Materiały źródłowe

• #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: […] A physical exam. Your provider will look for any weight gain, increases in your waist size and abdominal pain you may have. […] An ultrasound. If you have ovarian hyperstimulation syndrome (OHSS), an ultrasound may show that your ovaries are bigger than usual, with large fluid-filled cysts where follicles developed. During treatment with fertility drugs, your provider regularly evaluates your ovaries with a vaginal ultrasound. […] A blood test. Certain blood tests allow your provider to check for abnormalities in your blood and whether your kidney function is being impaired because of OHSS. […] Does ovarian hyperstimulation syndrome usually go away on its own, or will I need treatment?

• #2 Ovarian hyperstimulation syndrome (OHSS) | RCOG

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

  Ovarian hyperstimulation syndrome is a potentially serious complication of fertility treatment, particularly of in vitro fertilisation (IVF). […] A diagnosis is made on the basis of your symptoms, the examination findings and the results of your tests. […] Although there is no treatment that can reverse OHSS, it will usually get better with time. Treatment is to help symptoms and prevent complications.

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

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

  Pathogenesis, clinical manifestations, and diagnosis of ovarian hyperstimulation syndrome […] The pathogenesis, clinical manifestations, and diagnosis of OHSS are reviewed here. […] Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian hyperstimulation (COH) for assisted reproduction technologies (ART). […] 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 frequency of OHSS depends upon the clinical setting (eg, ovulation induction/ovarian stimulation followed by timed intercourse or intrauterine insemination versus in vitro fertilization [IVF]) and the classification criteria used for OHSS. […] 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.

• #4 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. […] Ovarian hyperstimulation syndrome (OHSS) is an uncommon but serious complication associated with controlled ovarian stimulation during assisted reproductive technology (ART). Historically, moderate-to-severe OHSS has been reported to occur in approximately 1%5% of in vitro fertilization (IVF) cycles.

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

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

  Ovarian hyperstimulation syndrome (OHSS) happens when your ovaries swell and leak fluid into your abdomen. OHSS is a complication that typically occurs in women who receive fertility treatments that stimulate their ovaries to produce a large number of eggs. […] Healthcare providers diagnose OHSS with several tests. These tests can include: Physical exam: A provider checks your weight and measures the size of your waist to look for signs of swelling. A pelvic exam isnt recommended because your ovaries are swollen and may burst under direct pressure. Ultrasound: Detects free fluid in your belly (abdomen) the abdomen and the size of your ovaries. Chest X-ray: Looks for fluid in your chest. Blood test: Measures your hormone levels for signs of OHSS. […] The treatment for OHSS varies depending on how severe the condition is. Treatment aims to manage symptoms and avoid complications. Mild cases tend to go away within a week or two. However, if you get pregnant that cycle, your symptoms could last much longer.

• #6 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: […] A physical exam. Your provider will look for any weight gain, increases in your waist size and abdominal pain you may have. […] An ultrasound. If you have ovarian hyperstimulation syndrome (OHSS), an ultrasound may show that your ovaries are bigger than usual, with large fluid-filled cysts where follicles developed. During treatment with fertility drugs, your provider regularly evaluates your ovaries with a vaginal ultrasound. […] A blood test. Certain blood tests allow your provider to check for abnormalities in your blood and whether your kidney function is being impaired because of OHSS. […] Does ovarian hyperstimulation syndrome usually go away on its own, or will I need treatment?

• #7 Ovarian hyperstimulation syndrome – WikEM

  https://wikem.org/wiki/Ovarian_hyperstimulation_syndrome

  Female pelvic anatomy. […] Fertility treatments causing development of multiple follicles at once […] Exaggerated ovarian response to ovulation induction (esp in IVF when HCG is used to stimulate) […] Fluid shifts out of vasculature (third spacing) […] Typically 5-10d after 1st dose […] Ranges in severity from mild to severe multiorgan dysfunction, relating in part to massive intravascular fluid shifts. […] Vaginal ultrasonography in mild ovarian hyperstimulation syndrome (coronal). Pelvic ultrasound (sagittal) in woman with OHSS showing ascites and enlarged ovary (diameter = 6.5mm) […] Urine or serum pregnancy […] Beta-HCG may be positive if beta-HCG injection given as part of fertility treatment, consider obtaining beta quantitative instead of qualitative […] CBC […] Chem 10

• #8 Ovarian hyperstimulation syndrome – WikEM

  https://wikem.org/wiki/Ovarian_hyperstimulation_syndrome

  PT/PTT […] Pelvic ultrasound […] Consider: […] CXR (rule out pleural effusion) […] Cardiac ultrasound (rule out pericardial effusion) […] Progesterone level […] Estradiol level […] Fibrinogen (rule out DIC) […] Classification […] Clinical features […] Lab findings […] Mild […] Abdominal distention/discomfort […] Mild nausea/vomiting […] Diarrhea […] Enlarged ovaries […] Normal Moderate Above plus: […] Ultrasonographic evidence of ascites […] Elevated hematocrit (41%) […] Elevated WBC (15,000/mL) […] Hypoproteinemia […] Severe Above plus: […] Clinical evidence of ascites (can be tense ascites) […] Severe abdominal pain […] Intractable nausea and vomiting […] Rapid weight gain (1 kg in 24 hours) […] Pleural effusion […] Severe dyspnea […] Oliguria/anuria

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

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

  Ovarian hyperstimulation syndrome (OHSS) happens when your ovaries swell and leak fluid into your abdomen. OHSS is a complication that typically occurs in women who receive fertility treatments that stimulate their ovaries to produce a large number of eggs. […] Healthcare providers diagnose OHSS with several tests. These tests can include: Physical exam: A provider checks your weight and measures the size of your waist to look for signs of swelling. A pelvic exam isnt recommended because your ovaries are swollen and may burst under direct pressure. Ultrasound: Detects free fluid in your belly (abdomen) the abdomen and the size of your ovaries. Chest X-ray: Looks for fluid in your chest. Blood test: Measures your hormone levels for signs of OHSS. […] The treatment for OHSS varies depending on how severe the condition is. Treatment aims to manage symptoms and avoid complications. Mild cases tend to go away within a week or two. However, if you get pregnant that cycle, your symptoms could last much longer.

• #10 Ovarian Hyperstimulation Syndrome: Causes, Symptoms, and More

  https://www.webmd.com/infertility-and-reproduction/what-is-ovarian-hyperstimulation-syndrome

  Diagnosing Ovarian Hyperstimulation Syndrome […] If you are receiving fertility treatment and begin to experience symptoms of OHSS, tell your doctor. They may perform some of the following exams to diagnose the condition. […] A physical exam can indicate weight gain and bloating. Weighing yourself every day will determine how quickly you gain weight and can make a diagnosis easier. Your doctor will likely measure your belly for any signs of severe bloating. […] Electronic imaging, like ultrasounds and X-rays, will locate fluid elsewhere in the body. OHSS becomes severe when fluid begins leaking into the abdomen and torso. Leakage leads to bloating and weight gain. […] Ultrasounds will also reveal how much the ovaries have swollen. The size of the ovaries is often a sign of how severe your OHSS is.

