Materiały źródłowe

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

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

  Ovarian hyperstimulation syndrome is an exaggerated response to excess hormones. It usually occurs in women taking injectable hormone medications to stimulate the development of eggs in the ovaries. Ovarian hyperstimulation syndrome (OHSS) causes the ovaries to swell and become painful. […] The cause of ovarian hyperstimulation syndrome isn’t fully understood. Having a high level of human chorionic gonadotropin (HCG) a hormone usually produced during pregnancy introduced into your system plays a role. Ovarian blood vessels react abnormally to human chorionic gonadotropin (HCG) and begin to leak fluid. This fluid swells the ovaries, and sometimes large amounts move into the abdomen. […] Injectable fertility medications are more likely to cause OHSS than is treatment with clomiphene, a medication given as a pill you take by mouth. Occasionally OHSS occurs spontaneously, not related to fertility treatments.

• #2 Ovarian hyperstimulation syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3205536/

  Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology. The syndrome is characterized by cystic enlargement of the ovaries and a fluid shift from the intravascular to the third space due to increased capillary permeability and ovarian neoangiogenesis. Its occurrence is dependent on the administration of human chorionic gonadotrophin (hCG). […] -hCG and its analogs, estrogen, estradiol, prolactin, histamine and prostaglandins have all been implicated in OHSS but now it is increasingly better understood that the vasoactive substances such as interleukins, tumor necrosis factor-, endothelin-1, and vascular endothelial growth factor (VEGF) secreted by the ovaries have been implicated in increasing vascular permeability. […] The relationship between hCG and OHSS is thought to be mediated via the production of the angiogenic molecule VEGF.

• #3 All About OHSS (Ovarian Hyperstimulation Syndrome)

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

  OHSS happens when the ovaries swell with fluid that eventually leaks into the body. This condition is a direct result of the drugs used in IVF and other procedures that enhance egg production and maturity. […] OHSS is considered an iatrogenic complication. This is just a fancy way of saying that it results from hormone therapy used in certain fertility treatments. […] Mild OHSS happens in up to a third of all IVF cycles while more moderate to severe OHSS happens only 3 percent to 8 percent of the time. […] Less commonly, OHSS can arise after taking injectable hormones or even oral medications like Clomid as part of intrauterine insemination (IUI). Again, these drugs are used to promote egg production or release mature eggs. […] Risk factors include things like having polycystic ovary syndrome (PCOS) or having a large number of follicles in any given cycle. Women younger than age 35 are also at a higher risk of developing this complication. […] Other risk factors: previous episode of OHSS, fresh versus frozen IVF cycle, high estrogen level during an IVF cycle, high doses of hCG during any given IVF cycle, low body mass index (BMI).

• #4 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. […] It may occur after stimulation of the ovaries into superovulation with drugs such as human chorionic gonadotrophin (hCG) and human menopausal gonadotrophin. […] OHSS is a systemic disease. Vasoactive mediators are released from the hyperstimulated ovaries, causing an increase in capillary permeability. […] Morbidity and even mortality can then be caused by effusions (pericardial, pleural, ascites), haemoconcentration (causing increased risk of thrombosis and coagulopathy) and liver or kidney dysfunction. […] Despite careful monitoring, a mild degree of OHSS occurs in up to 33% of in vitro fertilisation (IVF) cycles. […] A combined moderate-severe degree of OHSS occurs in 3-8.1% of treatment cycles.

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

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

  Ovarian hyperstimulation syndrome is an exaggerated response to excess hormones. It usually occurs in women taking injectable hormone medications to stimulate the development of eggs in the ovaries. Ovarian hyperstimulation syndrome (OHSS) causes the ovaries to swell and become painful. […] The cause of ovarian hyperstimulation syndrome isn’t fully understood. Having a high level of human chorionic gonadotropin (HCG) a hormone usually produced during pregnancy introduced into your system plays a role. Ovarian blood vessels react abnormally to human chorionic gonadotropin (HCG) and begin to leak fluid. This fluid swells the ovaries, and sometimes large amounts move into the abdomen. […] Injectable fertility medications are more likely to cause OHSS than is treatment with clomiphene, a medication given as a pill you take by mouth. Occasionally OHSS occurs spontaneously, not related to fertility treatments.

• #6 Ovarian hyperstimulation syndrome | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome is an exaggerated response to excess hormones. It usually occurs in women taking injectable hormone medications to stimulate the development of eggs in the ovaries. Ovarian hyperstimulation syndrome (OHSS) causes the ovaries to swell and become painful. […] The cause of ovarian hyperstimulation syndrome isn’t fully understood. Having a high level of human chorionic gonadotropin (HCG) a hormone usually produced during pregnancy introduced into your system plays a role. Ovarian blood vessels react abnormally to HCG and begin to leak fluid. This fluid swells the ovaries, and sometimes large amounts move into the abdomen. […] Injectable fertility medications are more likely to cause OHSS than is treatment with clomiphene, a medication given as a pill you take by mouth. Occasionally OHSS occurs spontaneously, not related to fertility treatments.

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

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

  Ovarian hyperstimulation syndrome (OHSS) is a condition caused when the ovaries adversely react to an abundance of hormones. The ovaries become swollen and painful and possibly leak fluid. […] OHSS is caused by a pregnancy hormone called human chorionic gonadotropin (HCG). HCG is created by the cells that form the placenta around a developing embryo and can be detected as early as one week after your egg is fertilized. […] OHSS occurs when you have higher levels of HCG. High levels rarely happen naturally. Fertility treatments, especially those that involve injections of HCG, can overstimulate your ovaries. When HCG is introduced to your system, your ovaries may react abnormally by swelling and leaking fluid, leading to OHSS.

• #8 Ovarian hyperstimulation syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3205536/

  Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology. The syndrome is characterized by cystic enlargement of the ovaries and a fluid shift from the intravascular to the third space due to increased capillary permeability and ovarian neoangiogenesis. Its occurrence is dependent on the administration of human chorionic gonadotrophin (hCG). […] -hCG and its analogs, estrogen, estradiol, prolactin, histamine and prostaglandins have all been implicated in OHSS but now it is increasingly better understood that the vasoactive substances such as interleukins, tumor necrosis factor-, endothelin-1, and vascular endothelial growth factor (VEGF) secreted by the ovaries have been implicated in increasing vascular permeability. […] The relationship between hCG and OHSS is thought to be mediated via the production of the angiogenic molecule VEGF.

