone (GnRH) agonist triggering, dopamine agonists, and others.

• #1 Critical Ovarian Hyperstimulation Syndrome and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4818836/

  Ovarian hyperstimulation syndrome (OHSS) is a complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited, and spontaneous regression occurs. Mild manifestations of OHSS include transient lower abdominal discomfort, nausea, vomiting, diarrhea, and abdominal distension. Life-threatening OHSS can progress to adult respiratory distress syndrome, renal failure, hepatic injury, hemostatic imbalances, and thromboembolic episodes. […] Management of our patient was challenging because the patient had renal failure, respiratory failure, fluid overload, ascitis, pleural effusion, nosocomial infections, hypoxic brain injury, and poor GCS. The patient had life-threatening OHSS which required aggressive treatment including cardiac output and stroke volume variation monitoring to decide about the intravascular volume status. […] The physicians and intensivists should be familiar with the different clinical manifestations of OHSS and their management.

• #1 Prevention of ovarian hyperstimulation syndrome – UpToDate

  https://www.uptodate.com/contents/prevention-of-ovarian-hyperstimulation-syndrome

  The pathophysiology of OHSS is not fully understood, but the pivotal stimulus is typically exposure of granulosa cells from multiple follicles to administration of exogenous human chorionic gonadotropin (hCG) for final follicular maturation. hCG exposure leads to the overproduction of vascular endothelial growth factor (VEGF) by the ovaries, the release of vasoactive-angiogenic substances and increased vascular permeability, and loss of fluid to the third space. Signs and symptoms include enlarged ovaries, ascites, abdominal distention and discomfort, and other complications. […] There are two clinical forms of OHSS, both hCG related: the early-onset form (occurring in the first eight days after hCG administration) and the late-onset form (occurring nine or more days after hCG administration, related to pregnancy-induced hCG production).

• #1 Was the Cure Worse Than the Disease? Case 3: Ovarian Hyperstimulation Syndrome | Consultant360

  https://www.consultant360.com/article/was-cure-worse-disease-case-3-ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome (OHSS) is a rare adverse effect of assisted reproduction therapy. The syndrome is thought to result from increased capillary permeability, triggered by the expression of cytokines, that leads to fluid shifts from the intravascular space. OHSS is classified as mild, moderate, or severe based on clinical and laboratory findings. The incidence varies from 3.1% to 6% for moderate disease and from 0.25% to 1.8% for severe disease. Risk factors are young age, low body weight, polycystic ovary syndrome, and previous episodes. Symptoms include abdominal pain, nausea, vomiting, and weight gain. Transudative or exudative pleural effusions, pericardial effusions, tense ascites, oliguria, or hypovolemia can also occur. Laboratory findings may show hemoconcentration and increased renin, antidiuretic hormone, and vascular endothelial growth factor (VEGF) levels. VEGF can be used as a marker of disease severity. Respiratory alkalosis with hypoxemia is often present. Pelvic ultrasonography may reveal large ovaries with multiple cysts (necklace sign) as in this patient or ovarian torsion. OHSS usually resolves within 10 to 14 days after cessation of the gonadotropin-releasing hormone agonist. Mild and moderate OHSS require observation and bed rest. Severe OHSS requires intravascular support with isotonic saline. Some experts advocate the use of plasma expanders, such as albumin. Diuretics are contraindicated. Thoracentesis or paracentesis is often necessary to relieve dyspnea. Potentially fatal complications include hypovolemic shock, renal failure, acute respiratory distress syndrome, pulmonary emboli, cerebral vascular accidents, intracranial hypertension, and adnexal torsion requiring surgery.

• #1 Reddit – The heart of the internet

  https://www.reddit.com/r/IVF/comments/12ppgrm/ohss_survival_guide_for_mild_to_moderate_ohss/

  I’m by no means a medical professional but I did a lot of online research, Reddit thread reading, and got some great tips from my clinic. I wanted to collect the best info in one easy place because this subreddit has been a huge resource to me during this process and I wanted to contribute where I could. Please add any more tips you have in the comments! […] Officially, around 20-35% of IVF cycles result in mild OHSS and only 3-6% result in moderate OHSS. Although all IVF cycles overstimulate the ovaries to some extent. […] Risk factors include: age under 35, low body weight, large number of follicles, high levels of estrogen, PCOS, previous episodes of OHSS, HCG trigger shot. […] The general consensus is that most symptoms of mild to moderate OHSS should go away once you get your period (usually within a week or two of retrieval), however it can last for a few weeks longer in more severe cases.

• #1 Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment | Reproductive Biology and Endocrinology | Full Text

  https://rbej.biomedcentral.com/articles/10.1186/1477-7827-10-32

  Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian stimulation (COS) as part of assisted reproductive technologies (ART). […] Physicians should always be aware of the risk of OHSS in patients undergoing COS, as it can be fatal. […] Risk factors and predictive factors for OHSS will be presented, as recognizing these risk factors and individualizing the COS protocol appropriately is the key to the primary prevention of OHSS, as the benefits and risks of each COS strategy vary among individuals. Individualized COS (iCOS) could effectively eradicate OHSS, and the identification of hormonal, functional and genetic markers of ovarian response will facilitate iCOS. […] However, if iCOS is not properly applied, various preventive measures can be instituted once COS has begun, including cancelling the cycle, coasting, individualizing the human chorionic gonadotropin trigger dose or using a gonadotropin-releasing hormone (GnRH) agonist (for those using a GnRH antagonist protocol), the use of intravenous fluids at the time of oocyte retrieval, and cryopreserving/vitrifying all embryos for subsequent transfer in an unstimulated cycle.

• #1 Ovarian Hyperstimulation Syndrome (OHSS): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17972-ovarian-hyperstimulation-syndrome-ohss

  Ovarian hyperstimulation syndrome (OHSS) is a possible complication of in vitro fertilization (IVF). In this condition, your ovaries swell and fluid leaks into your abdomen. OHSS is more common in women with PCOS who are going through fertility treatments. […] OHSS is a complication that typically occurs in women who receive fertility treatments that stimulate their ovaries to produce a large number of eggs. […] Contact your healthcare provider if you’re receiving fertility medication to get pregnant and have any symptoms of OHSS. Your team is likely closely monitoring you and would tell you if you’re at risk for developing OHSS based on your estrogen levels and number of follicles on your ultrasound. […] The treatment for OHSS varies depending on how severe the condition is. Treatment aims to manage symptoms and avoid complications.

• #1 Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023) – practice guidance | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/prevention-and-treatment-of-moderate-and-severe-ovarian-hyperstimulation-syndrome-a-guideline/

  Ovarian hyperstimulation syndrome is a serious complication associated with assisted reproductive technology. This systematic review aims to identify who is at high risk for developing ovarian hyperstimulation syndrome, along with evidence-based strategies to prevent it and replaces the document of the same name last published in 2016. […] It is recommended to counsel patients with elevated antimullerian hormone levels, polycystic ovary syndrome (PCOS), and anticipated high oocyte yields that they are at increased risk for ovarian hyperstimulation syndrome (OHSS). Interventions to reduce OHSS risk should be focused on this patient population. […] It is recommended to employ ovarian stimulation protocols using gonadotropin-releasing hormone (GnRH) antagonists over protocols using GnRH agonists when there is a concern for OHSS.

• #1 Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023) – practice guidance | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/prevention-and-treatment-of-moderate-and-severe-ovarian-hyperstimulation-syndrome-a-guideline/

  There is strong evidence associating OHSS with stimulation-related factors such as a heightened number of mature range follicles at the trigger, elevated estradiol at the trigger, and an increased number of oocytes retrieved. […] It is recommended to counsel patients with elevated AMH levels, PCOS, and anticipated high oocyte yields that they are at increased risk for OHSS. Strategies to reduce OHSS risk should be implemented in this patient population. […] There is strong evidence to support the use of GnRH antagonist cycles over GnRH agonist cycles in controlled ovarian stimulation protocols to decrease the risk of OHSS. […] There is moderate evidence to support individualized gonadotropin dosing on the basis of ORT compared with standardized dosing to decrease the risk of OHSS.

• #1 OHSS — PCOS Awareness Association

  https://www.pcosaa.org/ohss

  Ovarian hyperstimulation syndrome (OHSS) causes swelling of the ovaries, which leak fluid within the body. This condition occurs in women who receive fertility treatments that stimulate the ovaries to produce more eggs. […] OHSS develops because of high levels of the pregnancy hormone HCG following these fertility treatments. PCOS and the use of fertility treatments increase the risk of OHSS. […] Symptoms of ovarian hyperstimulation syndrome often begin within a week after using injectable medications of HCG to stimulate ovulation, though sometimes it can take two weeks or longer for symptoms to appear. If you become pregnant during a treatment cycle, OHSS may worsen as your body begins producing its own HCG in response to the pregnancy. […] The treatment for OHSS varies depending on how severe the condition is. Treatment aims to manage symptoms and avoid complications.

