Materiały źródłowe

• #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. […] 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. However, the true incidence is difficult to delineate as a strict, consensus definition is lacking. […] 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). Early-onset OHSS occurs after controlled ovarian hyperstimulation and an ovulatory dose of hCG. Symptoms begin in the 47 days after the hCG trigger and usually resolve with menses. Late-onset OHSS typically begins at least 9 days after the hCG trigger in response to the rising hCG of pregnancy, is more severe, and significantly lengthens the course of OHSS. Severe OHSS can lead to life-threatening complications, including pleural effusion, acute renal insufficiency, and venous thromboembolism.

• #2

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

  Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovulation induction that usually occurs after gonadotropin stimulation, followed by human chorionic gonadotropin administration, for infertility treatment. The existing knowledge about the pathophysiology, risk factors, and primary and secondary methods for the prevention of OHSS is reviewed in this manuscript. […] 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 secondary risk factors depend on ovarian response to COS. Ultrasound monitoring and serum E2 are the vital components of surveillance for OHSS. […] The prevention of OHSS is based on its prediction. There is no method that can completely abolish OHSS. However, its prevention can be lifesaving and is principally preferred over its treatment.

• #3 Ovarian Hyperstimulation Syndrome: Practice Essentials, Background, Pathophysiology

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

  The incidence of ovarian hyperstimulation syndrome (OHSS) depends on definitions, risk factors, stimulation protocols, and conception. Rates of occurrence have been estimated as follows: Mild – 8-23%, Moderate – 1-7%, Severe – 0.25-5%. […] The frequency of OHSS may increase if the ovary is overstimulated, as documented by high levels of estradiol and depicted as an increased number of follicles on ultrasonography. The incidence rises when protocols combine GnRH agonists and gonadotropins, as compared with gonadotropins alone, to induce ovulation. […] The overall incidence of OHSS has been decreasing over time; however, a Danish study showed that the incidence of severe OHSS resulting in hospitalization has remained stable for the past few decades. […] OHSS affects only women of childbearing age.

• #4 Ovarian Hyperstimulation: Not Your Ovarian Average Cyst — NUEM Blog

  https://www.nuemblog.com/blog/ovarian-hyperstimulation

  Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening iatrogenic complication of assisted reproductive technologies, and it is the most common complication of IVF. […] Approximately 1-2% of all live births in the United States are as a result of assisted reproductive technologies (ART), which includes procedures such as fertility medication, artificial insemination, IVF and surrogacy. […] The incidence of OHSS as a complication of ART varies by severity: Mild (20-33%), Moderate (3-6%), Severe (0.1-2%). […] Risk factors for OHSS include prior OHSS, exaggerated ovarian response, and PCOS. […] The complications of OHSS include VTE, ovarian torsion, intravascular depletion, life-threatening fluid shifts, and significant end organ damage, all of which should be addressed and ruled out on presentation to the emergency department.

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

  https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688255/all/Ovarian_Hyperstimulation_Syndrome__OHSS_?q=Hypertension

  Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic physiologic complication of controlled ovarian hyperstimulation (COH) (most often related to treatment for infertility). […] Incidence: Predominant age: women of reproductive age. With COH and in vitro fertilization (IVF): Mild OHSS: 20-33% of cycles, Moderate OHSS: 3-6% of cycles, Severe OHSS: 0.12% of cycles. […] OHSS is an iatrogenic syndrome that occurs during COH for infertility treatment.

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

  https://im.unboundmedicine.com/medicine/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). […] Incidence: Predominant age: women of reproductive age. With COH and in vitro fertilization (IVF): Mild OHSS: 20-33% of cycles, Moderate OHSS: 3-6% of cycles, Severe OHSS: 0.12% of cycles. […] Patients who have had OHSS are more at risk for OHSS in the future, and this should be taken into consideration in subsequent treatment cycles.