• #9 Ovarian hyperstimulation syndrome | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome is an exaggerated response to excess hormones. It usually occurs in women taking injectable hormone medications to stimulate the development of eggs in the ovaries. Ovarian hyperstimulation syndrome (OHSS) causes the ovaries to swell and become painful. […] The cause of ovarian hyperstimulation syndrome isn’t fully understood. Having a high level of human chorionic gonadotropin (HCG) a hormone usually produced during pregnancy introduced into your system plays a role. Ovarian blood vessels react abnormally to HCG and begin to leak fluid. This fluid swells the ovaries, and sometimes large amounts move into the abdomen. […] Injectable fertility medications are more likely to cause OHSS than is treatment with clomiphene, a medication given as a pill you take by mouth. Occasionally OHSS occurs spontaneously, not related to fertility treatments.

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

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

  Spontaneous ovarian hyperstimulation syndrome is a rare subtype and occurs in the absence of any external stimulation. This form can occur in pregnancy, or due to a genetic component. These have an association with early pubertal development and primary hypothyroidism (Van Wyk-Grumbach syndrome). […] Ovarian stimulation in the hypothyroid child may result in estrogen production, breast development, endometrial proliferation, and vaginal bleeding. It is likely that raised TSH concentrations bind and stimulate the FSH receptor, although a similar overlap phenomenon might occur at the level of the pituitary, with enhanced TRH production stimulating the GnRH receptor with subsequent ovarian enlargement. The cystic ovarian enlargement resolves with thyroid hormone replacement. A hyperstimulation phenomenon in patients with an abnormal FSH receptor has been described.

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

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

  Ovarian hyperstimulation syndrome (OHSS) is a rare, iatrogenic complication of ovarian stimulation by assisted reproduction technology and other infertility treatments. Following gonadotropin therapy, OHSS usually develops several days after oocyte retrieval or assisted ovulation. This syndrome is characterized by ovarian enlargement due to multiple ovarian cysts and an acute fluid shift into the extravascular space. Complications of OHSS include ascites, hemoconcentration, hypovolemia, and electrolyte imbalances. […] The pathogenesis of ovarian hyperstimulation syndrome (OHSS) is unknown, but the process is related to increased vascular permeability in the region surrounding the ovaries and their vasculature. Beta human chorionic gonadotropin (hCG) and its analogs, as well as estrogen, estradiol, prolactin, histamine, and prostaglandins, have been implicated in the past.

• #12 Ovarian hyperstimulation syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3205536/

  The pathophysiology of OHSS is unknown, but the process is related to increased vascular permeability in the region surrounding the ovaries and their vasculature. […] Existing factors likely to amplify the response to ovarian stimulation include young age, a history of elevated response to gonadotrophins, previous OHSS, polycystic ovary syndrome (PCOS). […] A number of ovarian response parameters have been evaluated for their ability to predict the development of OHSS, including absolute levels or rate of increase of serum E2, follicular size and number, and number of oocytes collected. […] Leakage of fluid from follicles, increased capillary permeability leading to third spacing (due to the release of vasoactive substances), or frank rupture of follicles can all cause ascites. […] Due to leakage of fluid through the impaired blood vessels both within and outside the ovary there is massive fluid-shift from the intra-vesicular bed to the third compartment results in intravascular hypovolemia with concomitant development of edema, ascites, hydrothorax and/or hydropericardium.

• #13

  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 hallmark of OHSS is an increase in the permeability of the capillaries, resulting in a fluid shift from the intravascular space to the extravascular compartments. Vascular endothelial growth factor (VEGF) plays a critical role in the pathogenesis of OHSS by increasing vascular permeability.

• #14 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/

  Understanding the pathophysiology of this condition may aid in identifying measures to prevent its development and treat associated symptoms. Classic physiologic changes of OHSS include arteriolar vasodilation and an increase in capillary permeability that results in fluid shifting from intravascular to extravascular spaces. […] Vascular endothelial growth factor (VEGF) appears to be integral to the development of this condition and is involved in follicular growth, corpus luteum function, angiogenesis, and vascular endothelial stimulation. In response to human chorionic gonadotropin (hCG), VEGF appears to mediate the vascular permeability of OHSS, as systemic hCG levels positively correlate with the severity of the disease. […] 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.

• #15 OHSS (Ovarian Hyperstimulation Syndrome): Symptoms, Causes, and Prevention

  https://www.medlineacademics.com/blog/ovarian-hyperstimulation-syndrome.php

  It occurs due to the use of certain medications to stimulate egg production from the ovaries during ART. […] The signs and symptoms of OHSS result due to certain chemicals secreted in the body when the ovaries respond excessively during stimulation. These causative chemicals include hCG (Human chorionic gonadotropin) which acts through VEGF (Vascular Endothelial growth Factor), RAS (Renin-Angiotensin System) both at local ovarian level and at systemic level, while the end-mediators include Interleukins 1,2,6,8; Tumor necrosis factor alfa, Endothelins etc. […] Early OHSS develops because of administering hCG injection as a trigger for ovulation during treatment. Late OHSS is when it develops because the woman has conceived in the treatment cycle. […] Primary prevention- The woman’s risk for OHSS is assessed before the start of treatment and the stimulation protocols for ovarian induction is tailor made to her. […] Secondary Prevention: This involves identifying cases threatening to progress into OHSS and taking appropriate measure to reduce the risk and complication thereon.

• #16 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. […] Significant OHSS occurs in a small percentage of women undergoing ovarian stimulation for IVF, especially those with polycystic ovarian syndrome (PCOS) or high antral follicle counts. […] OHSS is caused by increased vascular permeability, resulting in fluid leakage from blood vessels. High levels of vascular endothelial growth factor (VEGF) are believed to play a major role in triggering this process. […] OHSS prevention involves careful use of injectable FSH medications, especially for those at higher risk. Fertility specialists assess factors such as: High antral follicle count, High AMH blood level, High LH blood level or high LH to FSH ratio.

• #17

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

  The other suggested factors that may act directly or indirectly on the development or severity of OHSS are angiotensin II, insulin-like growth factor, epidermal growth factor, transforming growth factor alpha and beta, basic fibroblast growth factor, platelet-derived growth factor, interleukin-1B, and interleukin-6. […] The intra-ovarian renin-angiotensin system (RAS) is another pathophysiological mechanism implicated in OHSS. […] High levels of the VEGF and the RAS seem to play a role in the development of OHSS.

• #18

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

  The other suggested factors that may act directly or indirectly on the development or severity of OHSS are angiotensin II, insulin-like growth factor, epidermal growth factor, transforming growth factor alpha and beta, basic fibroblast growth factor, platelet-derived growth factor, interleukin-1B, and interleukin-6. […] The intra-ovarian renin-angiotensin system (RAS) is another pathophysiological mechanism implicated in OHSS. […] High levels of the VEGF and the RAS seem to play a role in the development of OHSS.