• #1 Ovarian Hyperstimulation Syndrome (OHSS) – University Hospitals Sussex NHS Foundation Trust

  https://www.uhsussex.nhs.uk/resources/ovarian-hyperstimulation-syndrome-ohss/

  Ovarian Hyperstimulation is a complication of fertility treatment, particularly that of in vitro fertilisation (IVF). […] Depending on severity of your symptoms, OHSS is graded as mild, moderate or severe. […] Mild OHSS: mild abdominal swelling/bloating, abdominal discomfort and feeling sick. […] Moderate OHSS: The same symptoms as mild but worsening of abdominal discomfort, swelling/bloating due to a build up of fluid in the abdomen, minor weight gain, pain, nausea and loose stools may be present. […] Severe OHSS: The same symptoms as moderate plus: weight gain, increased abdominal girth measurements, extreme thirst, dehydration, passing little amounts of urine, difficulty in breathing, redness and tenderness in legs or chest pain. […] OHSS can therefore be managed as an outpatient meaning you will be allowed to go home with follow up appointments (the doctor you see will decide when these will be arranged) or you will be admitted as an inpatient (requiring you to stay in hospital).

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  https://www.cgh.com.sg/patient-care/conditions-treatments/ovarian-hyperstimulation-syndrome-problems-conceiving

  Although uncommon, it warrants medical attention as it can be potentially life threatening, if left untreated in severe cases. […] When detected early and managed appropriately, the condition can be controlled. […] Ovarian Hyperstimulation Syndrome (OHSS) – Symptoms […] You may be developing OHSS if you experience some or all of the following symptoms: […] Persistent lower abdominal discomfort […] Nausea and vomiting […] Bloatedness […] Shortness of breath […] Dehydration […] Reduction of urine volume […] Abdominal pain […] Ovarian Hyperstimulation Syndrome (OHSS) – How to prevent? […] Prevention is the best form of treatment and we will endeavor to avoid OHSS at all stages. […] Some women are more likely to develop OHSS, especially those with polycystic ovaries, those who are thin and those who had responded with many follicles or experienced OHSS in the past.

• #1 Ovarian hyperstimulation syndrome: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/007294.htm

  Contact your provider if you experience any of the following symptoms: Less urine output, Dizziness, Excessive weight gain, more than 2 pounds (1 kg) a day, Very bad nausea (you cannot keep food or liquids down), Severe abdominal pain, Shortness of breath. […] If you are getting injections of fertility medicines, you will need to have regular blood tests and pelvic ultrasounds to make sure that your ovaries aren’t over-responding.

• #1 Reddit – The heart of the internet

  https://www.reddit.com/r/IVF/comments/12ppgrm/ohss_survival_guide_for_mild_to_moderate_ohss/

  More severe symptoms include: fever (temperature over 100.5F/38C), hallucinations, severe abdominal pain that doesn’t respond to Tylenol, persistent nausea and vomiting, difficulty breathing, rapid weight gain (more than 2 pounds per day), inability to urinate, and some Redditors said they experienced shoulder pain. […] Severe cases of OHSS happen in less than 1% of IVF cases. […] If you’re experiencing severe symptoms, contact your doctor. Redditors recommended reaching out to the fertility clinic (most have an after-hours number if needed) rather than just going to the ER because many hospitals aren’t super familiar with how to handle an IVF-related case. […] Treatment – your doctor may recommend paracentesis, which involves draining the fluid with a needle. […] Yes, it feels very counterintuitive, but you want to avoid water and eat as much salt as you can.

• #1 Ovarian Hyperstimulation Syndrome (OHSS) | University of Iowa Health Care

  https://uihc.org/services/ovarian-hyperstimulation-syndrome-ohss

  OHSS is a problem sometimes seen in women who take fertility medicines to stimulate egg production. […] OHSS happens in 3 to 6 out of 100 of women who go through in vitro fertilization (IVF). […] If you have more serious signs, your care team will check you for OHSS. […] In the rare case you get severe OHSS, you may need to go to a hospital. […] Most mild cases go away on their own after menstruation starts. […] In rare cases, OHSS can lead to life-threatening problems, such as: Blood clots, Kidney failure, Severe electrolyte imbalance, Severe fluid buildup in the belly or chest. […] Call your care team if you: Pee less than normal, Gain more than 5 pounds overnight, Have nausea or vomiting (you cannot keep food or liquids down), Have severe abdominal pain, Feel short of breath, Have a severe headache, feel dizzy or weak, have visual changes, or have calf tenderness.

• #1 Ovarian Hyperstimulation Syndrome – Symptoms, Diagnosis and Management

  https://www.safeconception.com/post/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome (OHSS) is a complication of Fertility treatment, which uses pharmacological agents to cause ovarian stimulation to increase the number of oocytes and therefore the number of embryos available during assisted reproductive technology (ART). […] Ovarian hyperstimulation syndrome (OHSS) is by far the most serious complication of ovulation induction which results in a wide spectrum of clinical and laboratory signs and symptoms. […] The key principles of OHSS management therefore are early recognition and the prompt assessment and treatment of women with moderate or severe OHSS. […] Those with severe form should be admitted and those with critical OHSS are best managed in consultation with other specialist in an intensive care setting. […] In patients having mild to moderate OHSS, bed rest, abundant liquid intake and analgesics is the first-line of treatment. […] If there is Massive Ascitis and hemoconcentration, it means that OHSS is in the severe phase and hospitalization with intravenous (IV) fluid therapy is essential.

• #1 Ovarian Hyperstimulation Syndrome (OHSS): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17972-ovarian-hyperstimulation-syndrome-ohss

  For mild to moderate cases of OHSS, treatment usually involves avoiding vigorous physical activity, drinking electrolyte-rich fluid like Gatorade or Propel, using acetaminophen to relieve symptoms, weighing yourself daily, and monitoring yourself for any severe symptoms. […] Severe cases of OHSS often require hospitalization. Treatment of severe OHSS may include receiving intravenous (directly into the vein) fluids, undergoing paracentesis (a procedure to remove fluid from your belly), taking medicines to ease symptoms or reduce activity in your ovaries, and a blood thinner to help decrease the risk of a blood clot. […] Some cases of OHSS can’t be prevented. However, your healthcare provider will know if you’re at risk based on your health history and bloodwork. […] If you have OHSS, you may want to ask your provider about the severity of your condition, treatment options, signs of complications to look out for, and whether OHSS will harm your chances of becoming pregnant or affect the fetus.

• #1 OHSS — PCOS Awareness Association

  https://www.pcosaa.org/ohss

  For mild to moderate cases of OHSS, treatment usually involves: Avoiding vigorous physical activity, Increasing fluids, Using acetaminophen to relieve symptoms, Weighing yourself daily, Monitoring yourself for any severe symptoms, Frequent physical exams and ultrasounds, Blood tests to monitor for dehydration, electrolyte imbalance, and other problems, Medications to prevent blood clots (anticoagulants). […] Severe cases of OHSS often require hospitalization for monitoring and aggressive treatment, including IV fluids. Your doctor may give you a medication called cabergoline to lessen your symptoms. Sometimes, your doctor may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara), to help suppress ovarian activity. […] Serious complications from ovarian hyperstimulation syndrome may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.

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• #1 Ovarian hyperstimulation syndrome // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications. […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) to help suppress ovarian activity. […] If you develop mild ovarian hyperstimulation syndrome, you’ll probably be able to continue your day-to-day routine. Follow your provider’s advice, which may include these recommendations: Try an over-the-counter painkiller such as acetaminophen (Tylenol, others) for abdominal discomfort, but avoid ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) if you have recently had an embryo transfer, as these drugs can interfere with implantation of the embryo. […] Call your provider if your signs and symptoms get worse.

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• #1 Ovarian Hyperstimulation Syndrome | Doctor

  https://patient.info/doctor/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome (OHSS) is the most serious consequence of induction of ovulation, as part of assisted conception techniques. […] Education and good communication are particularly important in providing safe and effective care to women with OHSS. […] Management is essentially supportive until the condition resolves spontaneously. This often involves a multidisciplinary approach and should follow agreed protocols. […] Women should be encouraged to increase oral fluids and drink according to their thirst. […] In moderate cases admission to hospital for thromboprophylaxis with low molecular weight heparin and monitoring may be judicious. […] An intensive care setting may be required. […] Careful monitoring of fluid balance is needed. Intravenous (IV) fluids should be used if hydration cannot be maintained orally.

• #1 Ovarian Hyperstimulation Syndrome – RCEMLearning

  https://www.rcemlearning.co.uk/reference/ovarian-hyperstimulation-syndrome/

  Importantly, OHSS alone does not commonly cause severe abdominal pain, peritonism or pyrexia. These features should prompt the clinician to exclude ectopic pregnancy, ovarian torsion or cyst rupture, as well as intra-abdominal infection or perforation, as causes. […] […] Treatment of OHSS is supportive with most non-pregnancy associated cases resolving in 10-14 days. […] […] Mild (the vast majority of cases) and most moderate OHSS will be managed on an outpatient basis by the fertility treatment centre with oral analgesia, advice about monitoring fluid intake and urine output, regular reviews and contact details for advice. […] […] If a patient attends the ED with OHSS, consultation with obstetric colleagues is important to help guide management. Indications for hospital admission include inability to achieve adequate pain control, inability to take maintain hydration, worsening symptoms (such as weight gain, breathlessness or reduced urine output) while being managed as an outpatient, social circumstances which prevent regular face to face follow up, and critical OHSS. […]

• #1 Ovarian Hyperstimulation Syndrome | Doctor

  https://patient.info/doctor/ovarian-hyperstimulation-syndrome

  Intense monitoring (as per the 'Investigations’ section, above) is needed so that complications such as acute kidney injury (AKI), thromboembolism, pericardial effusion and Adult Respiratory Distress Syndrome (ARDS) are diagnosed early and managed appropriately. […] Techniques which may reduce risk include: Individualised stimulation regimes dependent on risk stratification. […] Use of metformin in women with PCOS. This has been found to possibly reduce the risk of OHSS, but does not improve live birth rates and may have greater risk of adverse effects. […] Preventative infusions of volume expanders such as albumin, hydroxyethyl starch (HES) and mannitol reduce rates of moderate or severe OHSS.