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

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

  Ovarian hyperstimulation syndrome diagnosis may be based on: […] A physical exam. Your provider will look for any weight gain, increases in your waist size and abdominal pain you may have. […] An ultrasound. If you have OHSS, an ultrasound may show that your ovaries are bigger than usual, with large fluid-filled cysts where follicles developed. During treatment with fertility drugs, your provider regularly evaluates your ovaries with a vaginal ultrasound. […] A blood test. Certain blood tests allow your provider to check for abnormalities in your blood and whether your kidney function is being impaired because of OHSS.

• #12 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: […] A physical exam. Your provider will look for any weight gain, increases in your waist size and abdominal pain you may have. […] An ultrasound. If you have ovarian hyperstimulation syndrome (OHSS), an ultrasound may show that your ovaries are bigger than usual, with large fluid-filled cysts where follicles developed. During treatment with fertility drugs, your provider regularly evaluates your ovaries with a vaginal ultrasound. […] A blood test. Certain blood tests allow your provider to check for abnormalities in your blood and whether your kidney function is being impaired because of OHSS. […] Does ovarian hyperstimulation syndrome usually go away on its own, or will I need treatment?

• #13 OHSS Explained : Symptoms, Causes, and Life-saving Treatment

  https://www.artfertilityclinics.com/in/en/art-blog/ohss-symptoms-causes-treatment

  Ovarian hyperstimulation syndrome is an excessive reaction to hormone excess. […] The diagnostic process may involve the following procedures: Physical Exam: A physical examination can reveal weight gain and abdominal bloating signs. Monitoring your daily weight gain is essential for a more accurate diagnosis. Your doctor will also assess your belly for indications of severe bloating. […] Ultrasounds and X-rays: Imaging techniques such as ultrasounds and X-rays can help identify fluid accumulation in various body regions. OHSS escalates when fluid leaks into the abdomen and torso, leading to bloating and weight gain. Additionally, ultrasounds provide insights into the extent of ovarian swelling, often reflecting the severity of OHSS. […] Blood Tests: Blood tests are performed in conjunction with ultrasounds for individuals undergoing fertility treatment. These tests assess hormone levels, detect blood abnormalities, and evaluate the impact of swollen, leaking ovaries on kidney function. Regular blood tests can facilitate early OHSS detection, allowing for prompt intervention.

• #14 Ultrasound and Ovarian Hyperstimulation Syndrome | Radiology Key

  https://radiologykey.com/ultrasound-and-ovarian-hyperstimulation-syndrome/

  Once OHSS is suspected on clinical grounds, the diagnosis is aided by ultrasound findings. […] The differentiation involves sonographic features including the degree of ovarian enlargement, presence and volume of abdominal ascites, presence or absence of pleural effusions, and Doppler studies showing venous thromboembolism. […] Mild OHSS is common and involves symptoms such as lower abdominal or pelvic discomfort, gastrointestinal complaints including nausea, emesis, and diarrhea, and some degree of abdominal distention. […] The only sonographic characteristic of mild OHSS may be enlarged ovaries (512 cm). […] Moderate OHSS consists of intensified pain, nausea or emesis, enlarged ovaries seen on ultrasound, and sonographic identification of abdominal or pelvic ascites with normal serum laboratory parameters.

• #15 Ultrasound and Ovarian Hyperstimulation Syndrome | Radiology Key

  https://radiologykey.com/ultrasound-and-ovarian-hyperstimulation-syndrome/

  Given that abdominal ascites is a key characteristic of the diagnosis of moderate OHSS, it is critical that the ultrasound findings be interpreted correctly in the context of the clinical presentation. […] Severe OHSS has been reported to be fatal, so the prompt diagnosis and treatment is paramount. […] Current research indicates that the fluid shifts which occur in OHSS are directly caused by increased VEGF. […] These fluid shifts can be identified sonographically, and it is recommended that in the evaluation of the patient suspected to have moderate or severe OHSS, ultrasound should be used to check for abdominal ascites or pleural effusions.

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

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

  Ovarian hyperstimulation syndrome diagnosis may be based on: […] A physical exam. Your provider will look for any weight gain, increases in your waist size and abdominal pain you may have. […] An ultrasound. If you have OHSS, an ultrasound may show that your ovaries are bigger than usual, with large fluid-filled cysts where follicles developed. During treatment with fertility drugs, your provider regularly evaluates your ovaries with a vaginal ultrasound. […] A blood test. Certain blood tests allow your provider to check for abnormalities in your blood and whether your kidney function is being impaired because of OHSS.

• #17 FloridaHealthFinder | Ovarian hyperstimulation syndrome | Health Encyclopedia | FloridaHealthFinder

  https://quality.healthfinder.fl.gov/health-encyclopedia/HIE/1/007294

  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. […] Tests that may be done include: abdominal ultrasound or vaginal ultrasound, chest x-ray, complete blood count, electrolytes panel, liver function test, tests to measure urine output. […] If your provider diagnoses severe OHSS before transferring embryos in an IVF, they may decide to cancel the embryo transfer. […] 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.

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

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

  Ovarian hyperstimulation syndrome (OHSS) happens when your ovaries swell and leak fluid into your abdomen. OHSS is a complication that typically occurs in women who receive fertility treatments that stimulate their ovaries to produce a large number of eggs. […] Healthcare providers diagnose OHSS with several tests. These tests can include: Physical exam: A provider checks your weight and measures the size of your waist to look for signs of swelling. A pelvic exam isnt recommended because your ovaries are swollen and may burst under direct pressure. Ultrasound: Detects free fluid in your belly (abdomen) the abdomen and the size of your ovaries. Chest X-ray: Looks for fluid in your chest. Blood test: Measures your hormone levels for signs of OHSS. […] The treatment for OHSS varies depending on how severe the condition is. Treatment aims to manage symptoms and avoid complications. Mild cases tend to go away within a week or two. However, if you get pregnant that cycle, your symptoms could last much longer.