• #19 OHSS (Ovarian Hyperstimulation Syndrome): Symptoms, Causes, and Prevention

  https://www.medlineacademics.com/blog/ovarian-hyperstimulation-syndrome.php

  It occurs due to the use of certain medications to stimulate egg production from the ovaries during ART. […] The signs and symptoms of OHSS result due to certain chemicals secreted in the body when the ovaries respond excessively during stimulation. These causative chemicals include hCG (Human chorionic gonadotropin) which acts through VEGF (Vascular Endothelial growth Factor), RAS (Renin-Angiotensin System) both at local ovarian level and at systemic level, while the end-mediators include Interleukins 1,2,6,8; Tumor necrosis factor alfa, Endothelins etc. […] Early OHSS develops because of administering hCG injection as a trigger for ovulation during treatment. Late OHSS is when it develops because the woman has conceived in the treatment cycle. […] Primary prevention- The woman’s risk for OHSS is assessed before the start of treatment and the stimulation protocols for ovarian induction is tailor made to her. […] Secondary Prevention: This involves identifying cases threatening to progress into OHSS and taking appropriate measure to reduce the risk and complication thereon.

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

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

  Vasoactive substances such as interleukins, tumor necrosis factor (TNF)-alpha, endothelin-1, and VEGF secreted by the ovaries have been implicated in increasing vascular permeability. […] Withholding hCG decreases OHSS. Hence, it plays a critical role in enhancing ovarian angiogenesis and triggering the cascade of vascular permeability in ovarian vessels that leads to third spacing and OHSS. Exogenous and endogenous gonadotropins from molar pregnancy, gonadotroph adenomas, and even pregnancy can aggravate OHSS. […] Age younger than 35 years, low body mass index (BMI), gonadotropin treatment, high estradiol concentrations, large number of follicles, history of polycystic ovarian syndrome, administration of exogenous hCG, and endogenous hCG from treatments resulting in pregnancy increase a patients risk of developing OHSS. […] According to Martin et al, if the pre-hCG estradiol amount is greater than 6000 mcg and/or if more than 30 follicles are present, the rate of severe OHSS approaches 80%.

• #21 OHSS (Ovarian Hyperstimulation Syndrome): Symptoms, Causes, and Prevention

  https://www.medlineacademics.com/blog/ovarian-hyperstimulation-syndrome.php

  It occurs due to the use of certain medications to stimulate egg production from the ovaries during ART. […] The signs and symptoms of OHSS result due to certain chemicals secreted in the body when the ovaries respond excessively during stimulation. These causative chemicals include hCG (Human chorionic gonadotropin) which acts through VEGF (Vascular Endothelial growth Factor), RAS (Renin-Angiotensin System) both at local ovarian level and at systemic level, while the end-mediators include Interleukins 1,2,6,8; Tumor necrosis factor alfa, Endothelins etc. […] Early OHSS develops because of administering hCG injection as a trigger for ovulation during treatment. Late OHSS is when it develops because the woman has conceived in the treatment cycle. […] Primary prevention- The woman’s risk for OHSS is assessed before the start of treatment and the stimulation protocols for ovarian induction is tailor made to her. […] Secondary Prevention: This involves identifying cases threatening to progress into OHSS and taking appropriate measure to reduce the risk and complication thereon.

• #22 Ovarian hyperstimulation syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3205536/

  Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology. The syndrome is characterized by cystic enlargement of the ovaries and a fluid shift from the intravascular to the third space due to increased capillary permeability and ovarian neoangiogenesis. Its occurrence is dependent on the administration of human chorionic gonadotrophin (hCG). […] -hCG and its analogs, estrogen, estradiol, prolactin, histamine and prostaglandins have all been implicated in OHSS but now it is increasingly better understood that the vasoactive substances such as interleukins, tumor necrosis factor-, endothelin-1, and vascular endothelial growth factor (VEGF) secreted by the ovaries have been implicated in increasing vascular permeability. […] The relationship between hCG and OHSS is thought to be mediated via the production of the angiogenic molecule VEGF.

• #23

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

  The other suggested factors that may act directly or indirectly on the development or severity of OHSS are angiotensin II, insulin-like growth factor, epidermal growth factor, transforming growth factor alpha and beta, basic fibroblast growth factor, platelet-derived growth factor, interleukin-1B, and interleukin-6. […] The intra-ovarian renin-angiotensin system (RAS) is another pathophysiological mechanism implicated in OHSS. […] High levels of the VEGF and the RAS seem to play a role in the development of OHSS.

• #24

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

  The other suggested factors that may act directly or indirectly on the development or severity of OHSS are angiotensin II, insulin-like growth factor, epidermal growth factor, transforming growth factor alpha and beta, basic fibroblast growth factor, platelet-derived growth factor, interleukin-1B, and interleukin-6. […] The intra-ovarian renin-angiotensin system (RAS) is another pathophysiological mechanism implicated in OHSS. […] High levels of the VEGF and the RAS seem to play a role in the development of OHSS.

• #25

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

  The other suggested factors that may act directly or indirectly on the development or severity of OHSS are angiotensin II, insulin-like growth factor, epidermal growth factor, transforming growth factor alpha and beta, basic fibroblast growth factor, platelet-derived growth factor, interleukin-1B, and interleukin-6. […] The intra-ovarian renin-angiotensin system (RAS) is another pathophysiological mechanism implicated in OHSS. […] High levels of the VEGF and the RAS seem to play a role in the development of OHSS.

• #26

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

  The other suggested factors that may act directly or indirectly on the development or severity of OHSS are angiotensin II, insulin-like growth factor, epidermal growth factor, transforming growth factor alpha and beta, basic fibroblast growth factor, platelet-derived growth factor, interleukin-1B, and interleukin-6. […] The intra-ovarian renin-angiotensin system (RAS) is another pathophysiological mechanism implicated in OHSS. […] High levels of the VEGF and the RAS seem to play a role in the development of OHSS.

• #27

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

  The other suggested factors that may act directly or indirectly on the development or severity of OHSS are angiotensin II, insulin-like growth factor, epidermal growth factor, transforming growth factor alpha and beta, basic fibroblast growth factor, platelet-derived growth factor, interleukin-1B, and interleukin-6. […] The intra-ovarian renin-angiotensin system (RAS) is another pathophysiological mechanism implicated in OHSS. […] High levels of the VEGF and the RAS seem to play a role in the development of OHSS.

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

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

  Vasoactive substances such as interleukins, tumor necrosis factor (TNF)-alpha, endothelin-1, and VEGF secreted by the ovaries have been implicated in increasing vascular permeability. […] Withholding hCG decreases OHSS. Hence, it plays a critical role in enhancing ovarian angiogenesis and triggering the cascade of vascular permeability in ovarian vessels that leads to third spacing and OHSS. Exogenous and endogenous gonadotropins from molar pregnancy, gonadotroph adenomas, and even pregnancy can aggravate OHSS. […] Age younger than 35 years, low body mass index (BMI), gonadotropin treatment, high estradiol concentrations, large number of follicles, history of polycystic ovarian syndrome, administration of exogenous hCG, and endogenous hCG from treatments resulting in pregnancy increase a patients risk of developing OHSS. […] According to Martin et al, if the pre-hCG estradiol amount is greater than 6000 mcg and/or if more than 30 follicles are present, the rate of severe OHSS approaches 80%.