• #7 Pharmacologic Interventions in Preventing Ovarian Hyperstimulation Syndrome: A Systematic Review and Network Meta-Analysis | Scientific Reports

  https://www.nature.com/articles/srep19093

  Ovarian hyperstimulation syndrome (OHSS) is a severe iatrogenic complication of controlled ovarian stimulation. The overall incidence of OHSS is 11-14% in all IVF/ICSI cycles. According to a WHO report, the incidence of moderate and severe OHSS was 36% and 0.21%, respectively. This disease imposes a heavy physical, psychological and economical burden on patients as a consequence of hospitalization, fear of infertility or miscarriage and absenteeism. […] Randomised controlled trials (RCTs) have proven several pharmacologic interventions to be effective in OHSS prevention, but these trials have seldom compared multiple drugs. […] A series of randomized controlled trials and meta-analyses compared the effectiveness of different drugs. […] Network meta-analysis (NMA), which is a statistical method, enables a comparison among multiple interventions by synthesizing direct and indirect evidence from RCTs. […] Our conclusion from this network meta-analysis may provide clinicians with an objective and comprehensive reference to guide their selection of pharmacologic intervention in OHSS prevention.

• #8 Prevention and Management of Ovarian Hyperstimulation Syndrome

  https://www.ijifm.com/abstractArticleContentBrowse/IJIFM/21671/JPJ/fullText

  Ovarian hyperstimulation syndrome (OHSS) is a potential iatrogenic life-threatening situation. The occurrence is directly proportional to estradiol in blood, follicle number, and human chorionic gonadotropin (hCG) with more chances of happening in polycystic ovarian disease. Complete prevention of OHSS is never possible, but endocrine profile and ultrasonographic follicular monitoring are the mainstay of its prediction. Prevalence of severe Ovarian hyperstimulation syndrome is 1.4% of all cycles. Mortality risk is evaluated as around one in approximately four to five lakh cases. Most OHSS is mild and of little clinical concern. Severe OHSS can lead to significant morbidity and mortality. Reported incidence of moderate variety of OHSS is 36%, while severe is 0.12%. The mild form occurs in about 20-33% of IVF cycles. Finnish registry in 2005 concluded incidence of severe OHSS of 1.4% per cycle.

• #8 Prevention and Management of Ovarian Hyperstimulation Syndrome

  https://www.ijifm.com/abstractArticleContentBrowse/IJIFM/21671/JPJ/fullText

  Awareness of risk factors is important for clinicians to predict and preempt occurrence of OHSS to reduce its incidence as a complication of controlled ovarian stimulation. Primary risk factors: Young age, low BMI, PCOS, high AMH, and previous history of OHSS. Studies have demonstrated that AMH 1.26 ng/mL is predicted as a risk factor. Recent studies have shown that an AFC of more than equal to 24 is estimated to be an important predictor for occurrence of moderate to severe OHSS. […] Prevention strategies for OHSS can be studied as primary and secondary. Primary prevention is based on assessment of a patients profile and identifying risk factors and working on them. Secondary prevention helps in early diagnosis and intervention. Deterrence and early detection of OHSS are the most important strategies for the patients safety. Young, thin women with polycystic ovaries on ultrasound (12 antral follicles in each ovary) are at higher risk for OHSS, and thus lower starting dose of gonadotropin should be used.

• #9 Ovarian hyperstimulation syndrome after assisted reproductive technologies: trends, predictors, and pregnancy outcomes

  https://stacks.cdc.gov/view/cdc/105641

  Objectives: To assess trends, predictors, and perinatal outcomes of ovarian hyperstimulation syndrome (OHSS) associated with in vitro fertilization (IVF) cycles in the United States. […] The proportion of IVF cycles complicated by OHSS increased from 10.0 to 14.3 cases per 1,000 from 2000 to 2006, and decreased to 5.3 per 1,000 from 2006 to 2015. […] The risk of OHSS was highest for cycles with more than 30 oocytes retrieved (adjusted risk ratio [aRR] 3.85). […] OHSS was associated with a diagnosis of ovulatory disorder (aRR 2.61), tubal factor (aRR 1.14), uterine factor (aRR 1.17) and cycles resulting in pregnancy (aRR 3.12). […] In singleton pregnancies, OHSS was associated with increased risk of low birth weight (aRR 1.29) and preterm delivery (aRR 1.32). […] In twin pregnancies, OHSS was associated with an increased risk of second-trimester loss (aRR 1.81), low birth weight (aRR 1.06), and preterm delivery (aRR 1.16).