• #1 Preventing Ovarian Hyperstimulation Syndrome

  https://www.rmany.com/blog/preventing-ovarian-hyperstimulation-syndrome

  Choosing an appropriate stimulation dosage that isn’t too high for a patient is the primary step to avoid hyperstimulation risk, which increases as the stimulation treatment days progress. […] Patient education about the risks and drivers of OHSS are an integral part of any treatment program because patient participation in the treatment plan can help to avoid the occurrence of OHSS. […] Advancements in understanding the causes of OHSS, the availability of techniques to modify the risk of its occurrence, and experienced practitioners trained in the proper management of patients undergoing ovarian stimulation procedures have thankfully made the likelihood of the severest forms of OHSS rare and have made fertility treatments very safe.

• #1 Ovarian hyperstimulation syndrome – UF Health

  https://ufhealth.org/conditions-and-treatments/ovarian-hyperstimulation-syndrome

  Contact your provider if you experience any of the following symptoms: Less urine output, Dizziness, Excessive weight gain, more than 2 pounds (1 kg) a day, Very bad nausea (you cannot keep food or liquids down), Severe abdominal pain, Shortness of breath. […] If you are getting injections of fertility medicines, you will need to have regular blood tests and pelvic ultrasounds to make sure that your ovaries aren’t over-responding.

• #1 Ovarian hyperstimulation syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/diagnosis-treatment/drc-20354703

  Ovarian hyperstimulation syndrome diagnosis may be based on: […] Your provider may give you a medication called cabergoline to lessen your symptoms. […] If you develop mild ovarian hyperstimulation syndrome, you’ll probably be able to continue your day-to-day routine. Follow your provider’s advice, which may include these recommendations: […] Depending on how severe your ovarian hyperstimulation syndrome is, your first appointment may be with your primary care provider, your gynecologist or infertility specialist, or possibly with a treating doctor in the emergency room. […] Make sure that you completely understand everything that your provider tells you. Don’t hesitate to ask your provider to repeat information or to ask follow-up questions for clarification.

• #1 Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023) – practice guidance | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/prevention-and-treatment-of-moderate-and-severe-ovarian-hyperstimulation-syndrome-a-guideline/

  It is recommended to dose gonadotropins based on individualized ovarian reserve testing to decrease the risk of OHSS. […] It is recommended to consider lowering the starting dose of gonadotropins and/or supplementing with oral ovulation-inducing medications (clomiphene citrate and/or letrozole) to decrease the risk of OHSS. […] Coasting is generally not recommended as a primary strategy to reduce the risk of moderate-to-severe OHSS. However, when other more effective strategies are not available to reduce the risk of OHSS, coasting in combination with cabergoline and a freeze-only strategy may mitigate the risk. […] It is recommended to use a GnRH agonist to trigger oocyte maturation as a first-line strategy to reduce the risk of moderate-to-severe OHSS. […] It is recommended to add adequate luteal support when using a GnRH agonist as a trigger and planning a fresh embryo transfer.

• #1 Ovarian hyperstimulation syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697

  Strategies to help prevent OHSS include: Adjusting medication. Your provider uses the lowest possible dose of gonadotropins to stimulate your ovaries and trigger ovulation. […] Adding medication. Some medications seem to reduce the risk of OHSS without affecting the odds of pregnancy. […] Coasting. If your estrogen level is high or you have a large number of developed follicles, your provider may have you stop injectable medications and wait a few days before giving HCG, which triggers ovulation. […] Avoiding use of an HCG trigger shot. Because OHSS often develops after an HCG trigger shot is given, alternatives to HCG for triggering have been developed using gonadotropin-releasing hormone (Gn-RH) agonists, such as leuprolide (Lupron), as a way to prevent or limit OHSS. […] Freezing embryos. If you’re undergoing in vitro fertilization (IVF), all the follicles (mature and immature) may be removed from your ovaries to reduce the chance of OHSS.

• #1 Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023) – practice guidance | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/prevention-and-treatment-of-moderate-and-severe-ovarian-hyperstimulation-syndrome-a-guideline/

  In patients at risk for moderate-to-severe OHSS, it is recommended to start a dopamine agonist such as cabergoline on the day of the hCG trigger or soon thereafter and continue for several days. […] It is not recommended to administer letrozole as an intervention to reduce rates of moderate-to-severe OHSS. […] It is not recommended to administer a luteal GnRH antagonist alone to reduce rates of moderate-to-severe OHSS. Most studies report no reduction in rates of moderate-to-severe OHSS or signs or symptoms associated with OHSS. […] It is not recommended to use aspirin as a primary strategy to reduce the incidence of OHSS. […] It is recommended to consider a freeze-only cycle and subsequent frozen embryo transfer in patients at risk for OHSS on the basis of a high ovarian response or elevated serum estradiol levels.

• #1 Ovarian hyperstimulation syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697

  Ovarian hyperstimulation syndrome is an exaggerated response to excess hormones. It usually occurs in women taking injectable hormone medications to stimulate the development of eggs in the ovaries. Ovarian hyperstimulation syndrome (OHSS) causes the ovaries to swell and become painful. […] Treatment depends on the severity of the condition. OHSS may improve on its own in mild cases, while severe cases may require hospitalization and additional treatment. […] If you’re having fertility treatments and you experience symptoms of ovarian hyperstimulation syndrome, tell your health care provider. Even if you have a mild case of OHSS, your provider will want to observe you for sudden weight gain or worsening symptoms. […] To decrease your chances of developing ovarian hyperstimulation syndrome, you’ll need an individualized plan for your fertility medications. Expect your health care provider to carefully monitor each treatment cycle, including frequent ultrasounds to check the development of follicles and blood tests to check your hormone levels.

• #1 Reddit – The heart of the internet

  https://www.reddit.com/r/IVF/comments/12ppgrm/ohss_survival_guide_for_mild_to_moderate_ohss/

  Protein (medically referred to as albumin) can help fix fluid leaks in the body and electrolytes can help you replenish the vital nutrients you’re missing from dehydration. […] Try some low-key movement. […] Elevate your feet. Not only does it feel nice, but it also helps prevent the small risk of thrombosis (aka blood clots) that can come with the dehydration and bloating of OHSS. […] Take it easy on yourself. Beyond the strain IVF can have on your body and mind, you’re going through a big hormone crash right now which can cause (in some cases) depression, an increase in anxiety, and an overall feeling of weakness in the body.

• #1 Ovarian Hyperstimulation Syndrome (OHSS): A Narrative Review and Legal Implications

  https://www.mdpi.com/2075-4426/14/9/915

  Ovarian hyperstimulation syndrome (OHSS) is an important iatrogenic complication caused by ovarian stimulation which is associated with increased luteinizing hormone (LH), follicle-stimulating hormone (FSH), human chorionic gonadotropin (hCG), and estradiol (E2) levels. […] OHSS has mild, moderate, severe, and critical forms, and the mild form is the most frequent. […] Providing effective care for OHSS patients begins with early diagnosis, while also evaluating for comorbidities and complications. In addition to that, we should pay more attention to the psychological component of this complication and of infertility as a whole. […] The complexities inherent in OHSS require absolute compliance with guidelines and evidence-based recommendations, both for the sake of patient welfare and the medicolegal tenability of all procedures.

• #1 Day care management of severe ovarian hyperstimulation syndrome avoids hospitalization and morbidity – PubMed

  https://pubmed.ncbi.nlm.nih.gov/7929727/

  Severe ovarian hyperstimulation syndrome (OHSS) is a dreaded complication of ovulation induction for assisted reproduction treatment. […] A total of 18 patients who developed severe OHSS were managed according to two protocols. […] A second group (n = 10) was managed on an out-patient basis with early, ultrasound-guided trans-abdominal paracentesis. […] Day care management with easy abdominal paracentesis was found to be simple, safe and effective; patients found it more acceptable as it avoided in-patient hospitalization.

• #1 Ovarian Hyperstimulation Syndrome (OHSS) – University Hospitals Sussex NHS Foundation Trust

  https://www.uhsussex.nhs.uk/resources/ovarian-hyperstimulation-syndrome-ohss/

  Outpatient management (mild to moderate OHSS): Take pain killers regularly such as paracetamol and/or codeine. No Non-Steroidal Anti Inflammatory Drugs (Ibuprofen/Nurofen) should be prescribed or administered. […] Inpatient management (moderate to severe OHSS): Take pain killers regularly such as paracetamol and/or codeine. No Non-Steroidal Anti Inflammatory Drugs (NSAIDs) should be prescribed or administered. […] Every person who has symptoms of OHSS suffers differently so the above is a list of the most common management options. […] There is no treatment to reverse OHSS and is symptom management and control only. Symptoms can take a few days to a few weeks to resolve depending on the severity and management plan undertaken. […] When the clinicians have made you medically fit to leave the hospital they will give you a copy of your discharge summary. This gets sent to your GP who needs to know of your hospital stay but you should inform your IVF clinic and have follow up appointment with them.