• #29

  https://journals.lww.com/jhrs/fulltext/2011/04020/ovarian_hyperstimulation_syndrome.2.aspx

  Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology. The syndrome is characterized by cystic enlargement of the ovaries and a fluid shift from the intravascular to the third space due to increased capillary permeability and ovarian neoangiogenesis. Its occurrence is dependent on the administration of human chorionic gonadotrophin (hCG). […] -hCG and its analogs, estrogen, estradiol, prolactin, histamine and prostaglandins have all been implicated in OHSS but now it is increasingly better understood that the vasoactive substances such as interleukins, tumor necrosis factor-, endothelin-1, and vascular endothelial growth factor (VEGF) secreted by the ovaries have been implicated in increasing vascular permeability. […] The relationship between hCG and OHSS is thought to be mediated via the production of the angiogenic molecule VEGF.

• #30

  https://journals.lww.com/jhrs/fulltext/2011/04020/ovarian_hyperstimulation_syndrome.2.aspx

  The pathophysiology of OHSS is unknown, but the process is related to increased vascular permeability in the region surrounding the ovaries and their vasculature. […] Existing factors likely to amplify the response to ovarian stimulation include young age, a history of elevated response to gonadotrophins, previous OHSS, polycystic ovary syndrome (PCOS). […] A number of ovarian response parameters have been evaluated for their ability to predict the development of OHSS, including absolute levels or rate of increase of serum E2, follicular size and number, and number of oocytes collected. […] Leakage of fluid from follicles, increased capillary permeability leading to third spacing (due to the release of vasoactive substances), or frank rupture of follicles can all cause ascites. […] Due to leakage of fluid through the impaired blood vessels both within and outside the ovary there is massive fluid-shift from the intra-vesicular bed to the third compartment results in intravascular hypovolemia with concomitant development of edema, ascites, hydrothorax and/or hydropericardium.

• #31 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). […] Fertility drugs, usually gonadotrophins, are used to stimulate the ovaries during IVF treatment to make eggs grow. Sometimes there is an excessive response to these drugs, leading to OHSS. […] Overstimulated ovaries enlarge and release chemicals into the bloodstream. Fluid from the blood vessels leaks into your abdomen and in severe cases into the space around the heart and lungs. OHSS can affect the kidneys, liver and lungs. A very small number of deaths due to OHSS have been reported.

• #32

  https://journals.lww.com/jhrs/fulltext/2011/04020/ovarian_hyperstimulation_syndrome.2.aspx

  The pathophysiology of OHSS is unknown, but the process is related to increased vascular permeability in the region surrounding the ovaries and their vasculature. […] Existing factors likely to amplify the response to ovarian stimulation include young age, a history of elevated response to gonadotrophins, previous OHSS, polycystic ovary syndrome (PCOS). […] A number of ovarian response parameters have been evaluated for their ability to predict the development of OHSS, including absolute levels or rate of increase of serum E2, follicular size and number, and number of oocytes collected. […] Leakage of fluid from follicles, increased capillary permeability leading to third spacing (due to the release of vasoactive substances), or frank rupture of follicles can all cause ascites. […] Due to leakage of fluid through the impaired blood vessels both within and outside the ovary there is massive fluid-shift from the intra-vesicular bed to the third compartment results in intravascular hypovolemia with concomitant development of edema, ascites, hydrothorax and/or hydropericardium.

• #33 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). […] Fertility drugs, usually gonadotrophins, are used to stimulate the ovaries during IVF treatment to make eggs grow. Sometimes there is an excessive response to these drugs, leading to OHSS. […] Overstimulated ovaries enlarge and release chemicals into the bloodstream. Fluid from the blood vessels leaks into your abdomen and in severe cases into the space around the heart and lungs. OHSS can affect the kidneys, liver and lungs. A very small number of deaths due to OHSS have been reported.

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

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

  Vasoactive substances such as interleukins, tumor necrosis factor (TNF)-alpha, endothelin-1, and VEGF secreted by the ovaries have been implicated in increasing vascular permeability. […] Withholding hCG decreases OHSS. Hence, it plays a critical role in enhancing ovarian angiogenesis and triggering the cascade of vascular permeability in ovarian vessels that leads to third spacing and OHSS. Exogenous and endogenous gonadotropins from molar pregnancy, gonadotroph adenomas, and even pregnancy can aggravate OHSS. […] Age younger than 35 years, low body mass index (BMI), gonadotropin treatment, high estradiol concentrations, large number of follicles, history of polycystic ovarian syndrome, administration of exogenous hCG, and endogenous hCG from treatments resulting in pregnancy increase a patients risk of developing OHSS. […] According to Martin et al, if the pre-hCG estradiol amount is greater than 6000 mcg and/or if more than 30 follicles are present, the rate of severe OHSS approaches 80%.

• #35 Ovarian hyperstimulation syndrome Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome (OHSS) is a problem that is sometimes seen in women who take fertility medicines that stimulate egg production. […] If these medicines stimulate the ovaries too much, the ovaries can become very swollen. Fluid can leak into the belly and chest area. This is called OHSS. This occurs only after the eggs are released from the ovary (ovulation). […] OHSS rarely occurs in women who only take fertility drugs by mouth. […] 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.

• #36 Ovarian hyperstimulation syndrome Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome (OHSS) is a problem that is sometimes seen in women who take fertility medicines that stimulate egg production. […] If these medicines stimulate the ovaries too much, the ovaries can become very swollen. Fluid can leak into the belly and chest area. This is called OHSS. This occurs only after the eggs are released from the ovary (ovulation). […] OHSS rarely occurs in women who only take fertility drugs by mouth. […] 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.

• #37 What is ovarian hyperstimulation syndrome (OHSS)? – IVF in Athens – Kolonaki | In Vitro Fertilization

  https://drakopoulos-ivf.gr/en/what-is-ovarian-hyperstimulation-syndrome-ohss/

  The risk factors that predispose to the onset of OHSS are: Age: the ovaries of young women (under 30) have a higher number of gonadotropin receptors or a higher number of follicles, making them more susceptible to this syndrome. […] Patients given high doses of gonadotropins are more likely to develop OHSS because there is a greater ovarian response. […] One of the most effective ways to prevent the occurrence of OHSS is to replace hCG with another drug such as GnRH agonists. […] Since there is a direct relationship between hCG levels and the severity of the syndrome, another approach to avoid the development of OHSS is to reduce the dose given to induce ovulation.