• #19 Ovarian Hyperstimulation Syndrome (OHSS) | Discover

  https://www.yourhormones.info/explore/discover/ovarian-hyperstimulation-syndrome-ohss/

  Ovarian Hyperstimulation Syndrome (OHSS) is a side-effect of in vitro fertilisation (IVF) treatment. It occurs due to over-stimulation of the ovaries by the hormone used to prepare the eggs for collection and fertilisation by sperm, in particular the hormone human chorionic gonadotrophin (hCG). […] How is OHSS diagnosed? […] OHSS is usually diagnosed in an outpatient setting, but if women have severe symptoms like difficulty breathing, admission to hospital may well be required. An ultrasound scan (US scan) of the pelvis is used to assess ovarian size and the presence of fluid in the abdomen (ascites). If there is concern about fluid in the lungs, an ultrasound scan of the lungs or chest X-ray can be used to identify this. If there is concern about a clot on the lungs, then a computed tomography pulmonary angiography (CTPA) can be conducted. Blood tests including for kidney function, protein levels, liver function and clotting factors are also carried out.

• #20 Ovarian Hyperstimulation Syndrome Workup: Approach Considerations

  https://emedicine.medscape.com/article/1343572-workup

  In ovarian hyperstimulation syndrome (OHSS), the hematocrit is the most important measure in deciding if a patient should be hospitalized. If the patient’s hematocrit level is greater than 60% and if she has ascites, hospitalize her immediately. […] Laboratory monitoring may involve the following parameters: Complete blood count (CBC) with differential – This is helpful because decreased intravascular volume leads to hemoconcentration and an increased hematocrit […] Coagulation profile, including the prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR) – These findings aid in detecting a hypercoagulable state and in monitoring anticoagulation […] Leukocyte count – A count higher than 22,000 cells/L is related to the seriousness of OHSS and predictive of thromboembolism.

• #21 Ovarian Hyperstimulation Syndrome Workup: Approach Considerations

  https://emedicine.medscape.com/article/1343572-workup

  A beta-hCG measurement is especially useful at more than 12 days after an injection of hCG. A positive result at this stage indicates pregnancy, an endogenous source of hCG for OHSS. […] Mild OHSS may deteriorate to severe OHSS because of the increased availability of hCG. […] Signs that may indicate a progression in the severity of OHSS are increases in the hCG level, increases in hematocrit level, hypoproteinemia, and hypoalbuminemia (third spacing). Additional signs are decreasing renal and liver function. […] OHSS is critical when the signs and symptoms of severe OHSS are present with any of the following findings: renal failure, ARDS, thromboembolism, or a hematocrit level greater than 60%. […] Ultrasonography may be needed to measure the size of the ovaries, to assess the follicles, and to evaluate ascites.

• #22 Ovarian hyperstimulation syndrome – WikEM

  https://wikem.org/wiki/Ovarian_hyperstimulation_syndrome

  PT/PTT […] Pelvic ultrasound […] Consider: […] CXR (rule out pleural effusion) […] Cardiac ultrasound (rule out pericardial effusion) […] Progesterone level […] Estradiol level […] Fibrinogen (rule out DIC) […] Classification […] Clinical features […] Lab findings […] Mild […] Abdominal distention/discomfort […] Mild nausea/vomiting […] Diarrhea […] Enlarged ovaries […] Normal Moderate Above plus: […] Ultrasonographic evidence of ascites […] Elevated hematocrit (41%) […] Elevated WBC (15,000/mL) […] Hypoproteinemia […] Severe Above plus: […] Clinical evidence of ascites (can be tense ascites) […] Severe abdominal pain […] Intractable nausea and vomiting […] Rapid weight gain (1 kg in 24 hours) […] Pleural effusion […] Severe dyspnea […] Oliguria/anuria

• #23 Ovarian hyperstimulation syndrome – WikEM

  https://wikem.org/wiki/Ovarian_hyperstimulation_syndrome

  Low blood/central venous pressure […] Syncope […] Venous thrombosis […] Hemoconcentration (hematocrit 55%) […] WBC 25,000/mL […] Serum creatinine 1.6mg/dL […] Creatinine clearance 50 mL/min […] Hyponatremia (Na+ 135 mEq/L) […] Hyperkalemia (K+ 5 mEq/L) […] Elevated liver enzymes […] Critical Above plus: […] Anuria/acute renal failure […] Arrhythmia […] Pericardial effusion […] Massive hydrothorax […] Thromboembolism […] Arterial thrombosis […] ARDS […] Sepsis […] Worsening findings.

• #24 Ovarian hyperstimulation syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Ovarian_hyperstimulation_syndrome

  Ovarian hyperstimulation syndrome (OHSS) is a medical condition that can occur in some women who take fertility medication to stimulate egg growth, and in other women in sporadic cases. Most cases are mild, but rarely the condition is severe and can lead to serious illness or even death. […] OHSS is divided into the categories mild, moderate, severe, and critical. In mild forms of OHSS the ovaries are enlarged (512 cm) and there may be additional accumulation of ascites with mild abdominal distension, abdominal pain, nausea, and diarrhea. In severe forms of OHSS there may be hemoconcentration, thrombosis, distension, oliguria (decreased urine production), pleural effusion, and respiratory distress. […] Criteria for severe OHSS include enlarged ovary, ascites, hematocrit 45%, WBC 15,000, oliguria, creatinine 1.0-1.5 mg/dl, creatinine clearance 50 ml/min, liver dysfunction, and anasarca. Critical OHSS includes enlarged ovary, tense ascites with hydrothorax and pericardial effusion, hematocrit 55%, WBC 25,000, oligoanuria, creatinine 1.6 mg/dl, creatinine clearance 50 ml/min, kidney failure, thromboembolic phenomena, and ARDS.

• #25

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5993897/

  Severe OHSS, which two decades ago was considered an iatrogenic life-threatening condition, can now be effectively prevented or managed during the early stages. […] An OHSS-free clinic can be established nowadays by carefully considering the endocrinology of ovulation and using appropriate and dose-adjusted pharmaceutical agents, which are summarized and discussed in this review. […] The prevention of OHSS is based on its prediction. […] The primary risk factors for OHSS are young age, low body mass index, polycystic ovarian syndrome (PCOS), and history of previous OHSS. […] Serum anti-Mullerian hormone (AMH) is a biomarker that may predict the risk of OHSS. […] The antral follicle count (AFC) is also predictive of OHSS. […] Ultrasound monitoring and serum E2 are the vital components of surveillance for OHSS.

• #26

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5993897/

  A rapid rise in estradiol levels and serum estradiol concentrations 2500 pg/mL are important predictive factors. […] The risk of OHSS should be assessed individually based on the history, physical examination, ultrasound results, and the AFC. […] Patients with PCOS are at a higher risk for OHSS. […] The minimum gonadotropin dose should be used for ovulation induction in patients with PCOS, and step-up regimens are considered superior to step-down regimens. […] The drug of choice to trigger the final maturation of follicles should be selected based on the predicted risk of OHSS development. […] It should be kept in mind that there is no agent capable of completely eliminating the risk of OHSS. […] The administration of recombinant LH to mimic the endogenous LH surge with a half-life of only 10 hours is a theoretically potential strategy for prevention of OHSS in high-risk patients.