• #1 ClinMed International Library | An Idiopathic Case of Recurrent Spontaneous Ovarian Hyper Stimulation Syndrome | Obstetrics and Gynaecology Cases – Reviews |

  https://clinmedjournals.org/articles/ogcr/obstetrics-and-gynaecology-cases-reviews-ogcr-3-081.php?jid=ogcr

  We report a case of recurrent spontaneous ovarian hyperstimulation syndrome (OHSS). The patient presented at 8 weeks gestation. Due to severity of symptoms, the patient required both inpatient and outpatient management. Her symptoms resolved at 11 weeks gestation and the pregnancy was carried to term. Recurrent spontaneous OHSS is a rare and potentially morbid event. While most cases will eventually resolve, patients require careful diagnosis, surveillance, and supportive care. […] Ovarian hyperstimulation syndrome (OHSS) is almost exclusively a complication of assisted reproductive technology (ART), with a reported incidence of 2.3% per patient. […] However, resolution may take weeks and requires close surveillance and supportive therapy. […] Patients with mild OHSS may be managed as an outpatient with daily communication of patient weight, abdominal circumference, and reported fluid intake and output. Serial laboratory evaluations for hematocrit, electrolytes, and creatinine should be reviewed for signs of disease progression. Hospitalization is required for serious disease. Indications for admission include uncontrolled pain, intractable nausea or vomiting, oliguria, dyspnea, electrolyte imbalances (hyponatremia: sodium < 135 mEq/L or hyperkalemia: potassium > 5 mEq/L), or hemoconcentration (Hct > 45%). Progression of symptoms, vital signs, and laboratory findings must be carefully monitored.

• #1

  https://journals.lww.com/00003246-200510001-00009

  Ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication of ovarian stimulation usually occurring during the luteal phase or during the early part of pregnancy. […] OHSS is a potential complication of ovarian induction by almost every agent used for ovarian stimulation. […] OHSS can be thought of as the loss of control over the hyperstimulation of the ovaries. […] it is important to remember that OHSS is usually an iatrogenic complication of a nonvital treatment that has the potential for a fatal outcome. Therefore, critical care physicians play an integral part in the care of these patients and therefore should be familiar with and recognize the various clinical manifestations and potential outcomes of this entity.

• #1 Spontaneous bacterial peritonitis complicating ovarian hyperstimulation syndrome-related ascites | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-spontaneous-bacterial-peritonitis-complicating-ovarian-S1807593222019317

  Ovarian hyperstimulation syndrome (OHSS) is a life-threatening iatrogenic complication of in vitro fertilization (IVF). One of the characteristic features of OHSS is increased vascular permeability due to the overproduction of vasoactive mediators from hyperstimulated and enlarged ovaries. Clinical manifestations, therefore, include hemoconcentration, hypovolemia, decreased renal perfusion, hypotension, electrolyte imbalance, and in severe forms (0.5%5% of cases), tense ascites. In addition, lower-than-normal levels of plasma immunoglobulin have been detected in patients with severe OHSS, which may predispose patients to serious infections. In this case report, we describe SBP as a new infectious complication of OHSS. […] Ovarian hyperstimulation syndrome is an iatrogenic complication of the ovarian stimulation commonly used for IVF. The condition is potentially life-threatening; therefore, it represents one of the most serious complications of assisted reproduction treatments.

• #1 Spontaneous bacterial peritonitis complicating ovarian hyperstimulation syndrome-related ascites | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-spontaneous-bacterial-peritonitis-complicating-ovarian-S1807593222019317

  The most important aspect of our case report is the evidence of SBP as a cause of sepsis during OHSS. The presence of 250 PMN cells/mm3 in the ascitic fluid is diagnostic of this condition and mandates immediate treatment. A delay in antibiotic treatment could result in a significant and potentially fatal deterioration in clinical status. […] Albumin administration has been suggested to be an effective plasma expander in OHSS, and it has also been demonstrated to be beneficial in the treatment of cirrhotic patients with SBP. The mechanisms of action might be related to the prevention of circulatory dysfunction and to the subsequent activation of vasoconstrictor systems. […] Recognition of the risk factors for OHSS is a crucial step in the identification of patients with a high-risk profile who would demand careful follow-up after ovulation induction and might benefit from prevention strategies. The described risk factors for OHSS include young age, low body weight, polycystic ovary syndrome, and previous episodes of OHSS.

• #1 Ovarian hyperstimulation syndrome (OHSS) | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ovarian-hyperstimulation-syndrome/

  To lower the risk of developing a blood clot in your legs or lungs, you will be advised to continue wearing support stockings and taking heparin (blood-thinning) injections until 12 weeks of your pregnancy. […] If you develop OHSS, your ovaries will be enlarged and painful. You should avoid having sex or doing strenuous exercise to avoid injury to the ovaries.

• #1 Unusual ovarian hyperstimulation syndrome presentation: Pleural effusion without ascites. A case report

  https://www.wjgnet.com/2307-8960/full/v13/i8/100028.htm

  The present case underscores the severe nature of OHSS and its potential complications, which can include respiratory distress and pleural effusion, as well as impact on the cardiac function. […] An ideal approach for treating OHSS should focus on prevention and supportive care. […] For severe cases, morbidity prevention depends on monitoring clinical parameters, maintaining fluid balance, managing electrolytes, providing thrombosis prophylaxis, and addressing ascites. […] The management of this patient included the control of inputs and outputs, balance, and daily weight. […] Although the clinical outcome of the patient was favorable, with a significant decrease in dyspnea on oxygen therapy, the tendency for tachycardia persisted together with light dyspnea on exertion and oxygen saturation between 95% and 96%.

• #1 Ovarian Hyperstimulation Syndrome – RCEMLearning

  https://www.rcemlearning.co.uk/reference/ovarian-hyperstimulation-syndrome/

  In the emergency department, fluid resuscitation to restore intravascular volume is the treatment priority. Analgesia, antiemetics and electrolyte correction may also be required, in addition to oxygenation and ventilatory support as necessary. […] […] Patients admitted with OHSS should all receive thromboprophylaxis unless there is a contraindication. […]

• #1

  https://www.sgh.com.sg/patient-care/conditions-treatments/ovarian-hyperstimulation-syndrome-problems-conceiving

  Ovarian Hyperstimulation Syndrome (OHSS) is usually self-limiting and can then be treated at home with rest and adequate fluid intake. Immediate medical attention is required should the symptoms persist or worsen. In this instance, admission to hospital for treatment and close monitoring are required. Most of the time, the symptoms will subside in 5 to 15 days. […] You should report any concern at any time to the KKIVF Centre or the Women’s 24-Hour Clinic, which is located at Basement 1, Women’s Tower.

• #2

  https://journals.lww.com/00003246-200510001-00009

  Ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication of ovarian stimulation usually occurring during the luteal phase or during the early part of pregnancy. […] OHSS is a potential complication of ovarian induction by almost every agent used for ovarian stimulation. […] OHSS can be thought of as the loss of control over the hyperstimulation of the ovaries. […] it is important to remember that OHSS is usually an iatrogenic complication of a nonvital treatment that has the potential for a fatal outcome. Therefore, critical care physicians play an integral part in the care of these patients and therefore should be familiar with and recognize the various clinical manifestations and potential outcomes of this entity.

• #2 Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023) – practice guidance | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/prevention-and-treatment-of-moderate-and-severe-ovarian-hyperstimulation-syndrome-a-guideline/

  Ovarian hyperstimulation syndrome (OHSS) is an uncommon but serious complication associated with controlled ovarian stimulation during assisted reproductive technology (ART). […] Ovarian hyperstimulation syndrome is staged (mild, moderate, severe, or critical) by the severity of symptoms and laboratory findings. […] Ovarian hyperstimulation syndrome is further classified by the timing of onset (early or late). […] A systematic search of the literature was performed to answer 3 questions about OHSS: who is at high risk, how can it be prevented, and what is the treatment for it? […] There is strong evidence that factors associated with a robust response to ovarian stimulation predispose to OHSS. This includes baseline characteristics such as younger age and the diagnosis of PCOS, in addition to elevated ovarian reserve markers, including AFC and AMH levels.

• #2 Reddit – The heart of the internet

  https://www.reddit.com/r/IVF/comments/12ppgrm/ohss_survival_guide_for_mild_to_moderate_ohss/

  I’m by no means a medical professional but I did a lot of online research, Reddit thread reading, and got some great tips from my clinic. I wanted to collect the best info in one easy place because this subreddit has been a huge resource to me during this process and I wanted to contribute where I could. Please add any more tips you have in the comments! […] Officially, around 20-35% of IVF cycles result in mild OHSS and only 3-6% result in moderate OHSS. Although all IVF cycles overstimulate the ovaries to some extent. […] Risk factors include: age under 35, low body weight, large number of follicles, high levels of estrogen, PCOS, previous episodes of OHSS, HCG trigger shot. […] The general consensus is that most symptoms of mild to moderate OHSS should go away once you get your period (usually within a week or two of retrieval), however it can last for a few weeks longer in more severe cases.