• #38 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. […] Sometimes your ovaries overrespond or overreact to these drugs, leading to OHSS. This is more common with injectable medications that stimulate the ovaries. […] OHSS is more common in women receiving fertility treatments who have polycystic ovary syndrome (PCOS). PCOS is a reproductive disorder involving a hormonal imbalance. Its also more common in women with a high egg supply. […] In most cases, OHSS develops because of the hormone HCG (human chorionic gonadotropin) stimulating your ovaries. Your ovaries typically produce just one egg at a time, but hormone treatments stimulate your ovaries to grow a lot of eggs at one time.

• #39 Ovarian Hyperstimulation Syndrome | Doctor

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

  Risk factors include Polycystic Ovarian Syndrome (PCOS), age under 30, rapidly rising oestrogen levels and a large number of follicles, the use of hCG for luteal phase support, low body weight, previous history of OHSS, and high levels of anti-Mullerian hormone. […] OHSS is an iatrogenic condition and large numbers of strategies have been investigated to try to reduce the incidence. Techniques which may reduce risk include individualised stimulation regimes dependent on risk stratification, avoiding aggressive ovarian stimulation, and the use of gonadotrophin-releasing hormone (GnRH) agonists rather than hCG as an ovulation trigger.

• #40 Ovarian hyperstimulation syndrome Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome (OHSS) is a problem that is sometimes seen in women who take fertility medicines that stimulate egg production. […] If these medicines stimulate the ovaries too much, the ovaries can become very swollen. Fluid can leak into the belly and chest area. This is called OHSS. This occurs only after the eggs are released from the ovary (ovulation). […] OHSS rarely occurs in women who only take fertility drugs by mouth. […] 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.

• #41 Ovarian hyperstimulation syndrome – Hancock Health

  https://www.hancockhealth.org/mayo-health-library/ovarian-hyperstimulation-syndrome/

  But factors that are known to increase your risk of OHSS include: Polycystic ovary syndrome a common reproductive disorder that causes irregular menstrual periods, excess hair growth and unusual appearance of the ovaries on ultrasound examination, Large number of follicles, Age under 35, Low body weight, High or steeply increasing level of estradiol (estrogen) before an HCG trigger shot, Previous episodes of OHSS.

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

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

  When women develop a lot of potential eggs, the ovaries can respond excessively to this medication, and they can develop OHSS. […] In people with OHSS, drugs used in fertility treatments cause the blood vessels surrounding their ovaries to leak fluid. Sometimes this fluid moves into your belly and causes symptoms like swelling and pain. […] Women at a higher risk for OHSS include those who have PCOS, have previously had OHSS, have a large number of follicles or high levels of estrogen during IVF stimulation, received high doses of HCG during an IVF cycle, and have undergone a fresh rather than frozen embryo transfer.

• #43 Ovarian Hyperstimulation Syndrome | Doctor

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

  Risk factors include Polycystic Ovarian Syndrome (PCOS), age under 30, rapidly rising oestrogen levels and a large number of follicles, the use of hCG for luteal phase support, low body weight, previous history of OHSS, and high levels of anti-Mullerian hormone. […] OHSS is an iatrogenic condition and large numbers of strategies have been investigated to try to reduce the incidence. Techniques which may reduce risk include individualised stimulation regimes dependent on risk stratification, avoiding aggressive ovarian stimulation, and the use of gonadotrophin-releasing hormone (GnRH) agonists rather than hCG as an ovulation trigger.

• #44

  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 hallmark of OHSS is an increase in the permeability of the capillaries, resulting in a fluid shift from the intravascular space to the extravascular compartments. Vascular endothelial growth factor (VEGF) plays a critical role in the pathogenesis of OHSS by increasing vascular permeability.

• #45 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/

  Ovulation disorders, including polycystic ovary syndrome (PCOS), have been consistently associated with a higher incidence of OHSS. Among women with PCOS, those with metabolic syndrome appear to be at lower OHSS risk than those without. […] An elevated AMH level has consistently predicted risk for OHSS. In one study, AMH levels in women who developed OHSS were sixfold higher than in age- and weight-matched controls. […] 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.

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

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

  Vasoactive substances such as interleukins, tumor necrosis factor (TNF)-alpha, endothelin-1, and VEGF secreted by the ovaries have been implicated in increasing vascular permeability. […] Withholding hCG decreases OHSS. Hence, it plays a critical role in enhancing ovarian angiogenesis and triggering the cascade of vascular permeability in ovarian vessels that leads to third spacing and OHSS. Exogenous and endogenous gonadotropins from molar pregnancy, gonadotroph adenomas, and even pregnancy can aggravate OHSS. […] Age younger than 35 years, low body mass index (BMI), gonadotropin treatment, high estradiol concentrations, large number of follicles, history of polycystic ovarian syndrome, administration of exogenous hCG, and endogenous hCG from treatments resulting in pregnancy increase a patients risk of developing OHSS. […] According to Martin et al, if the pre-hCG estradiol amount is greater than 6000 mcg and/or if more than 30 follicles are present, the rate of severe OHSS approaches 80%.

• #47 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. […] Significant OHSS occurs in a small percentage of women undergoing ovarian stimulation for IVF, especially those with polycystic ovarian syndrome (PCOS) or high antral follicle counts. […] OHSS is caused by increased vascular permeability, resulting in fluid leakage from blood vessels. High levels of vascular endothelial growth factor (VEGF) are believed to play a major role in triggering this process. […] OHSS prevention involves careful use of injectable FSH medications, especially for those at higher risk. Fertility specialists assess factors such as: High antral follicle count, High AMH blood level, High LH blood level or high LH to FSH ratio.

• #48 What is ovarian hyperstimulation syndrome (OHSS)? – IVF in Athens – Kolonaki | In Vitro Fertilization

  https://drakopoulos-ivf.gr/en/what-is-ovarian-hyperstimulation-syndrome-ohss/

  The risk factors that predispose to the onset of OHSS are: Age: the ovaries of young women (under 30) have a higher number of gonadotropin receptors or a higher number of follicles, making them more susceptible to this syndrome. […] Patients given high doses of gonadotropins are more likely to develop OHSS because there is a greater ovarian response. […] One of the most effective ways to prevent the occurrence of OHSS is to replace hCG with another drug such as GnRH agonists. […] Since there is a direct relationship between hCG levels and the severity of the syndrome, another approach to avoid the development of OHSS is to reduce the dose given to induce ovulation.