• #27 FloridaHealthFinder | Ovarian hyperstimulation syndrome | Health Encyclopedia | FloridaHealthFinder

  https://quality.healthfinder.fl.gov/health-encyclopedia/HIE/1/007294

  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. […] Tests that may be done include: abdominal ultrasound or vaginal ultrasound, chest x-ray, complete blood count, electrolytes panel, liver function test, tests to measure urine output. […] If your provider diagnoses severe OHSS before transferring embryos in an IVF, they may decide to cancel the embryo transfer. […] 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.

• #28

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5993897/

  Secondary preventive measures should be undertaken in patients with an exaggerated response to COS. […] The administration of intravenous albumin is suggested to prevent OHSS. […] The administration of 20-50 g of 25% albumin at the time of oocyte retrieval has been proposed to decrease the risk of OHSS. […] Dopamine agonists in the prevention of ovarian hyperstimulation syndrome (cabergoline) are suggested to successfully reduce the incidence of moderate OHSS. […] The clinical treatment of OHSS depends on its severity, complications, and absence or presence of pregnancy. […] The main event in the pathogenesis of OHSS is ovarian enlargement, secretion of vasoactive substances, ascites, and hypovolemia resulting from an acute extravasation of fluid into the interstitial space. […] OHSS is classified into 4 categories based on the severity of symptoms, signs, and laboratory findings.

• #29 Ovarian hyperstimulation syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Ovarian_hyperstimulation_syndrome

  Ovarian hyperstimulation syndrome (OHSS) is a medical condition that can occur in some women who take fertility medication to stimulate egg growth, and in other women in sporadic cases. Most cases are mild, but rarely the condition is severe and can lead to serious illness or even death. […] OHSS is divided into the categories mild, moderate, severe, and critical. In mild forms of OHSS the ovaries are enlarged (512 cm) and there may be additional accumulation of ascites with mild abdominal distension, abdominal pain, nausea, and diarrhea. In severe forms of OHSS there may be hemoconcentration, thrombosis, distension, oliguria (decreased urine production), pleural effusion, and respiratory distress. […] Criteria for severe OHSS include enlarged ovary, ascites, hematocrit 45%, WBC 15,000, oliguria, creatinine 1.0-1.5 mg/dl, creatinine clearance 50 ml/min, liver dysfunction, and anasarca. Critical OHSS includes enlarged ovary, tense ascites with hydrothorax and pericardial effusion, hematocrit 55%, WBC 25,000, oligoanuria, creatinine 1.6 mg/dl, creatinine clearance 50 ml/min, kidney failure, thromboembolic phenomena, and ARDS.

• #30 Ovarian Hyperstimulation Syndrome (OHSS) | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688255/all/Ovarian_Hyperstimulation_Syndrome__OHSS_?q=Ascites

  Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic physiologic complication of controlled ovarian hyperstimulation (COH) (most often related to treatment for infertility). […] Classification of OHSS is based on clinical symptoms and ultrasound (US) findings: Mild: abdominal distension and discomfort, Moderate: abdominal distension, enlarged ovaries (8 to 10 cm3), and ascites on US (largest pocket 3 cm), Severe: clinical evidence of ascites and/or hydrothorax, hemoconcentration 45%, Critical: hemoconcentration 55%, creatinine clearance 50 mL/min, renal failure, thromboembolism, acute respiratory distress syndrome (ARDS). […] Symptoms of OHSS may occur early (within 10 days of human chorionic gonadotropin [hCG] administration) or late (10 days after hCG administration). Late OHSS is usually associated with a pregnancy and may often be more severe.

• #31 Ovarian hyperstimulation syndrome – WikEM

  https://wikem.org/wiki/Ovarian_hyperstimulation_syndrome

  PT/PTT […] Pelvic ultrasound […] Consider: […] CXR (rule out pleural effusion) […] Cardiac ultrasound (rule out pericardial effusion) […] Progesterone level […] Estradiol level […] Fibrinogen (rule out DIC) […] Classification […] Clinical features […] Lab findings […] Mild […] Abdominal distention/discomfort […] Mild nausea/vomiting […] Diarrhea […] Enlarged ovaries […] Normal Moderate Above plus: […] Ultrasonographic evidence of ascites […] Elevated hematocrit (41%) […] Elevated WBC (15,000/mL) […] Hypoproteinemia […] Severe Above plus: […] Clinical evidence of ascites (can be tense ascites) […] Severe abdominal pain […] Intractable nausea and vomiting […] Rapid weight gain (1 kg in 24 hours) […] Pleural effusion […] Severe dyspnea […] Oliguria/anuria

• #32 Ovarian hyperstimulation syndrome – WikEM

  https://wikem.org/wiki/Ovarian_hyperstimulation_syndrome

  Low blood/central venous pressure […] Syncope […] Venous thrombosis […] Hemoconcentration (hematocrit 55%) […] WBC 25,000/mL […] Serum creatinine 1.6mg/dL […] Creatinine clearance 50 mL/min […] Hyponatremia (Na+ 135 mEq/L) […] Hyperkalemia (K+ 5 mEq/L) […] Elevated liver enzymes […] Critical Above plus: […] Anuria/acute renal failure […] Arrhythmia […] Pericardial effusion […] Massive hydrothorax […] Thromboembolism […] Arterial thrombosis […] ARDS […] Sepsis […] Worsening findings.

• #33 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). […] The diagnosis is based on clinical criteria. It is therefore very important to have a classification, based on the symptoms. […] The diagnosis of OHSS is made on clinical grounds. […] Early OHSS usually presents within 7 days of the hCG injection and is usually associated with an excessive ovarian response. Late OHSS typically presents 10 or more days after the hCG injection and is usually the result of endogenous hCG derived from an early pregnancy. […] Your physician will following the following steps for diagnosis of OHSS: Take detailed history from a woman suspected to be suffering from OHSS. […] The primary way of preventing OHSS is identification of a high-risk patient. […] Whenever a patient is at high risk, hCG trigger should be withheld or GnRH agonist trigger should be used.

• #34 Ovarian Hyperstimulation Syndrome – RCEMLearning

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

  An ultrasound is required to measure ovarian size, assess for ovarian torsion or presence of ascites/free fluid, and to exclude other differential diagnoses of abdominal pain. […] It is challenging to interpret a quantitative hCG level (to help determine whether a fertility cycle has resulted in early pregnancy), especially if a hCG trigger injection has been used. Seek specialist advice. […] Some patients present with early OHSS, within seven days of the trigger injection due to an excessive ovarian response. Patients with late OHSS present ten or more days after the trigger injection, usually from endogenous hCG due to an implanting pregnancy. […] The Royal College of Obstetricians and Gynaecologists (RCOG) have proposed the following severity classification.1 […] Treatment of OHSS is supportive with most non-pregnancy associated cases resolving in 10-14 days.