• #2 Spontaneous bacterial peritonitis complicating ovarian hyperstimulation syndrome-related ascites | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-spontaneous-bacterial-peritonitis-complicating-ovarian-S1807593222019317

  The most important aspect of our case report is the evidence of SBP as a cause of sepsis during OHSS. The presence of 250 PMN cells/mm3 in the ascitic fluid is diagnostic of this condition and mandates immediate treatment. A delay in antibiotic treatment could result in a significant and potentially fatal deterioration in clinical status. […] Albumin administration has been suggested to be an effective plasma expander in OHSS, and it has also been demonstrated to be beneficial in the treatment of cirrhotic patients with SBP. The mechanisms of action might be related to the prevention of circulatory dysfunction and to the subsequent activation of vasoconstrictor systems. […] Recognition of the risk factors for OHSS is a crucial step in the identification of patients with a high-risk profile who would demand careful follow-up after ovulation induction and might benefit from prevention strategies. The described risk factors for OHSS include young age, low body weight, polycystic ovary syndrome, and previous episodes of OHSS.

• #2 Was the Cure Worse Than the Disease? Case 3: Ovarian Hyperstimulation Syndrome | Consultant360

  https://www.consultant360.com/article/was-cure-worse-disease-case-3-ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome (OHSS) is a rare adverse effect of assisted reproduction therapy. The syndrome is thought to result from increased capillary permeability, triggered by the expression of cytokines, that leads to fluid shifts from the intravascular space. OHSS is classified as mild, moderate, or severe based on clinical and laboratory findings. The incidence varies from 3.1% to 6% for moderate disease and from 0.25% to 1.8% for severe disease. Risk factors are young age, low body weight, polycystic ovary syndrome, and previous episodes. Symptoms include abdominal pain, nausea, vomiting, and weight gain. Transudative or exudative pleural effusions, pericardial effusions, tense ascites, oliguria, or hypovolemia can also occur. Laboratory findings may show hemoconcentration and increased renin, antidiuretic hormone, and vascular endothelial growth factor (VEGF) levels. VEGF can be used as a marker of disease severity. Respiratory alkalosis with hypoxemia is often present. Pelvic ultrasonography may reveal large ovaries with multiple cysts (necklace sign) as in this patient or ovarian torsion. OHSS usually resolves within 10 to 14 days after cessation of the gonadotropin-releasing hormone agonist. Mild and moderate OHSS require observation and bed rest. Severe OHSS requires intravascular support with isotonic saline. Some experts advocate the use of plasma expanders, such as albumin. Diuretics are contraindicated. Thoracentesis or paracentesis is often necessary to relieve dyspnea. Potentially fatal complications include hypovolemic shock, renal failure, acute respiratory distress syndrome, pulmonary emboli, cerebral vascular accidents, intracranial hypertension, and adnexal torsion requiring surgery.

• #2 Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023) – practice guidance | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/prevention-and-treatment-of-moderate-and-severe-ovarian-hyperstimulation-syndrome-a-guideline/

  There is strong evidence associating OHSS with stimulation-related factors such as a heightened number of mature range follicles at the trigger, elevated estradiol at the trigger, and an increased number of oocytes retrieved. […] It is recommended to counsel patients with elevated AMH levels, PCOS, and anticipated high oocyte yields that they are at increased risk for OHSS. Strategies to reduce OHSS risk should be implemented in this patient population. […] There is strong evidence to support the use of GnRH antagonist cycles over GnRH agonist cycles in controlled ovarian stimulation protocols to decrease the risk of OHSS. […] There is moderate evidence to support individualized gonadotropin dosing on the basis of ORT compared with standardized dosing to decrease the risk of OHSS.

• #2

  https://www.cgh.com.sg/patient-care/conditions-treatments/ovarian-hyperstimulation-syndrome-problems-conceiving

  Although uncommon, it warrants medical attention as it can be potentially life threatening, if left untreated in severe cases. […] When detected early and managed appropriately, the condition can be controlled. […] Ovarian Hyperstimulation Syndrome (OHSS) – Symptoms […] You may be developing OHSS if you experience some or all of the following symptoms: […] Persistent lower abdominal discomfort […] Nausea and vomiting […] Bloatedness […] Shortness of breath […] Dehydration […] Reduction of urine volume […] Abdominal pain […] Ovarian Hyperstimulation Syndrome (OHSS) – How to prevent? […] Prevention is the best form of treatment and we will endeavor to avoid OHSS at all stages. […] Some women are more likely to develop OHSS, especially those with polycystic ovaries, those who are thin and those who had responded with many follicles or experienced OHSS in the past.

• #2 Ovarian Hyperstimulation Syndrome (OHSS) – University Hospitals Sussex NHS Foundation Trust

  https://www.uhsussex.nhs.uk/resources/ovarian-hyperstimulation-syndrome-ohss/

  Ovarian Hyperstimulation is a complication of fertility treatment, particularly that of in vitro fertilisation (IVF). […] Depending on severity of your symptoms, OHSS is graded as mild, moderate or severe. […] Mild OHSS: mild abdominal swelling/bloating, abdominal discomfort and feeling sick. […] Moderate OHSS: The same symptoms as mild but worsening of abdominal discomfort, swelling/bloating due to a build up of fluid in the abdomen, minor weight gain, pain, nausea and loose stools may be present. […] Severe OHSS: The same symptoms as moderate plus: weight gain, increased abdominal girth measurements, extreme thirst, dehydration, passing little amounts of urine, difficulty in breathing, redness and tenderness in legs or chest pain. […] OHSS can therefore be managed as an outpatient meaning you will be allowed to go home with follow up appointments (the doctor you see will decide when these will be arranged) or you will be admitted as an inpatient (requiring you to stay in hospital).

• #2 Reddit – The heart of the internet

  https://www.reddit.com/r/IVF/comments/12ppgrm/ohss_survival_guide_for_mild_to_moderate_ohss/

  More severe symptoms include: fever (temperature over 100.5F/38C), hallucinations, severe abdominal pain that doesn’t respond to Tylenol, persistent nausea and vomiting, difficulty breathing, rapid weight gain (more than 2 pounds per day), inability to urinate, and some Redditors said they experienced shoulder pain. […] Severe cases of OHSS happen in less than 1% of IVF cases. […] If you’re experiencing severe symptoms, contact your doctor. Redditors recommended reaching out to the fertility clinic (most have an after-hours number if needed) rather than just going to the ER because many hospitals aren’t super familiar with how to handle an IVF-related case. […] Treatment – your doctor may recommend paracentesis, which involves draining the fluid with a needle. […] Yes, it feels very counterintuitive, but you want to avoid water and eat as much salt as you can.

• #2 Ovarian hyperstimulation syndrome: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/007294.htm

  Contact your provider if you experience any of the following symptoms: Less urine output, Dizziness, Excessive weight gain, more than 2 pounds (1 kg) a day, Very bad nausea (you cannot keep food or liquids down), Severe abdominal pain, Shortness of breath. […] If you are getting injections of fertility medicines, you will need to have regular blood tests and pelvic ultrasounds to make sure that your ovaries aren’t over-responding.

• #2 Ovarian Hyperstimulation Syndrome (OHSS) | University of Iowa Health Care

  https://uihc.org/services/ovarian-hyperstimulation-syndrome-ohss

  OHSS is a problem sometimes seen in women who take fertility medicines to stimulate egg production. […] OHSS happens in 3 to 6 out of 100 of women who go through in vitro fertilization (IVF). […] If you have more serious signs, your care team will check you for OHSS. […] In the rare case you get severe OHSS, you may need to go to a hospital. […] Most mild cases go away on their own after menstruation starts. […] In rare cases, OHSS can lead to life-threatening problems, such as: Blood clots, Kidney failure, Severe electrolyte imbalance, Severe fluid buildup in the belly or chest. […] Call your care team if you: Pee less than normal, Gain more than 5 pounds overnight, Have nausea or vomiting (you cannot keep food or liquids down), Have severe abdominal pain, Feel short of breath, Have a severe headache, feel dizzy or weak, have visual changes, or have calf tenderness.

• #2 Critical Ovarian Hyperstimulation Syndrome and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4818836/

  Ovarian hyperstimulation syndrome (OHSS) is a complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited, and spontaneous regression occurs. Mild manifestations of OHSS include transient lower abdominal discomfort, nausea, vomiting, diarrhea, and abdominal distension. Life-threatening OHSS can progress to adult respiratory distress syndrome, renal failure, hepatic injury, hemostatic imbalances, and thromboembolic episodes. […] Management of our patient was challenging because the patient had renal failure, respiratory failure, fluid overload, ascitis, pleural effusion, nosocomial infections, hypoxic brain injury, and poor GCS. The patient had life-threatening OHSS which required aggressive treatment including cardiac output and stroke volume variation monitoring to decide about the intravascular volume status. […] The physicians and intensivists should be familiar with the different clinical manifestations of OHSS and their management.

• #2 Ovarian hyperstimulation syndrome // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications. […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) to help suppress ovarian activity. […] If you develop mild ovarian hyperstimulation syndrome, you’ll probably be able to continue your day-to-day routine. Follow your provider’s advice, which may include these recommendations: Try an over-the-counter painkiller such as acetaminophen (Tylenol, others) for abdominal discomfort, but avoid ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) if you have recently had an embryo transfer, as these drugs can interfere with implantation of the embryo. […] Call your provider if your signs and symptoms get worse.

• #2 Ovarian hyperstimulation syndrome (OHSS) | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ovarian-hyperstimulation-syndrome/

  To lower the risk of developing a blood clot in your legs or lungs, you will be advised to continue wearing support stockings and taking heparin (blood-thinning) injections until 12 weeks of your pregnancy. […] If you develop OHSS, your ovaries will be enlarged and painful. You should avoid having sex or doing strenuous exercise to avoid injury to the ovaries.