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

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

  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 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 (table 1) (see 'Classification’ below). Although the most severe form of OHSS is rare, it represents an iatrogenic complication with a potentially fatal outcome in young women undergoing fertility treatment. […] 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.

• #11 Epidemiology and pathophysiology of ovarian hyperstimulation syndrome

  https://www.taylorfrancis.com/chapters/edit/10.3109/9780203490471-18/epidemiology-pathophysiology-ovarian-hyperstimulation-syndrome-delvigne?context=ubx&refId=fc034ea2-10e5-476a-9e88-dfc9276965b9

  The reported incidence of ovarian hyperstimulation syndrome (OHSS) is extremely variable, according to different studies, because various classifications have been used. […] When considering IVF treatment, the reported incidence lies between 3 and 6% for the moderate and between 0.1 and 2% for the severe form of OHSS. […] It has been estimated that, worldwide, at least 100-200 women suffer annually from severe OHSS per 100 000 cycles of assisted reproductive technologies (ART); there are about 500 000 IVF/ intracytoplasmic sperm injection (ICSI) cycles worldwide per year and probably as many if not more non-IVF cycles in which gonadotropins are used. […] The largest cohort of OHSS cases was reported in Israel: the increase in incidence of the severe forms of OHSS surpassed the increase of total IVF activity during the same period (20-fold versus six-fold, respectively).

• #12 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/

  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? Although the quality of the data available to address these questions is variable, there are consistent trends in the literature that allow for the guidelines set forth in this document. […] 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. […] 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 (24) and AMH levels (3.4 ng/mL).

• #13 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 employ ovarian stimulation protocols using GnRH antagonists over protocols using GnRH agonists when there is concern for OHSS. […] It is recommended to dose gonadotropins on the basis of individualized ORT 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. […] There is strong evidence that dopamine agonist administration near the time of the hCG trigger reduces the incidence of moderate-to-severe OHSS.

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

  http://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). […] Ovarian hyperstimulation syndrome (OHSS) is almost exclusively a complication of assisted reproductive technology (ART), with a reported incidence of 2.3% per patient. […] While most cases will eventually resolve, patients require careful diagnosis, surveillance, and supportive care. […] 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. […] Hospitalization is required for serious disease. Indications for admission include uncontrolled pain, intractable nausea or vomiting, oliguria, dyspnea, electrolyte imbalances, or hemoconcentration.

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

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

  Progression of symptoms, vital signs, and laboratory findings must be carefully monitored. […] Supportive care with IV fluid hydration and ultrasound-guided paracentesis or thoracentesis may be needed to treat intravascular hypovolemia and extravascular volume overload. […] Although few cases of spontaneous OHSS have been reported, multiple etiologies have been described. […] Finally, polycystic ovary syndrome (PCOS) predisposes patients to the development of multiple dominant follicles and has been attributed to spontaneous OHSS, even with physiologic levels of FSH, TSH, and HCG.

• #16 Ovarian Hyperstimulation Syndrome: Epidemiology, Pathophysiology, Prevention and Management by Botros Rizk | 9780521857987 | Hardcover | Barnes & Noble®Ovarian Hyperstimulation Syndrome

  https://www.barnesandnoble.com/w/ovarian-hyperstimulation-syndrome-botros-rizk/1100956455

  Early OHSS presents 3 to 7 days after the ovulatory dose of hCG, whereas late OHSS presents 12 to 17 days after hCG. Early OHSS relates to “excessive” preovulatory response to stimulation, whereas late OHSS depends on the occurrence of pregnancy, is more likely to be severe, and is only poorly related to preovulatory events. […] Traditionally, it has always been stated that OHSS is the most serious iatrogenic complication of ovulation induction. Interestingly, over the last decade, a significant number of reports have been published about spontaneous OHSS without any pharmacological intervention.