• #49 OHSS Syndrome: Symptoms, Causes, Diagnosis & Treatment

  https://ankuranclinic.com/tips-to-prevent-ohss-syndrome-ovarian-hyperstimulation-before-ivf/

  OHSS Syndrome (Ovarian Hyperstimulation Syndrome) is a condition which occurs during the treatment of infertility through the In Vitro Fertilization (IVF) cycle. In this case, the ovaries over-response to the fertility drugs which are injected throughout the IVF process as a result ovaries are swollen and filled with excessive fluid that can cause serious complications in the fertility process. However, it is a temporary condition that can be managed with proper treatment. […] Ovarian hyperstimulation syndrome is typically caused by this stimulating injection. Other drugs such as gonadotropins (follicle-stimulating hormone FSH) and luteinizing hormone LH) also increase the risk of OHSS syndrome while used in high doses. […] Women who are aligned with these conditions would be positive prospects for an OHSS

• #50 Ovarian hyperstimulation syndrome – Wikipedia

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

  Ovarian hyperstimulation syndrome is particularly associated with injection of a hormone called human chorionic gonadotropin (hCG) which is used for inducing final oocyte maturation and/or triggering oocyte release. The risk is further increased by multiple doses of hCG after ovulation and if the procedure results in pregnancy.

• #51

  https://journals.lww.com/jhrs/fulltext/2011/04020/ovarian_hyperstimulation_syndrome.2.aspx

  Low-dose gonadotrophin protocols have been implemented to reduce the risks of fertility treatment in polycystic ovary syndrome patients. […] Cabergoline inhibits partially the VEGF receptor 2 phosphorylation levels and associated vascular permeability without affecting luteal angiogenesis reduces the early (within the first 9 days after hCG) onset of OHSS. […] The use of hCG in luteal phase support (LPS) has been shown to confer significant benefits over placebo in agonist suppressed cycles; however, hCG is also known to increase the risk of OHSS. […] Insulin resistance with compensatory hyperinsulinemia is thought to play a pathophysiological role in the ovarian dysfunction and hyperandrogenism associated with PCOS. […] A 2006 meta-analysis of eight randomized controlled trials of metformin co-administration during gonadotrophin-stimulated OI or IVF in women with PCOS found little benefit of metformin treatment in terms of improved ovulation or clinical outcome in this population but did note a significant positive effect on the incidence of OHSS. […] Cabergoline reduces the early onset of ovarian hyperstimulation syndrome: A prospective randomized study. […] A large RCT demonstrated that low-dose aspirin was associated with reduction in the OHSS incidence in a high-risk group with similar pregnancy rates.

• #52 Ovarian hyperstimulation syndrome Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/ovarian-hyperstimulation-syndrome

  Ovarian hyperstimulation syndrome (OHSS) is a problem that is sometimes seen in women who take fertility medicines that stimulate egg production. […] If these medicines stimulate the ovaries too much, the ovaries can become very swollen. Fluid can leak into the belly and chest area. This is called OHSS. This occurs only after the eggs are released from the ovary (ovulation). […] OHSS rarely occurs in women who only take fertility drugs by mouth. […] 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.

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

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

  When women develop a lot of potential eggs, the ovaries can respond excessively to this medication, and they can develop OHSS. […] In people with OHSS, drugs used in fertility treatments cause the blood vessels surrounding their ovaries to leak fluid. Sometimes this fluid moves into your belly and causes symptoms like swelling and pain. […] Women at a higher risk for OHSS include those who have PCOS, have previously had OHSS, have a large number of follicles or high levels of estrogen during IVF stimulation, received high doses of HCG during an IVF cycle, and have undergone a fresh rather than frozen embryo transfer.

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

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

  In patients at risk for moderate-to-severe OHSS, it is recommended to start a dopamine agonist such as cabergoline on the day of the hCG trigger or soon thereafter and continue for several days. […] It is not recommended to administer letrozole as an intervention to reduce rates of moderate-to-severe OHSS. […] 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.

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

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

  Vasoactive substances such as interleukins, tumor necrosis factor (TNF)-alpha, endothelin-1, and VEGF secreted by the ovaries have been implicated in increasing vascular permeability. […] Withholding hCG decreases OHSS. Hence, it plays a critical role in enhancing ovarian angiogenesis and triggering the cascade of vascular permeability in ovarian vessels that leads to third spacing and OHSS. Exogenous and endogenous gonadotropins from molar pregnancy, gonadotroph adenomas, and even pregnancy can aggravate OHSS. […] Age younger than 35 years, low body mass index (BMI), gonadotropin treatment, high estradiol concentrations, large number of follicles, history of polycystic ovarian syndrome, administration of exogenous hCG, and endogenous hCG from treatments resulting in pregnancy increase a patients risk of developing OHSS. […] According to Martin et al, if the pre-hCG estradiol amount is greater than 6000 mcg and/or if more than 30 follicles are present, the rate of severe OHSS approaches 80%.

• #56 OHSS (Ovarian Hyperstimulation Syndrome): Symptoms, Causes, and Prevention

  https://www.medlineacademics.com/blog/ovarian-hyperstimulation-syndrome.php

  It occurs due to the use of certain medications to stimulate egg production from the ovaries during ART. […] The signs and symptoms of OHSS result due to certain chemicals secreted in the body when the ovaries respond excessively during stimulation. These causative chemicals include hCG (Human chorionic gonadotropin) which acts through VEGF (Vascular Endothelial growth Factor), RAS (Renin-Angiotensin System) both at local ovarian level and at systemic level, while the end-mediators include Interleukins 1,2,6,8; Tumor necrosis factor alfa, Endothelins etc. […] Early OHSS develops because of administering hCG injection as a trigger for ovulation during treatment. Late OHSS is when it develops because the woman has conceived in the treatment cycle. […] Primary prevention- The woman’s risk for OHSS is assessed before the start of treatment and the stimulation protocols for ovarian induction is tailor made to her. […] Secondary Prevention: This involves identifying cases threatening to progress into OHSS and taking appropriate measure to reduce the risk and complication thereon.

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

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

  Two clinical forms of OHSS exist with the early onset form occurring after administration of human chorionic gonadotropin (hCG), and the late onset form occurring due to hCG secreted during pregnancy. […] Many strategies have been employed in an attempt to reduce OHSS including alternatives to hCG such as GnRH agonist triggering, in vitro maturation, dopamine agonists, IV albumin, metformin, and cancelling the IVF stimulation. […] Presenting symptoms of OHSS may include nausea, vomiting, diarrhea, abdominal distension and rapid weight gain. […] If a patient who recently underwent controlled ovarian hyperstimulation presents to the ED with these symptoms, it is critical to consider OHSS as an etiology. […] Women who present to the ED with symptoms of OHSS should have laboratory testing performed with a complete blood count, electrolytes, serum hCG level, urine specific gravity and renal/liver function tests.