• #2 Ovarian hyperstimulation syndrome (OHSS) | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ovarian-hyperstimulation-syndrome/

  OHSS is a potentially serious complication of fertility treatment, particularly of IVF. […] It can range from mild to severe. Mild OHSS is common and usually gets better with time. More severe cases require specialist care and hospital admission. […] It is important to make contact with your fertility unit if you develop symptoms of OHSS. […] If you have mild OHSS, you can be looked after at home. Ensure that you drink fluids at regular intervals depending on how thirsty you feel. […] Call for medical help if you develop any of the symptoms of OHSS, particularly if the pain is not getting any better or if you start to vomit, have urinary problems or chest pain or have difficulty breathing. […] Although there is no treatment that can reverse OHSS, it will usually get better with time. Treatment is to help symptoms and prevent complications.

• #2

• #2 Ovarian Hyperstimulation Syndrome (OHSS): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17972-ovarian-hyperstimulation-syndrome-ohss

  For mild to moderate cases of OHSS, treatment usually involves avoiding vigorous physical activity, drinking electrolyte-rich fluid like Gatorade or Propel, using acetaminophen to relieve symptoms, weighing yourself daily, and monitoring yourself for any severe symptoms. […] Severe cases of OHSS often require hospitalization. Treatment of severe OHSS may include receiving intravenous (directly into the vein) fluids, undergoing paracentesis (a procedure to remove fluid from your belly), taking medicines to ease symptoms or reduce activity in your ovaries, and a blood thinner to help decrease the risk of a blood clot. […] Some cases of OHSS can’t be prevented. However, your healthcare provider will know if you’re at risk based on your health history and bloodwork. […] If you have OHSS, you may want to ask your provider about the severity of your condition, treatment options, signs of complications to look out for, and whether OHSS will harm your chances of becoming pregnant or affect the fetus.

• #2 Ovarian hyperstimulation syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/diagnosis-treatment/drc-20354703

  Ovarian hyperstimulation syndrome diagnosis may be based on: […] Your provider may give you a medication called cabergoline to lessen your symptoms. […] If you develop mild ovarian hyperstimulation syndrome, you’ll probably be able to continue your day-to-day routine. Follow your provider’s advice, which may include these recommendations: […] Depending on how severe your ovarian hyperstimulation syndrome is, your first appointment may be with your primary care provider, your gynecologist or infertility specialist, or possibly with a treating doctor in the emergency room. […] Make sure that you completely understand everything that your provider tells you. Don’t hesitate to ask your provider to repeat information or to ask follow-up questions for clarification.

• #2 Ovarian hyperstimulation syndrome | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20208704/

  Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if youre pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications. […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) to help suppress ovarian activity. […] If you develop mild ovarian hyperstimulation syndrome, youll probably be able to continue your day-to-day routine. Follow your providers advice, which may include these recommendations: Try an over-the-counter painkiller such as acetaminophen (Tylenol, others) for abdominal discomfort, but avoid ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) if you have recently had an embryo transfer, as these drugs can interfere with implantation of the embryo. […] Depending on how severe your ovarian hyperstimulation syndrome is, your first appointment may be with your primary care provider, your gynecologist or infertility specialist, or possibly with a treating doctor in the emergency room.

• #2 OHSS — PCOS Awareness Association

  https://www.pcosaa.org/ohss

  For mild to moderate cases of OHSS, treatment usually involves: Avoiding vigorous physical activity, Increasing fluids, Using acetaminophen to relieve symptoms, Weighing yourself daily, Monitoring yourself for any severe symptoms, Frequent physical exams and ultrasounds, Blood tests to monitor for dehydration, electrolyte imbalance, and other problems, Medications to prevent blood clots (anticoagulants). […] Severe cases of OHSS often require hospitalization for monitoring and aggressive treatment, including IV fluids. Your doctor may give you a medication called cabergoline to lessen your symptoms. Sometimes, your doctor may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara), to help suppress ovarian activity. […] Serious complications from ovarian hyperstimulation syndrome may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.

• #2 Ovarian Hyperstimulation Syndrome | Doctor

  https://patient.info/doctor/ovarian-hyperstimulation-syndrome

  Intense monitoring (as per the 'Investigations’ section, above) is needed so that complications such as acute kidney injury (AKI), thromboembolism, pericardial effusion and Adult Respiratory Distress Syndrome (ARDS) are diagnosed early and managed appropriately. […] Techniques which may reduce risk include: Individualised stimulation regimes dependent on risk stratification. […] Use of metformin in women with PCOS. This has been found to possibly reduce the risk of OHSS, but does not improve live birth rates and may have greater risk of adverse effects. […] Preventative infusions of volume expanders such as albumin, hydroxyethyl starch (HES) and mannitol reduce rates of moderate or severe OHSS.

• #2 Unusual ovarian hyperstimulation syndrome presentation: Pleural effusion without ascites. A case report

  https://www.wjgnet.com/2307-8960/full/v13/i8/100028.htm

  The present case underscores the severe nature of OHSS and its potential complications, which can include respiratory distress and pleural effusion, as well as impact on the cardiac function. […] An ideal approach for treating OHSS should focus on prevention and supportive care. […] For severe cases, morbidity prevention depends on monitoring clinical parameters, maintaining fluid balance, managing electrolytes, providing thrombosis prophylaxis, and addressing ascites. […] The management of this patient included the control of inputs and outputs, balance, and daily weight. […] Although the clinical outcome of the patient was favorable, with a significant decrease in dyspnea on oxygen therapy, the tendency for tachycardia persisted together with light dyspnea on exertion and oxygen saturation between 95% and 96%.

• #2 ClinMed International Library | An Idiopathic Case of Recurrent Spontaneous Ovarian Hyper Stimulation Syndrome | Obstetrics and Gynaecology Cases – Reviews |

  https://clinmedjournals.org/articles/ogcr/obstetrics-and-gynaecology-cases-reviews-ogcr-3-081.php?jid=ogcr

  We report a case of recurrent spontaneous ovarian hyperstimulation syndrome (OHSS). The patient presented at 8 weeks gestation. Due to severity of symptoms, the patient required both inpatient and outpatient management. Her symptoms resolved at 11 weeks gestation and the pregnancy was carried to term. Recurrent spontaneous OHSS is a rare and potentially morbid event. While most cases will eventually resolve, patients require careful diagnosis, surveillance, and supportive care. […] Ovarian hyperstimulation syndrome (OHSS) is almost exclusively a complication of assisted reproductive technology (ART), with a reported incidence of 2.3% per patient. […] However, resolution may take weeks and requires close surveillance and supportive therapy. […] Patients with mild OHSS may be managed as an outpatient with daily communication of patient weight, abdominal circumference, and reported fluid intake and output. Serial laboratory evaluations for hematocrit, electrolytes, and creatinine should be reviewed for signs of disease progression. Hospitalization is required for serious disease. Indications for admission include uncontrolled pain, intractable nausea or vomiting, oliguria, dyspnea, electrolyte imbalances (hyponatremia: sodium < 135 mEq/L or hyperkalemia: potassium > 5 mEq/L), or hemoconcentration (Hct > 45%). Progression of symptoms, vital signs, and laboratory findings must be carefully monitored.

• #2 Ovarian Hyperstimulation Syndrome: What is OHSS?

  https://drbrighten.com/understanding-ovarian-hyperstimulation-syndrome/

  Communicating with your provider of any concerning changes during the ovarian stimulation phase and in the days after oocyte retrieval or egg retrieval is important. […] If you develop breathing difficulties, decreased amounts of urine, rapid weight gain, or any symptoms of concern, please contact your provider. […] Ovarian Hyperstimulation Syndrome (OHSS) is an exaggerated response to hormone medications used in advanced reproductive technologies (ART). […] Severe cases of OHSS are rare. You can safely navigate your fertility treatments with proper monitoring and medical intervention. Awareness of the symptoms and seeking prompt medical attention are crucial for a positive outcome.

• #2

  https://www.cgh.com.sg/patient-care/conditions-treatments/ovarian-hyperstimulation-syndrome-problems-conceiving

  At KKIVF, we may recommend abandoning the cycle before the hCG injection if your risks of OHSS are high or unexpected rigorous response is encountered in your cycle. […] If you are undergoing the IVF/ICSI programmes, your eggs may be collected but you may not have fresh embryo transfer. The resulting good quality embryos will be frozen for later use. […] Ovarian Hyperstimulation Syndrome (OHSS) – Medical Attention […] OHSS is usually self-limiting and can then be treated at home with rest and adequate fluid intake. Immediate medical attention is required should the symptoms persist or worsen. In this instance, admission to hospital for treatment and close monitoring are required. Most of the time, the symptoms will subside in 5 to 15 days. […] You should report any concern at any time to the KKIVF Centre or the Women’s 24-Hour Clinic, which is located at Basement 1, Women’s Tower.

• #2 Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment | Reproductive Biology and Endocrinology | Full Text

  https://rbej.biomedcentral.com/articles/10.1186/1477-7827-10-32

  Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian stimulation (COS) as part of assisted reproductive technologies (ART). […] Physicians should always be aware of the risk of OHSS in patients undergoing COS, as it can be fatal. […] Risk factors and predictive factors for OHSS will be presented, as recognizing these risk factors and individualizing the COS protocol appropriately is the key to the primary prevention of OHSS, as the benefits and risks of each COS strategy vary among individuals. Individualized COS (iCOS) could effectively eradicate OHSS, and the identification of hormonal, functional and genetic markers of ovarian response will facilitate iCOS. […] However, if iCOS is not properly applied, various preventive measures can be instituted once COS has begun, including cancelling the cycle, coasting, individualizing the human chorionic gonadotropin trigger dose or using a gonadotropin-releasing hormone (GnRH) agonist (for those using a GnRH antagonist protocol), the use of intravenous fluids at the time of oocyte retrieval, and cryopreserving/vitrifying all embryos for subsequent transfer in an unstimulated cycle.