• #35 Ovarian Hyperstimulation Syndrome Differential Diagnoses

  https://emedicine.medscape.com/article/1343572-differential

  Conditions to consider in the differential diagnosis of ovarian hyperstimulation syndrome (OHSS) include the following: […] Ovarian hyperstimulation syndrome: an update review. […] Diagnosis, prevention and management of ovarian hyperstimulation syndrome. […] The pathophysiology of ovarian hyperstimulation syndrome–views and ideas. […] Role of vascular endothelial cell growth factor in Ovarian Hyperstimulation Syndrome. […] Ovarian hyperstimulation syndrome: imperatives for the emergency physician. […] Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. […] Dopamine agonists for preventing ovarian hyperstimulation syndrome.

• #36 Ovarian Hyperstimulation Syndrome – RCEMLearning

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

  Ovarian hyperstimulation syndrome (OHSS) is a complication of fertility treatment as outlined in the Royal College of Obstetricians and Gynaecologists Green-top guideline.1 […] The diagnosis of OHSS is clinical, but can be challenging as the symptoms are nonspecific and there is no conclusive diagnostic test.1 It should be suspected in all patients undergoing fertility treatment who attend the emergency department, particularly those with risk factors for OHSS. These include5: […] Symptoms and signs include: […] OHSS-associated thrombosis is infrequent, but typically occurs in the venous system (81% of cases) and unusually may preferentially affect the jugular and subclavian veins ahead of the lower, and then upper, extremities.6 […] 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.

• #37

  https://journals.lww.com/nimj/fulltext/2016/57010/ovarian_hyperstimulation_syndrome_in_a_spontaneous.14.aspx

  Ovarian hyperstimulation syndrome (OHSS) with the natural ovulatory cycle is extremely rare. […] Ovarian hyperstimulation syndrome (OHSS) typically is an iatrogenic, serious, and potentially fatal complication of supraphysiological ovarian stimulation in assisted conception cycles. […] However, rarely, it may occur spontaneously at the beginning of a natural pregnancy and in the absence of any assisted reproductive treatment. […] A diagnosis of severe OHSS, with viable intrauterine pregnancy, was made. […] Our patient was referred because of suspicion of an ovarian neoplasm owing to the ultrasound features in an unstimulated ovary. […] Our experience in management of OHSS from a dedicated in vitro fertilization program helped in apt and prompt diagnosis/management of this case. […] Early recognition and appropriate supportive therapy is advocated to ensure a good outcome.

• #38 Ovarian Hyperstimulation Syndrome – RCEMLearning

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

  Ovarian hyperstimulation syndrome (OHSS) is a complication of fertility treatment as outlined in the Royal College of Obstetricians and Gynaecologists Green-top guideline.1 […] The diagnosis of OHSS is clinical, but can be challenging as the symptoms are nonspecific and there is no conclusive diagnostic test.1 It should be suspected in all patients undergoing fertility treatment who attend the emergency department, particularly those with risk factors for OHSS. These include5: […] Symptoms and signs include: […] OHSS-associated thrombosis is infrequent, but typically occurs in the venous system (81% of cases) and unusually may preferentially affect the jugular and subclavian veins ahead of the lower, and then upper, extremities.6 […] 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.

• #39 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 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? […] Ovarian hyperstimulation syndrome could theoretically occur in any woman undergoing controlled ovarian stimulation with gonadotropins. However, evidence indicates that there are some women who are at a much higher risk. Suggested thresholds to identify risk factors for OHSS on the basis of conservative estimates from the literature are presented. […] Baseline patient characteristics are helpful when assessing risk for OHSS and may allow for early counseling and risk mitigation before treatment.

• #40 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/

  Markers of ovarian reserve have consistently proven to be better predictors of OHSS risk. Before treatment antimullerian hormone (AMH) levels and antral follicle count (AFC) have been studied as markers of response to ovarian stimulation, with various thresholds suggesting an elevated risk for OHSS. […] 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. […] 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. […] It is recommended to employ ovarian stimulation protocols using GnRH antagonists over protocols using GnRH agonists when there is concern for OHSS.

• #41

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5993897/

  Severe OHSS, which two decades ago was considered an iatrogenic life-threatening condition, can now be effectively prevented or managed during the early stages. […] An OHSS-free clinic can be established nowadays by carefully considering the endocrinology of ovulation and using appropriate and dose-adjusted pharmaceutical agents, which are summarized and discussed in this review. […] The prevention of OHSS is based on its prediction. […] The primary risk factors for OHSS are young age, low body mass index, polycystic ovarian syndrome (PCOS), and history of previous OHSS. […] Serum anti-Mullerian hormone (AMH) is a biomarker that may predict the risk of OHSS. […] The antral follicle count (AFC) is also predictive of OHSS. […] Ultrasound monitoring and serum E2 are the vital components of surveillance for OHSS.

• #42 Ultrasound and Ovarian Hyperstimulation Syndrome | Radiology Key

  https://radiologykey.com/ultrasound-and-ovarian-hyperstimulation-syndrome/

  Several investigators have evaluated AFC to predict the development of OHSS. […] They categorized ovarian response as poor, normal, and high and then calculated the AFC cutoff which most accurately identified each group. […] The AFC value of 14 identified hyper-responders with a sensitivity of 82 % and a specificity of 89 %. […] Oncal et al. also evaluated the predictive role of AFC in OHSS in 41 women identified to have moderate to severe OHSS and 41 age-matched controls who did not develop OHSS. […] They found that AFC had a moderate accuracy to predict the development of OHSS. […] When these five studies of AFC were evaluated together, the sensitivity of AFC to predict ovarian hyper-response was seen to vary between 20 and 94 % depending on the AFC cutoff used, and the specificity varied between 33 and 98 %.

• #43 Ultrasound and Ovarian Hyperstimulation Syndrome | Radiology Key

  https://radiologykey.com/ultrasound-and-ovarian-hyperstimulation-syndrome/

  Considering this evidence, there is a clear association between increased AFC and increased risk of OHSS. […] When proposing the use of AFC to predict OHSS, it is important to be aware of the variability both in definition of antral follicle and operator technique in follicle counting. […] The number of growing follicles in response to gonadotropin stimulation during ART is another sonographic test which has been proposed to predict the development of OHSS. […] Papanikolaou et al. sought to correlate the number of follicles 11 mm growing in response to gonadotropin treatment during IVF with the likelihood of developing moderate or severe ovarian hyperstimulation syndrome. […] They found that a threshold of 13 follicles measuring 11 mm was predictive of the development of OHSS with a sensitivity of 85.5 % and a specificity of 69 %.