• #58 OHSS (Ovarian Hyperstimulation Syndrome): Symptoms, Causes, and Prevention

  https://www.medlineacademics.com/blog/ovarian-hyperstimulation-syndrome.php

  It occurs due to the use of certain medications to stimulate egg production from the ovaries during ART. […] The signs and symptoms of OHSS result due to certain chemicals secreted in the body when the ovaries respond excessively during stimulation. These causative chemicals include hCG (Human chorionic gonadotropin) which acts through VEGF (Vascular Endothelial growth Factor), RAS (Renin-Angiotensin System) both at local ovarian level and at systemic level, while the end-mediators include Interleukins 1,2,6,8; Tumor necrosis factor alfa, Endothelins etc. […] Early OHSS develops because of administering hCG injection as a trigger for ovulation during treatment. Late OHSS is when it develops because the woman has conceived in the treatment cycle. […] Primary prevention- The woman’s risk for OHSS is assessed before the start of treatment and the stimulation protocols for ovarian induction is tailor made to her. […] Secondary Prevention: This involves identifying cases threatening to progress into OHSS and taking appropriate measure to reduce the risk and complication thereon.

• #59 Ovarian Hyperstimulation Syndrome (OHSS) Caused by Fertility Treatment | Embryo Project Encyclopedia

  https://embryo.asu.edu/pages/ovarian-hyperstimulation-syndrome-ohss-caused-fertility-treatment

  While researchers recognize the role of hCG in the development of OHSS, it is not the only hormone that may cause women to experience the syndrome. […] However, despite those studies, researchers generally agree that the exact mechanism behind OHSS is still unclear. […] Physicians associate early onset OHSS with higher rates of pregnancy loss before seven weeks of gestation among women undergoing IVF. […] Late onset OHSS, which is more likely to cause serious symptoms than early onset OHSS, is mainly caused by hCG released from the placenta and usually only occurs in women who become pregnant as a result of IVF treatment. […] Approximately one out of three women undergoing IVF treatment may experience symptoms with mild OHSS that include nausea, abdominal bloating, abdominal discomfort, and diarrhea.

• #60 OHSS (Ovarian Hyperstimulation Syndrome): Symptoms, Causes, and Prevention

  https://www.medlineacademics.com/blog/ovarian-hyperstimulation-syndrome.php

  It occurs due to the use of certain medications to stimulate egg production from the ovaries during ART. […] The signs and symptoms of OHSS result due to certain chemicals secreted in the body when the ovaries respond excessively during stimulation. These causative chemicals include hCG (Human chorionic gonadotropin) which acts through VEGF (Vascular Endothelial growth Factor), RAS (Renin-Angiotensin System) both at local ovarian level and at systemic level, while the end-mediators include Interleukins 1,2,6,8; Tumor necrosis factor alfa, Endothelins etc. […] Early OHSS develops because of administering hCG injection as a trigger for ovulation during treatment. Late OHSS is when it develops because the woman has conceived in the treatment cycle. […] Primary prevention- The woman’s risk for OHSS is assessed before the start of treatment and the stimulation protocols for ovarian induction is tailor made to her. […] Secondary Prevention: This involves identifying cases threatening to progress into OHSS and taking appropriate measure to reduce the risk and complication thereon.

• #61 OHSS — PCOS Awareness Association

  https://www.pcosaa.org/ohss

  Ovarian hyperstimulation syndrome (OHSS) causes swelling of the ovaries, which leak fluid within the body. This condition occurs in women who receive fertility treatments that stimulate the ovaries to produce more eggs. […] OHSS develops because of high levels of the pregnancy hormone HCG following these fertility treatments. PCOS and the use of fertility treatments increase the risk of OHSS. […] Drugs used in fertility treatments cause the blood vessels surrounding the ovaries to leak fluid. This fluid causes the ovaries to swell. […] In severe forms, the excess fluid can result in difficulty breathing and decreased urination. […] OHSS used to occur in about 10% of women who receive in-vitro fertilization treatments, but today the number is less than 5%. […] If you become pregnant during a treatment cycle, OHSS may worsen as your body begins producing its own HCG in response to the pregnancy.

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

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

  Spontaneous ovarian hyperstimulation syndrome is a rare subtype and occurs in the absence of any external stimulation. This form can occur in pregnancy, or due to a genetic component. These have an association with early pubertal development and primary hypothyroidism (Van Wyk-Grumbach syndrome). […] Ovarian stimulation in the hypothyroid child may result in estrogen production, breast development, endometrial proliferation, and vaginal bleeding. It is likely that raised TSH concentrations bind and stimulate the FSH receptor, although a similar overlap phenomenon might occur at the level of the pituitary, with enhanced TRH production stimulating the GnRH receptor with subsequent ovarian enlargement. The cystic ovarian enlargement resolves with thyroid hormone replacement. A hyperstimulation phenomenon in patients with an abnormal FSH receptor has been described.

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

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

  Spontaneous ovarian hyperstimulation syndrome is a rare subtype and occurs in the absence of any external stimulation. This form can occur in pregnancy, or due to a genetic component. These have an association with early pubertal development and primary hypothyroidism (Van Wyk-Grumbach syndrome). […] Ovarian stimulation in the hypothyroid child may result in estrogen production, breast development, endometrial proliferation, and vaginal bleeding. It is likely that raised TSH concentrations bind and stimulate the FSH receptor, although a similar overlap phenomenon might occur at the level of the pituitary, with enhanced TRH production stimulating the GnRH receptor with subsequent ovarian enlargement. The cystic ovarian enlargement resolves with thyroid hormone replacement. A hyperstimulation phenomenon in patients with an abnormal FSH receptor has been described.

• #64 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. […] Sporadic OHSS is very rare and may have a genetic component. Clomifene citrate therapy can occasionally lead to OHSS, but the vast majority of cases develop after use of gonadotropin therapy (with administration of FSH), such as Pergonal, and administration of hCG to induce final oocyte maturation and/or trigger oocyte release, often in conjunction with in vitro fertilisation (IVF). 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. Risk factors include polycystic ovary syndrome, young age, low BMI, high antral follicle count, the development of many ovarian follicles under stimulation, extreme elevated serum estradiol concentrations, the use of hCG for final oocyte maturation and/or release, the continued use of hCG for luteal support, and the occurrence of a pregnancy (resulting in hCG production).

• #65 Ovarian Hyperstimulation Syndrome – BFI

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

  Ovarian hyperstimulation syndrome or OHSS is a condition where there is a hyper response in the ovary, and more eggs are produced inside the ovary. […] Normally it is an iatrogenic problem (it happens because of the treatment rather than the disease). Ovarian hyperstimulation syndrome can happen in any type of fertility treatment from a simple oral drug to injections used for IVF or other treatments. […] In very rare conditions such as gestational trophoblastic disease, pituitary tumours OHSS develop without any treatment, but this syndrome mainly arises because of the medical treatment. […] OHSS is caused by ovarian stimulation by various drugs. These drugs are used to create more follicles for treatments such as ovulation induction, IUI, or IVF. […] Women having PCOS are at a much greater risk of OHSS than other patients. […] The syndrome can be severe in women under 35 years of age because they have more follicles in their ovary, so they are more prone to develop follicles. […] Underweight women also have more symptoms of OHSS.