• #2 Preventing Ovarian Hyperstimulation Syndrome

  https://www.rmany.com/blog/preventing-ovarian-hyperstimulation-syndrome

  Choosing an appropriate stimulation dosage that isn’t too high for a patient is the primary step to avoid hyperstimulation risk, which increases as the stimulation treatment days progress. […] Patient education about the risks and drivers of OHSS are an integral part of any treatment program because patient participation in the treatment plan can help to avoid the occurrence of OHSS. […] Advancements in understanding the causes of OHSS, the availability of techniques to modify the risk of its occurrence, and experienced practitioners trained in the proper management of patients undergoing ovarian stimulation procedures have thankfully made the likelihood of the severest forms of OHSS rare and have made fertility treatments very safe.

• #2 Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023) – practice guidance | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/prevention-and-treatment-of-moderate-and-severe-ovarian-hyperstimulation-syndrome-a-guideline/

  It is recommended to dose gonadotropins based on individualized ovarian reserve testing to decrease the risk of OHSS. […] It is recommended to consider lowering the starting dose of gonadotropins and/or supplementing with oral ovulation-inducing medications (clomiphene citrate and/or letrozole) to decrease the risk of OHSS. […] Coasting is generally not recommended as a primary strategy to reduce the risk of moderate-to-severe OHSS. However, when other more effective strategies are not available to reduce the risk of OHSS, coasting in combination with cabergoline and a freeze-only strategy may mitigate the risk. […] It is recommended to use a GnRH agonist to trigger oocyte maturation as a first-line strategy to reduce the risk of moderate-to-severe OHSS. […] It is recommended to add adequate luteal support when using a GnRH agonist as a trigger and planning a fresh embryo transfer.

• #2 Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023) – practice guidance | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/prevention-and-treatment-of-moderate-and-severe-ovarian-hyperstimulation-syndrome-a-guideline/

  There is moderate evidence that lowering the starting dose of gonadotropins and/or supplementing with oral ovulation-inducing medications (clomiphene citrate and/or letrozole) may decrease the risk of OHSS. […] Coasting is generally not recommended as a primary strategy to reduce the risk of moderate-to-severe OHSS. However, when other more effective strategies are not available to reduce the risk of OHSS, coasting in combination with cabergoline and a freeze-only strategy may mitigate risk. […] It is recommended to use a GnRH agonist to trigger oocyte maturation as a first-line strategy to reduce the risk of moderate-to-severe OHSS. […] It is recommended to add adequate luteal support if using a GnRH agonist for trigger and planning a fresh embryo transfer. […] In patients at risk for moderate-to-severe OHSS, it is recommended to start a dopamine agonist such as cabergoline on the day of the hCG trigger or soon thereafter and continue for several days.

• #2 Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023) – practice guidance | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/prevention-and-treatment-of-moderate-and-severe-ovarian-hyperstimulation-syndrome-a-guideline/

  It is not recommended to administer letrozole as an intervention to reduce rates of moderate-to-severe OHSS. […] It is not recommended to administer a luteal GnRH antagonist alone to reduce rates of moderate-to-severe OHSS. […] It is not recommended to use volume expanders such as albumin, hydroxyethyl starch, or mannitol in patients who are at high risk of developing moderate or severe OHSS. […] There is strong evidence that avoiding a fresh embryo transfer and cryopreserving embryos (freeze-only cycle) significantly reduces the risk of moderate-to-severe OHSS compared with fresh embryo transfer cycles. […] It is recommended to consider a freeze-only cycle and subsequent frozen embryo transfer in patients at risk for OHSS on the basis of high ovarian response or elevated serum estradiol levels.

• #2 HIE Multimedia – Ovarian hyperstimulation syndrome

  https://adamcertificationdemo.adam.com/content.aspx?productid=117&pid=1&gid=007294

  Ovarian hyperstimulation syndrome (OHSS) is a problem that is sometimes seen in women who take fertility medicines that stimulate egg production. […] If you have a severe case of OHSS, your health care provider will need to monitor your symptoms carefully. You may be admitted to the hospital. […] Mild cases of OHSS usually don’t need to be treated. The condition may actually be associated with a greater chance of becoming pregnant. […] In the rare case that you develop severe OHSS, you will probably need to go to a hospital. Your provider will give you fluids through a vein (intravenous fluids). They will also remove fluids that have collected in your body, and monitor your condition. […] Most mild cases of OHSS will go away on their own after menstruation starts. If you have a more severe case, it can take several days for symptoms to improve. […] If you are getting injections of fertility medicines, you will need to have regular blood tests and pelvic ultrasounds to make sure that your ovaries aren’t over-responding.

• #2 Ovarian Hyperstimulation Syndrome (OHSS): A Narrative Review and Legal Implications

  https://www.mdpi.com/2075-4426/14/9/915

  Ovarian hyperstimulation syndrome (OHSS) is an important iatrogenic complication caused by ovarian stimulation which is associated with increased luteinizing hormone (LH), follicle-stimulating hormone (FSH), human chorionic gonadotropin (hCG), and estradiol (E2) levels. […] OHSS has mild, moderate, severe, and critical forms, and the mild form is the most frequent. […] Providing effective care for OHSS patients begins with early diagnosis, while also evaluating for comorbidities and complications. In addition to that, we should pay more attention to the psychological component of this complication and of infertility as a whole. […] The complexities inherent in OHSS require absolute compliance with guidelines and evidence-based recommendations, both for the sake of patient welfare and the medicolegal tenability of all procedures.

• #2 Ovarian Hyperstimulation Syndrome (OHSS) – University Hospitals Sussex NHS Foundation Trust

  https://www.uhsussex.nhs.uk/resources/ovarian-hyperstimulation-syndrome-ohss/

  Outpatient management (mild to moderate OHSS): Take pain killers regularly such as paracetamol and/or codeine. No Non-Steroidal Anti Inflammatory Drugs (Ibuprofen/Nurofen) should be prescribed or administered. […] Inpatient management (moderate to severe OHSS): Take pain killers regularly such as paracetamol and/or codeine. No Non-Steroidal Anti Inflammatory Drugs (NSAIDs) should be prescribed or administered. […] Every person who has symptoms of OHSS suffers differently so the above is a list of the most common management options. […] There is no treatment to reverse OHSS and is symptom management and control only. Symptoms can take a few days to a few weeks to resolve depending on the severity and management plan undertaken. […] When the clinicians have made you medically fit to leave the hospital they will give you a copy of your discharge summary. This gets sent to your GP who needs to know of your hospital stay but you should inform your IVF clinic and have follow up appointment with them.

• #2 Ovarian Hyperstimulation Syndrome | Doctor

  https://patient.info/doctor/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome (OHSS) is the most serious consequence of induction of ovulation, as part of assisted conception techniques. […] Education and good communication are particularly important in providing safe and effective care to women with OHSS. […] Management is essentially supportive until the condition resolves spontaneously. This often involves a multidisciplinary approach and should follow agreed protocols. […] Women should be encouraged to increase oral fluids and drink according to their thirst. […] In moderate cases admission to hospital for thromboprophylaxis with low molecular weight heparin and monitoring may be judicious. […] An intensive care setting may be required. […] Careful monitoring of fluid balance is needed. Intravenous (IV) fluids should be used if hydration cannot be maintained orally.

• #2

  https://link.springer.com/article/10.1007/s001340051215

  Objective: To present our experience and the current knowledge about pathophysiology, diagnosis, and management of the ovarian hyperstimulation syndrome (OHSS). […] Gynecologists and intensivists must be aware of the diagnosis and management of the syndrome because of the widely used reproductive techniques for assisted conception.

• #2 Ovarian Hyperstimulation Syndrome – RCEMLearning

  https://www.rcemlearning.co.uk/reference/ovarian-hyperstimulation-syndrome/

  In the emergency department, fluid resuscitation to restore intravascular volume is the treatment priority. Analgesia, antiemetics and electrolyte correction may also be required, in addition to oxygenation and ventilatory support as necessary. […] […] Patients admitted with OHSS should all receive thromboprophylaxis unless there is a contraindication. […]

• #2 Unusual ovarian hyperstimulation syndrome presentation: Pleural effusion without ascites. A case report

  https://www.wjgnet.com/2307-8960/full/v13/i8/100028.htm

  Ovarian hyperstimulation syndrome (OHSS) is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation. […] This case report highlights a unique manifestation of OHSS involving pleural effusion (PE) in a patient without identifiable risk factors. […] Clinical management involved fluid balance and treatment with albumin, furosemide, thromboembolic prophylaxis, and thoracentesis. […] OHSS and its potential complications can include respiratory distress and PE, as well as thromboembolic disorders. […] With the increasing use of assisted reproductive technologies, ovarian hyperstimulation syndrome (OHSS) should be a topic of continued research, and it is crucial to develop systematic guidelines for prevention, diagnosis, and management.