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

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

  Some cases of OHSS cant be prevented. However, your healthcare provider will know if youre at risk based on your health history and bloodwork. During fertility treatments, your healthcare provider may monitor your ovaries regularly using blood tests (to check hormone levels) and ultrasounds (to look at how many follicles are developing) to reduce your risk of OHSS.

• #45 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. […] The diagnosis of OHSS is based on clinical criteria and therefore clinicians should be aware of the signs and symptoms. […] Careful monitoring of the ovaries by ultrasound during treatment is mandatory. The rate of growth of follicles is measured and treatment is cut back if stimulation seems excessive. […] Management is essentially supportive until the condition resolves spontaneously. This often involves a multidisciplinary approach and should follow agreed protocols. […] If blood oestrogens and ultrasound scans show a high risk of severe OHSS, hCG should be withheld. […] An intensive care setting may be required. […] 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. […] The prevention of ovarian hyperstimulation syndrome.

• #46 Ultrasound and Ovarian Hyperstimulation Syndrome | Radiology Key

  https://radiologykey.com/ultrasound-and-ovarian-hyperstimulation-syndrome/

  Considering this evidence, there is a clear association between increased AFC and increased risk of OHSS. […] When proposing the use of AFC to predict OHSS, it is important to be aware of the variability both in definition of antral follicle and operator technique in follicle counting. […] The number of growing follicles in response to gonadotropin stimulation during ART is another sonographic test which has been proposed to predict the development of OHSS. […] Papanikolaou et al. sought to correlate the number of follicles 11 mm growing in response to gonadotropin treatment during IVF with the likelihood of developing moderate or severe ovarian hyperstimulation syndrome. […] They found that a threshold of 13 follicles measuring 11 mm was predictive of the development of OHSS with a sensitivity of 85.5 % and a specificity of 69 %.

• #47 Ultrasound and Ovarian Hyperstimulation Syndrome | Radiology Key

  https://radiologykey.com/ultrasound-and-ovarian-hyperstimulation-syndrome/

  Therefore, if it becomes apparent during an IVF cycle that there are 13 or more follicles measuring 11 mm, the patient and physician should both be cognizant of the increased risk of developing OHSS regardless of the serum estradiol level. […] It is well known that patients with polycystic ovarian syndrome (PCOS) have by definition a high antral follicle count and magnified response to IVF. […] Ultrasound assessment of ovarian morphology serves as one of the key criteria for the diagnosis of PCOS by the Rotterdam criteria. […] The sonographic findings which meet Rotterdam diagnostic criteria are either 12 or more follicles in each ovary measuring 29 mm in diameter and/or increased ovarian volume 10 mL. […] Interestingly, even women who do not technically meet criteria for PCOS but have isolated polycystic-appearing ovaries on ultrasound have been found to have a higher risk of developing OHSS.

• #48 Ultrasound and Ovarian Hyperstimulation Syndrome | Radiology Key

  https://radiologykey.com/ultrasound-and-ovarian-hyperstimulation-syndrome/

  Therefore, clinical management including gonadotropin dosing and choice of stimulation protocol should incorporate knowledge of PCOS or polycystic-appearing ovaries on ultrasound in an attempt to minimize the development of OHSS in these patients. […] The final ultrasound characteristics which have been used to attempt to predict the development of OHSS are Doppler flow studies of ovarian vasculature. […] In summary, ultrasound has been investigated as a tool to predict the development of OHSS through assessment of AFC, quantitation of follicular development during IVF, identification of polycystic-appearing ovaries or PCOS, determination of ovarian volume, and Doppler flow studies of ovarian vasculature. […] Of these potential sonographic markers, AFC is the most significant predictor of the development of OHSS and should be used to guide management.

• #49 Ultrasound and Ovarian Hyperstimulation Syndrome | Radiology Key

  https://radiologykey.com/ultrasound-and-ovarian-hyperstimulation-syndrome/

  Therefore, if it becomes apparent during an IVF cycle that there are 13 or more follicles measuring 11 mm, the patient and physician should both be cognizant of the increased risk of developing OHSS regardless of the serum estradiol level. […] It is well known that patients with polycystic ovarian syndrome (PCOS) have by definition a high antral follicle count and magnified response to IVF. […] Ultrasound assessment of ovarian morphology serves as one of the key criteria for the diagnosis of PCOS by the Rotterdam criteria. […] The sonographic findings which meet Rotterdam diagnostic criteria are either 12 or more follicles in each ovary measuring 29 mm in diameter and/or increased ovarian volume 10 mL. […] Interestingly, even women who do not technically meet criteria for PCOS but have isolated polycystic-appearing ovaries on ultrasound have been found to have a higher risk of developing OHSS.

• #50 Ovarian Hyperstimulation Syndrome | Nisha IVF Centre

  https://nishaivf.com/blog/ovarian-hyperstimulation-syndrome/

  Ovarian hyperstimulation syndrome (OHSS) is a side effect of fertility medication that involves using pharmacological substances to promote ovarian stimulation to increase the number of oocytes and thus the number of embryos accessible during assisted reproductive technology (ART). […] Clinical criteria are used to make the diagnosis. Fertility specialists use clinical symptoms, ultrasound findings, and laboratory markers to classify OHSS into different phases and grades. […] Early detection and timely evaluation and treatment of patients with moderate or severe OHSS are fundamental concepts of OHSS management. […] To diagnose OHSS, the doctor will take the below steps: Take a complete medical history of a patient suspected of having OHSS. […] Examining dehydration and edema (vulval, pedal, and sacral). Recording the heart rate, blood pressure, breathing rate, and weight.

• #51 Ovarian Hyperstimulation Syndrome | Nisha IVF Centre

  https://nishaivf.com/blog/ovarian-hyperstimulation-syndrome/

  Investigations: Complete blood count, CRP count, Haematocrit, Urea and electrolytes, LFT, Coagulation profile, Serum osmolality, hCG (to discover the outcome of treatment) if proper, Ultrasound scan: size of ovaries, pelvic and abdominal fluid. […] Identifying a high-risk patient is the most important step in preventing OHSS.

• #52 Ovarian Hyperstimulation Syndrome and Pregnancy: OHSS Treatment and IVF Complete Guide

  https://www.asianinfertility.com/blog/ovarian-hyperstimulation-syndrome-and-pregnancy

  Ovarian hyperstimulation syndrome (OHSS) is a medical condition that can occur rarely in women who undergo fertility treatments, particularly those involving assisted reproductive technologies like in vitro fertilization (IVF). It happens due to hyperstimulation of ovaries by hormones used to induce ovulation. […] OHSS impacts approximately 3% of women undergoing in vitro fertilization (IVF). Additional factors that increase the risk of OHSS comprise being under the age of 35 and experiencing markedly elevated estrogen levels during fertility procedures. […] To diagnose ovarian hyperstimulation syndrome (OHSS), we typically rely on a combination of clinical assessment, imaging techniques, and laboratory tests. […] During the clinical assessment, Ill carefully evaluate your symptoms and medical history, paying close attention to any signs of abdominal bloating, discomfort, or difficulty breathing.