• #16 Ovarian Hyperstimulation Syndrome: Epidemiology, Pathophysiology, Prevention and Management by Botros Rizk | 9780521857987 | Hardcover | Barnes & Noble®Ovarian Hyperstimulation Syndrome

  https://www.barnesandnoble.com/w/ovarian-hyperstimulation-syndrome-botros-rizk/1100956455

  Ovarian Hyperstimulation Syndrome (OHSS) is a condition that can occur in women undergoing in vitro fertilization, after having follicle stimulation hormone (FSH) injections to stimulate egg growth and maturation. […] Botros Rizk, one of the world’s top experts on managing OHSS, reviews in depth the important classification, epidemiology, pathophysiology, complications and prediction, prevention and treatment options for this pathology. […] More recently, Rizk and Aboulghar (1999) classified the syndrome into only two categories, moderate and severe. The purpose of this classification is to categorize patients with OHSS into more-defined clinical groups that correlate with the prognosis of the syndrome. This would be ideal from an epidemiological point of view to set a registry for these cases.

• #17 SciELO Brazil – Ovarian hyperstimulation syndrome in a spontaneous singleton pregnancy Ovarian hyperstimulation syndrome in a spontaneous singleton pregnancy

  https://www.scielo.br/j/eins/a/6zP5SVNrNTKGw887bf5VMxg/

  The ovarian hyperstimulation syndrome is the combination of increased ovarian volume, due to the presence of multiple cysts and vascular hyperpermeability, with subsequent hypovolemia and hemoconcentration. […] In most cases, the OHSS is an iatrogenic complication of ovulation induction. Severe OHSS has incidence of 1 to 2% in superovulation cycles, and it remains one of the most important complications related with gonadotropin use in assisted reproductive technologies. […] The symptoms of spontaneous OHSS develop later than in iatrogenic OHSS: the syndrome occurs between 3 to 5 weeks of amenorrhea in iatrogenic cycle, and between 8 and 12 weeks of amenorrhea in spontaneous OHSS cases. […] The OHSS can be classified in mild, moderate and severe based on the gravity of signs, symptoms, laboratory tests and ultrasound findings. Severe OHSS is characterized by enlarged ovary (largest diameter greater than 12cm), presence of numerous ovarian cysts, ascites and, sometimes, pleural and/or pericardial effusion.

• #18 SciELO Brazil – Ovarian hyperstimulation syndrome in a spontaneous singleton pregnancy Ovarian hyperstimulation syndrome in a spontaneous singleton pregnancy

  https://www.scielo.br/j/eins/a/6zP5SVNrNTKGw887bf5VMxg/

  In general, spontaneous OHSS develops between 8 and 14 weeks of amenorrhoea, which differ from iatrogenic OHSS that usually start between 3-5 weeks of amenorrhea. Spontaneous forms of OHSS are extremely rare and always seen during pregnancy. […] A number of authors suggest that this syndrome occurrence is more frequent in cases of polycystic ovary syndrome, hypothyroidism, twin pregnancy and molar pathology. […] The cause of spontaneous ovarian hyperstimulation appears to be a permittivity of ovarian follicle-stimulating hormone (FSH) receptor for hCG and/or TSH. […] De Leener classified spontaneous OHSS syndrome into three types based on clinical presentation and FSH receptor mutation. Type I is attributed to the mutated FSH receptor and seems to cause recurrent spontaneous OHSS. Type II is secondary to high levels of hCG as in hydatiform mole and multiple gestation and it is the most common one. Type III is associated with hypothyroidism. […] The presence of mutation has implications regarding the recurrence of the syndrome in future pregnancies.

• #19 Ovarian hyperstimulation syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ovarian-hyperstimulation-syndrome-1?lang=us

  Ovarian hyperstimulation syndrome (OHSS) is a complication of controlled ovarian stimulation, which is an assisted reproduction technique used for in vitro fertilisation (IVF). Rarely, it may also occur spontaneously in pregnancy. It consists of ovarian enlargement with an extravascular accumulation of fluid leading to variable weight gain, ascites, pleural effusion, intravascular volume depletion, and oliguria. […] The syndrome is relatively common, occurring in ~5% of patients undergoing in vitro fertilisation (IVF). There is probably an even higher incidence of the syndrome in „egg donors” due to their young age (which is a known risk factor for the disease), however, there is a known problem of lack of reporting of such cases. […] The profoundly altered maternal environment of ovarian hyperstimulation syndrome is a significant risk factor for miscarriage, especially when occurring in the early phase after IVF (defined as 10 days after oocyte retrieval).