• #2 Unusual ovarian hyperstimulation syndrome presentation: Pleural effusion without ascites. A case report

  https://www.wjgnet.com/2307-8960/full/v13/i8/100028.htm

  This clinical case highlights the necessity for an accurate management in all patients undergoing IVF, as severe OHSS can occur unexpectedly even in patients with lack of risk factors. […] Our experience with aspiration of the pleural cavity combined with intravenous albumin administration demonstrates an effective treatment modality for managing massive PE.

• #2

  https://www.sgh.com.sg/patient-care/conditions-treatments/ovarian-hyperstimulation-syndrome-problems-conceiving

  Ovarian Hyperstimulation Syndrome (OHSS) is usually self-limiting and can then be treated at home with rest and adequate fluid intake. Immediate medical attention is required should the symptoms persist or worsen. In this instance, admission to hospital for treatment and close monitoring are required. Most of the time, the symptoms will subside in 5 to 15 days. […] You should report any concern at any time to the KKIVF Centre or the Women’s 24-Hour Clinic, which is located at Basement 1, Women’s Tower.

• #2 All About OHSS (Ovarian Hyperstimulation Syndrome)

  https://www.healthline.com/health/infertility/ohss

  Some women may develop complications like ovarian hyperstimulation syndrome (OHSS) in response to all the extra hormones theyre taking. OHSS happens when the ovaries swell with fluid that eventually leaks into the body. This condition is a direct result of the drugs used in IVF and other procedures that enhance egg production and maturity. […] Mild OHSS may go away on its own within a week or so. If you get pregnant that cycle, the symptoms may persist a bit longer more like a few days to a few weeks. […] Treatment of mild OHSS is conservative and involves things like avoiding strenuous exercise and increasing fluid intake to address dehydration. You may want to take some acetaminophen for pain. […] Most importantly, your doctor may ask you to weigh and otherwise monitor yourself daily to track any potential worsening of the condition.

• #3 Ovarian Hyperstimulation Syndrome (OHSS) – University Hospitals Sussex NHS Foundation Trust

  https://www.uhsussex.nhs.uk/resources/ovarian-hyperstimulation-syndrome-ohss/

  Outpatient management (mild to moderate OHSS): Take pain killers regularly such as paracetamol and/or codeine. No Non-Steroidal Anti Inflammatory Drugs (Ibuprofen/Nurofen) should be prescribed or administered. […] Inpatient management (moderate to severe OHSS): Take pain killers regularly such as paracetamol and/or codeine. No Non-Steroidal Anti Inflammatory Drugs (NSAIDs) should be prescribed or administered. […] Every person who has symptoms of OHSS suffers differently so the above is a list of the most common management options. […] There is no treatment to reverse OHSS and is symptom management and control only. Symptoms can take a few days to a few weeks to resolve depending on the severity and management plan undertaken. […] When the clinicians have made you medically fit to leave the hospital they will give you a copy of your discharge summary. This gets sent to your GP who needs to know of your hospital stay but you should inform your IVF clinic and have follow up appointment with them.

• #3 Ovarian hyperstimulation syndrome // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications. […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) to help suppress ovarian activity. […] If you develop mild ovarian hyperstimulation syndrome, you’ll probably be able to continue your day-to-day routine. Follow your provider’s advice, which may include these recommendations: Try an over-the-counter painkiller such as acetaminophen (Tylenol, others) for abdominal discomfort, but avoid ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) if you have recently had an embryo transfer, as these drugs can interfere with implantation of the embryo. […] Call your provider if your signs and symptoms get worse.

• #3 All About OHSS (Ovarian Hyperstimulation Syndrome)

  https://www.healthline.com/health/infertility/ohss

  Severe OHSS, on the other hand, often requires a hospital stay and can be very dangerous (even fatal) if left untreated. Your doctor may decide to admit you to the hospital if: your pain level is considerable, youre having trouble staying hydrated (due to gastro issues), your OHSS seems to be getting worse even with intervention. […] At the hospital, you may be given intravenous (IV) fluids to aid with hydration. In some cases, your doctor may want to alter your dose of fertility medication. You may be placed on a blood thinner to prevent blood clots. […] Your doctor may also recommend paracentesis, which is a procedure that can remove excess fluid buildup in your abdomen. And there are certain medications you can take to calm down all that activity going on in your ovaries. […] If you do develop OHSS, keep a close eye on your symptoms. Mild cases can resolve on their own with rest and time. Severe cases may land you in the hospital for care. So, if at any point something feels off or wrong, dont hesitate to contact your doctor ASAP.

• #3 Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023) – practice guidance | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/prevention-and-treatment-of-moderate-and-severe-ovarian-hyperstimulation-syndrome-a-guideline/

  In patients at risk for moderate-to-severe OHSS, it is recommended to start a dopamine agonist such as cabergoline on the day of the hCG trigger or soon thereafter and continue for several days. […] It is not recommended to administer letrozole as an intervention to reduce rates of moderate-to-severe OHSS. […] It is not recommended to administer a luteal GnRH antagonist alone to reduce rates of moderate-to-severe OHSS. Most studies report no reduction in rates of moderate-to-severe OHSS or signs or symptoms associated with OHSS. […] It is not recommended to use aspirin as a primary strategy to reduce the incidence of OHSS. […] It is recommended to consider a freeze-only cycle and subsequent frozen embryo transfer in patients at risk for OHSS on the basis of a high ovarian response or elevated serum estradiol levels.

• #3

  https://www.sgh.com.sg/patient-care/conditions-treatments/ovarian-hyperstimulation-syndrome-problems-conceiving

  Ovarian Hyperstimulation Syndrome (OHSS) is usually self-limiting and can then be treated at home with rest and adequate fluid intake. Immediate medical attention is required should the symptoms persist or worsen. In this instance, admission to hospital for treatment and close monitoring are required. Most of the time, the symptoms will subside in 5 to 15 days. […] You should report any concern at any time to the KKIVF Centre or the Women’s 24-Hour Clinic, which is located at Basement 1, Women’s Tower.

• #3 Preventing Ovarian Hyperstimulation Syndrome

  https://www.rmany.com/blog/preventing-ovarian-hyperstimulation-syndrome

  Choosing an appropriate stimulation dosage that isn’t too high for a patient is the primary step to avoid hyperstimulation risk, which increases as the stimulation treatment days progress. […] Patient education about the risks and drivers of OHSS are an integral part of any treatment program because patient participation in the treatment plan can help to avoid the occurrence of OHSS. […] Advancements in understanding the causes of OHSS, the availability of techniques to modify the risk of its occurrence, and experienced practitioners trained in the proper management of patients undergoing ovarian stimulation procedures have thankfully made the likelihood of the severest forms of OHSS rare and have made fertility treatments very safe.

• #3 Ovarian hyperstimulation syndrome – UF Health

  https://ufhealth.org/conditions-and-treatments/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome (OHSS) is a problem that is sometimes seen in women who take fertility medicines that stimulate egg production. […] If you have a severe case of OHSS, your health care provider will need to monitor your symptoms carefully. You may be admitted to the hospital. […] Mild cases of OHSS usually don’t need to be treated. The condition may actually be associated with a greater chance of becoming pregnant. […] If your provider diagnoses severe OHSS before transferring embryos in an IVF, they may decide to cancel the embryo transfer. […] In the rare case that you develop severe OHSS, you will probably need to go to a hospital. Your provider will give you fluids through a vein (intravenous fluids). They will also remove fluids that have collected in your body, and monitor your condition.

• #3 Ovarian Hyperstimulation Syndrome – RCEMLearning

  https://www.rcemlearning.co.uk/reference/ovarian-hyperstimulation-syndrome/

  Importantly, OHSS alone does not commonly cause severe abdominal pain, peritonism or pyrexia. These features should prompt the clinician to exclude ectopic pregnancy, ovarian torsion or cyst rupture, as well as intra-abdominal infection or perforation, as causes. […] […] Treatment of OHSS is supportive with most non-pregnancy associated cases resolving in 10-14 days. […] […] Mild (the vast majority of cases) and most moderate OHSS will be managed on an outpatient basis by the fertility treatment centre with oral analgesia, advice about monitoring fluid intake and urine output, regular reviews and contact details for advice. […] […] If a patient attends the ED with OHSS, consultation with obstetric colleagues is important to help guide management. Indications for hospital admission include inability to achieve adequate pain control, inability to take maintain hydration, worsening symptoms (such as weight gain, breathlessness or reduced urine output) while being managed as an outpatient, social circumstances which prevent regular face to face follow up, and critical OHSS. […]

• #3 Ovarian Hyperstimulation Syndrome – RCEMLearning

  https://www.rcemlearning.co.uk/reference/ovarian-hyperstimulation-syndrome/

  In the emergency department, fluid resuscitation to restore intravascular volume is the treatment priority. Analgesia, antiemetics and electrolyte correction may also be required, in addition to oxygenation and ventilatory support as necessary. […] […] Patients admitted with OHSS should all receive thromboprophylaxis unless there is a contraindication. […]

• #3 Unusual ovarian hyperstimulation syndrome presentation: Pleural effusion without ascites. A case report

  https://www.wjgnet.com/2307-8960/full/v13/i8/100028.htm

  This clinical case highlights the necessity for an accurate management in all patients undergoing IVF, as severe OHSS can occur unexpectedly even in patients with lack of risk factors. […] Our experience with aspiration of the pleural cavity combined with intravenous albumin administration demonstrates an effective treatment modality for managing massive PE.

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