• #53 Ovarian Hyperstimulation Syndrome and Pregnancy: OHSS Treatment and IVF Complete Guide

  https://www.asianinfertility.com/blog/ovarian-hyperstimulation-syndrome-and-pregnancy

  Imaging techniques, such as ultrasound, can help visualize the size and appearance of your ovaries and detect any fluid accumulation in the abdomen or chest. […] Laboratory tests, including blood tests, may be conducted to assess hormone levels and electrolyte imbalances, which can provide further insight into the severity of OHSS and guide treatment decisions.

• #54 FloridaHealthFinder | Ovarian hyperstimulation syndrome | Health Encyclopedia | FloridaHealthFinder

  https://quality.healthfinder.fl.gov/health-encyclopedia/HIE/1/007294

  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. […] Tests that may be done include: abdominal ultrasound or vaginal ultrasound, chest x-ray, complete blood count, electrolytes panel, liver function test, tests to measure urine output. […] If your provider diagnoses severe OHSS before transferring embryos in an IVF, they may decide to cancel the embryo transfer. […] 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.

• #55 Ovarian Hyperstimulation Syndrome, OHSS | Blog

  https://www.advancedfertility.com/blog/ovarian-hyperstimulation-syndrome-ohss

  Ovarian hyperstimulation syndrome, or OHSS, is a condition that occurs when the ovaries become enlarged and fluid accumulates in the abdominal cavity. This condition typically appears a few days after egg retrieval or in early pregnancy. […] Mild and moderate cases are managed through observation, exams, and sometimes blood work, while severe cases may require hospitalization or paracentesis (removal of excess abdominal fluid). […] Severe OHSS may necessitate hospitalization under the following conditions: Severe abdominal pain, Severe nausea and vomiting, Very low blood pressure, Severe blood test abnormalities, Extremely low urine output. […] Paracentesis is sometimes performed for moderate to severe OHSS cases to relieve symptoms by draining fluid from the abdomen. […] OHSS prevention involves careful use of injectable FSH medications, especially for those at higher risk.

• #56 Ovarian Hyperstimulation Syndrome – RCEMLearning

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

  An ultrasound is required to measure ovarian size, assess for ovarian torsion or presence of ascites/free fluid, and to exclude other differential diagnoses of abdominal pain. […] It is challenging to interpret a quantitative hCG level (to help determine whether a fertility cycle has resulted in early pregnancy), especially if a hCG trigger injection has been used. Seek specialist advice. […] Some patients present with early OHSS, within seven days of the trigger injection due to an excessive ovarian response. Patients with late OHSS present ten or more days after the trigger injection, usually from endogenous hCG due to an implanting pregnancy. […] The Royal College of Obstetricians and Gynaecologists (RCOG) have proposed the following severity classification.1 […] Treatment of OHSS is supportive with most non-pregnancy associated cases resolving in 10-14 days.

• #57 Case Number: 202104-136668 | Department of Financial Services

  https://www.dfs.ny.gov/public-appeals/case-number-202104-136668

  Diagnosis: moderate ovarian hyperstimulation syndrome Treatment: inpatient admission The insurer denied coverage for inpatient admission The denial is upheld. This female patient has a history of thyroid disease, secondary infertility, and polycystic ovary syndrome (PCOS) who presented to the Emergency Department (ED) with complaints of urinary retention status post first egg retrieval for in vitro fertilization (IVF) performed. The patient endorsed bladder distention and bilateral flank pain. Transabdominal and transvaginal sonography of the pelvis revealed enlarged bilateral ovaries with multiple cysts with associated moderate intra-abdominal ascites raising concern for ovarian hyperstimulation syndrome. The patient was admitted to Medicine for suspected mild to moderate ovarian hyperstimulation syndrome.

• #58 Case Number: 202104-136668 | Department of Financial Services

  https://www.dfs.ny.gov/public-appeals/case-number-202104-136668

  Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian hyperstimulation (COH) for assisted reproduction. It is characterized by a broad spectrum of signs and symptoms that includes abdominal distention and discomfort, enlarged ovaries, ascites, and other complications of enhanced vascular permeability. Most OHSS cases are mild or moderate and can be managed on an outpatient basis. Mild OHSS is seen in many women undergoing ovarian stimulation for assisted reproduction. Mild OHSS is characterized by bilateral ovarian enlargement with multiple follicular and corpus luteum cysts, abdominal distention and discomfort, mild nausea, and, less frequently, vomiting and diarrhea. There are no biochemical abnormalities. Normally, these cases are self-limited and can be managed conservatively, with a goal of relieving symptoms. This patient had mild OHSS as her hematocrit was less than 40. For mild OHSS, analgesics and avoidance of heavy physical activity are usually enough. Patients should be instructed to call for any signs or symptoms of worsening (oliguria, abdominal distention, shortness of breath, or weight gain). This patient was stable. She was not in hemoconcentration as indicated by a normal hematocrit. IV hydration in the ED with some analgesics would have managed her symptoms. Admission to the hospital was not medically necessary. The health plan did act reasonably with sound medical judgment, and in the best interest of the patient. The carrier’s denial of coverage for the inpatient hospital admission is upheld. The medical necessity is not substantiated.

• #59 Ovarian hyperstimulation syndrome (OHSS) patient education fact sheet | ReproductiveFacts.org

  https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/ovarian-hyperstimulation-syndrome-ohss/

  Ovarian hyperstimulation syndrome (OHSS) is an excessive response to taking the medicines (especially injectable gonadotropins) used to make eggs grow, particularly in individuals undergoing in vitro fertilization (IVF). […] If symptoms are present, a transvaginal or abdominal ultrasound can be done to measure ovary size and the amount of fluid that has been collected. […] Individuals with symptoms of OHSS should see a doctor familiar with assisted reproduction as soon as they have symptoms. […] OHSS often can be managed with decreased activity, drinking electrolyte-rich fluids, draining fluid that accumulates in the abdomen, medication for nausea and pain, careful monitoring, and frequent doctor visits. […] Severe OHSS (continued vomiting, severe swelling of the abdomen, shortness of breath, inability to drink fluids, or abnormal laboratory results) may require hospitalization for intensive monitoring and treatment.

• #60 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/

  Markers of ovarian reserve have consistently proven to be better predictors of OHSS risk. Before treatment antimullerian hormone (AMH) levels and antral follicle count (AFC) have been studied as markers of response to ovarian stimulation, with various thresholds suggesting an elevated risk for OHSS. […] 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. […] 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. […] It is recommended to employ ovarian stimulation protocols using GnRH antagonists over protocols using GnRH agonists when there is concern for OHSS.