• #20 Ovarian hyperstimulation syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ovarian-hyperstimulation-syndrome-1?embed_domain=external.radpair.com%252525252525252527%25252525252525255b0%25252525252525255d&lang=us

  Ovarian hyperstimulation syndrome (OHSS) is a complication of controlled ovarian stimulation, which is an assisted reproduction technique used for in vitro fertilisation (IVF. The syndrome is relatively common, occurring in ~5% of patients undergoing in vitro fertilisation (IVF). There is probably an even higher incidence of the syndrome in „egg donors” due to their young age (which is a known risk factor for the disease), however, there is a known problem of lack of reporting of such cases. […] The syndrome is usually self-limiting in most cases and management is mainly supportive, however, cases with fatal outcomes have been reported. Severe cases usually require hospitalization and close monitoring of hematocrit, liver function, renal function, serum electrolytes and oxygen saturation. […] The profoundly altered maternal environment of ovarian hyperstimulation syndrome is a significant risk factor for miscarriage, especially when occurring in the early phase after IVF (defined as 10 days after oocyte retrieval).

• #21 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 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. Multiple high-quality studies have reported a significant reduction in rates of moderate or severe OHSS when this strategy is employed. […] 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.

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

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

  Severe ovarian hyperstimulation syndrome is uncommon, but can be life-threatening. […] 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.

• #23 Ovarian hyperstimulation syndrome: MedlinePlus Medical EncyclopediaLock

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

  Ovarian hyperstimulation syndrome (OHSS) is a problem that is sometimes seen in women who take fertility medicines that stimulate egg production. […] OHSS affects 3% to 6% of women who go through in vitro fertilization (IVF). […] Other risk factors for OHSS include: Being younger than age 35, Having a very high estrogen level during fertility treatments, Developing an unusually large number of ovarian follicles with your fertility treatment, Having polycystic ovarian syndrome, Low body weight. […] 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.

• #24 Epidemiology and pathophysiology of ovarian hyperstimulation syndrome

  https://www.taylorfrancis.com/chapters/edit/10.3109/9780203490471-18/epidemiology-pathophysiology-ovarian-hyperstimulation-syndrome-delvigne?context=ubx&refId=fc034ea2-10e5-476a-9e88-dfc9276965b9

  Therefore, although the incidence of the severe form of OHSS is only about 1%, one should be aware of its recent, progressive increase. […] This constitutes a serious health hazard as well as a prophylactic challenge, since women treated with IVF/ICSI are a priori healthy young women. […] Moreover, there is a general unawareness of the syndrome among the lay public, which increases the risk for late or inappropriate diagnosis as well as its psychological impact on those who succumb to it.

• #25 Ovarian Hyperstimulation Syndrome – Epidemiology

  https://www.liquisearch.com/ovarian_hyperstimulation_syndrome/epidemiology

  Sporadic OHSS is very rare, and may have a genetic component. […] The frequency varies and depends on patient factors, management, and methods of surveillance. About 5% of treated patients may encounter moderate to severe OHSS. […] Mortality is low, but several fatal cases have been reported.

• #26

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

  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. […] The establishment of OHSS-free clinics is feasible through careful primary evaluation of infertile couples, paying special attention to the risk factors for OHSS development and considering the aforementioned primary preventive measures.

• #27 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. […] The frequency varies and depends on a woman’s risk factors, management, and methods of surveillance. About 5% of treated women may encounter moderate to severe OHSS. […] Physicians can reduce the risk of OHSS by monitoring of FSH therapy to use this medication judiciously, and by withholding hCG medication. […] A Cochrane review found administration of hydroxyethyl starch decreases the incidence of severe OHSS.

• #28 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). […] Severe OHSS occurs in approximately 1.4% of all cycles, affecting approximately 6020 patients per year in the United States and Europe. […] The mortality risk is estimated to be 1 in 450000 to 500000 cases. […] Several primary and secondary risk factors for OHSS have been identified. […] Despite this, as indicators of risk, these risk factors/biomarkers assist in the identification of patients that require individualized COS (iCOS). […] The key to the primary prevention of OHSS during COS is recognizing risk factors and individualizing the ovarian stimulation protocol appropriately using iCOS. […] iCOS should aim to reduce the cycle cancelation rate and the iatrogenic complications of COS, including OHSS, and is key to improving ART outcomes.

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