• #61 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/

  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. […] 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.

• #62 What is Ovarian Hyperstimulation Syndrome (OHSS), and how can I prevent it?

  https://www.rmany.com/blog/what-is-ovarian-hyperstimulation-syndrome-ohss-and-how-can-i-prevent-it

  Ovarian hyperstimulation syndrome (OHSS) is a potential, albeit very rare, complication of fertility treatment (occurring in less than 1% of women receiving in vitro fertilization (IVF) treatment). […] In very few cases of IVF, the ovaries become overly stimulated, leading to discomfort and pain. […] In most cases, OHSS resolves quickly and without intervention within 2 weeks. […] Before diving into the tangible strategies that may be taken to prevent OHSS, it is important to recognize associated risk factors. […] The following strategies may be taken to reduce the risk of OHSS. […] Two small studies involving IVF patients at high risk for OHSS demonstrated that a reduced dose human chorionic gonadotrophin (hCG) trigger eliminated the occurrence of severe OHSS. […] Another study showed that low dose hCG was able to reduce the risk of both early and severe OHSS by factors of 7 and 4, respectively.

• #63 What is Ovarian Hyperstimulation Syndrome (OHSS), and how can I prevent it?

  https://www.rmany.com/blog/what-is-ovarian-hyperstimulation-syndrome-ohss-and-how-can-i-prevent-it

  Given that evidence suggests hCG plays a role in the development of OHSS, it is a natural consideration that avoiding hCG from would reduce the risk of OHSS. […] Adding dopamine agonists (dopamine activators) after the hCG trigger may reduce the incidence of OHSS. […] The method of frozen embryo transfer (FET) has been increasingly used following the publication of clinical evidence suggesting that the risk of OHSS could be minimized, particularly in women with PCOS or high response to ovarian stimulation. […] Your doctor is best suited to offer you advice with respect to the optimal approach to preventing OHSS in your individual scenario; however, understanding strategies that have been demonstrated to be effective may help you feel more at ease when considering IVF treatment, or in the rare event of an OHSS diagnosis.

• #64 Ovarian Hyperstimulation Syndrome (OHSS) – California IVF Fertility Center Sacramento

  https://www.californiaivf.com/ovarian-hyperstim-ohss/

  The degree of OHSS can change with time and fluid status as well. You should monitor your weight daily and keep in close contact with the clinic. […] Please call us immediately if any of these symptoms of severe OHSS occur. […] There are times when we recommend canceling treatment cycles or delay retrievals due to the risk of hyperstimulation. “Coasting” can be done for patients on Lupron, Antagon, or Cetrotide. This involves continued use of Lupron, or an antagonist, without gonadotropins. This allows of the resolution of smaller follicles and a decline in estradiol. Cancellations and coasting are done with the patients well being as the primary concern. Estradiol levels may be used to monitor the risk of ovarian hyperstimulation. A history of irregular menses is one of the strongest factors associated with ovarian hyperstimulation so it is important to notify your physician of any history of irregular menses.

• #65 Ovarian Hyperstimulation Syndrome (OHSS) | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688255/all/Ovarian_Hyperstimulation_Syndrome__OHSS_?q=Ascites

  A general principle in the prevention of OHSS is to recognize patients at high risk based on the above-list risk factors and to use a GnRH antagonist protocol, low doses of stimulation, and frequent monitoring. […] If a patient develops risk factors during stimulation, consideration should be given to the use of a GnRH agonist to trigger ovulation in GnRH antagonist cycles. […] Other preventative measures can include cancelling the cycle by withholding the preovulatory injection of hCG, proceeding with a lower dose of hCG, coasting or withholding stimulatory drugs for several days to allow for estradiol levels to plateau or decrease, avoiding the use of hCG for luteal supporting, or freezing all viable embryos without proceeding with an embryo transfer. […] Off-label use of dopamine agonists (cabergoline 0.5 mg) after hCG administration may decrease the incidence of OHSS. […] GnRH antagonists may reduce the incidence of early OHSS. […] Plasma expanders may reduce the incidence of moderate or severe OHSS in patients at high risk.

• #66

  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.

• #67 Ovarian Hyperstimulation Syndrome – Core EM

  https://coreem.net/core/ovarian-hyperstimulation-syndrome/

  Ovarian Hyperstimulation Syndrome (OHSS) occurs with hyperstimulation of the ovaries secondary to fertility therapy during assisted reproductive technology cycles (ART) or an inherited mutation in the FSH receptor ultimately leading to complications due to capillary leakage and the third spacing of fluid. […] Diagnosis involves history of fertility therapy, ultrasonography, CBC, BMP, LFTs, bHCG, and appropriate additional imaging depending on symptoms. […] Treatment is focused on treating the individual complications of increased intraabdominal pressure and third spacing of fluid.

• #68 Ovarian Hyperstimulation: Diagnosis, Prevention, and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34644798/

  Ovarian hyperstimulation syndrome (OHSS) is a severe complication of controlled ovarian stimulation (COS). […] Nowadays OHSS can easily be avoided by several prevention methods, ranging from identification of high-risk patients, choice of a correct protocol stimulation, trigger with gonadotropin-releasing hormone (GnRH) agonists or, finally, the freeze-all strategy. […] When OHSS occurs, it can usually be managed as outpatient care. Only if severe/critical cases are diagnosed hospitalization is necessary for appropriate rehydration, monitoring of fluid balance and eventual drainage of ascitic fluid. […] One of the most dangerous complications of OHSS is venous thromboembolism (VTE). Thromboprophylaxis has shown to be cost effective and widely used, while there are controversies regarding the usage of low dose aspirin (LDA) as a preventive measure.

• #69 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). […] There is no specific tests to diagnose OHSS but is based on the severity of symptoms experienced, the size of your ovaries, and if there is presence of fluid in your abdomen. An ultrasound scan will be carried out to measure these. […] Symptoms can take a few days to a few weeks to resolve depending on the severity and management plan undertaken.

• #70 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). […] The diagnosis is based on clinical criteria. It is therefore very important to have a classification, based on the symptoms. […] The diagnosis of OHSS is made on clinical grounds. […] Early OHSS usually presents within 7 days of the hCG injection and is usually associated with an excessive ovarian response. Late OHSS typically presents 10 or more days after the hCG injection and is usually the result of endogenous hCG derived from an early pregnancy. […] Your physician will following the following steps for diagnosis of OHSS: Take detailed history from a woman suspected to be suffering from OHSS. […] The primary way of preventing OHSS is identification of a high-risk patient. […] Whenever a patient is at high risk, hCG trigger should be withheld or GnRH agonist trigger should be used.

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