• #66

  https://journals.lww.com/jhrs/fulltext/2011/04020/ovarian_hyperstimulation_syndrome.2.aspx

  Low-dose gonadotrophin protocols have been implemented to reduce the risks of fertility treatment in polycystic ovary syndrome patients. […] Cabergoline inhibits partially the VEGF receptor 2 phosphorylation levels and associated vascular permeability without affecting luteal angiogenesis reduces the early (within the first 9 days after hCG) onset of OHSS. […] The use of hCG in luteal phase support (LPS) has been shown to confer significant benefits over placebo in agonist suppressed cycles; however, hCG is also known to increase the risk of OHSS. […] Insulin resistance with compensatory hyperinsulinemia is thought to play a pathophysiological role in the ovarian dysfunction and hyperandrogenism associated with PCOS. […] A 2006 meta-analysis of eight randomized controlled trials of metformin co-administration during gonadotrophin-stimulated OI or IVF in women with PCOS found little benefit of metformin treatment in terms of improved ovulation or clinical outcome in this population but did note a significant positive effect on the incidence of OHSS. […] Cabergoline reduces the early onset of ovarian hyperstimulation syndrome: A prospective randomized study. […] A large RCT demonstrated that low-dose aspirin was associated with reduction in the OHSS incidence in a high-risk group with similar pregnancy rates.

• #67 OHSS — PCOS Awareness Association

  https://www.pcosaa.org/ohss

  Severe cases of OHSS occur rarely and can lead to hospitalization due to serious symptoms and complications including: […] Some medications seem to reduce the risk of OHSS without affecting the odds of pregnancy. […] Giving women who have polycystic ovary syndrome, the drug metformin during ovarian stimulation may also help prevent hyperstimulation. […] Because OHSS often develops after an HCG trigger shot is given, alternatives to HCG for triggering have been developed using Gn-RH agonists, such as leuprolide (Lupron), as a way to prevent or limit OHSS. […] The treatment for OHSS varies depending on how severe the condition is. Treatment aims to manage symptoms and avoid complications. […] Severe cases of OHSS often require hospitalization for monitoring and aggressive treatment, including IV fluids.

• #68 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). […] Rarely, OHSS can result from taking other medications, such as clomiphene citrate or gonadotropin-releasing hormone. […] There are several strategies used to lower the risk of OHSS. Reducing the dose of ovarian stimulation medications may reduce the risk of OHSS. […] The use of a medicine called leuprolide instead of human chorionic gonadotropin (hCG) as the final trigger to prepare the eggs for release can prevent OHSS. […] Additionally, a high AMH and polycystic ovary syndrome are risk factors; however, individuals with low ovarian reserve are not at risk. […] The risk of OHSS can be reduced by the use of lower doses of gonadotropins, leuprolide (vs. hCG) to trigger ovulation and cabergoline.

• #69 Ovarian hyperstimulation syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3205536/

  Low-dose gonadotrophin protocols have been implemented to reduce the risks of fertility treatment in polycystic ovary syndrome patients. […] Cabergoline inhibits partially the VEGF receptor 2 phosphorylation levels and associated vascular permeability without affecting luteal angiogenesis reduces the early (within the first 9 days after hCG) onset of OHSS. […] OHSS is significantly lower in an antagonist protocol than in an agonist protocol.

• #70 Ovarian Hyperstimulation Syndrome | Doctor

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

  Risk factors include Polycystic Ovarian Syndrome (PCOS), age under 30, rapidly rising oestrogen levels and a large number of follicles, the use of hCG for luteal phase support, low body weight, previous history of OHSS, and high levels of anti-Mullerian hormone. […] OHSS is an iatrogenic condition and large numbers of strategies have been investigated to try to reduce the incidence. Techniques which may reduce risk include individualised stimulation regimes dependent on risk stratification, avoiding aggressive ovarian stimulation, and the use of gonadotrophin-releasing hormone (GnRH) agonists rather than hCG as an ovulation trigger.

• #71 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). […] Rarely, OHSS can result from taking other medications, such as clomiphene citrate or gonadotropin-releasing hormone. […] There are several strategies used to lower the risk of OHSS. Reducing the dose of ovarian stimulation medications may reduce the risk of OHSS. […] The use of a medicine called leuprolide instead of human chorionic gonadotropin (hCG) as the final trigger to prepare the eggs for release can prevent OHSS. […] Additionally, a high AMH and polycystic ovary syndrome are risk factors; however, individuals with low ovarian reserve are not at risk. […] The risk of OHSS can be reduced by the use of lower doses of gonadotropins, leuprolide (vs. hCG) to trigger ovulation and cabergoline.

• #72 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). […] Rarely, OHSS can result from taking other medications, such as clomiphene citrate or gonadotropin-releasing hormone. […] There are several strategies used to lower the risk of OHSS. Reducing the dose of ovarian stimulation medications may reduce the risk of OHSS. […] The use of a medicine called leuprolide instead of human chorionic gonadotropin (hCG) as the final trigger to prepare the eggs for release can prevent OHSS. […] Additionally, a high AMH and polycystic ovary syndrome are risk factors; however, individuals with low ovarian reserve are not at risk. […] The risk of OHSS can be reduced by the use of lower doses of gonadotropins, leuprolide (vs. hCG) to trigger ovulation and cabergoline.

• #73 Understanding Ovarian Hyperstimulation Syndrome (OHSS): Symptoms, Risk Factors, and Prevention: OC Fertility® + OC Biogenix®: Fertility Clinic

  https://www.ocfertility.com/blog/understanding-ovarian-hyperstimulation-syndrome-ohss-symptoms-risk-factors-and-prevention

  Controlled Ovarian Hyperstimulation (COH) is the process in which eggs are grown within the ovary during IVF, egg freezing, or egg donation. […] Occasionally, an individual’s ovarian reserve is so robust that, without careful monitoring, the number of eggs growing may be significant enough to cause a host of negative side effects called Ovarian Hyperstimulation Syndrome (OHSS). […] The severity of symptoms is related to the number of follicles—the greater the number, the more likely symptoms are to occur. […] The hormone HcG potentiates these symptoms, and if given for a trigger shot, it stays in the system for only a short period, ultimately limiting the duration of symptoms, usually 7 days. […] In patients at greater risk of OHSS, we typically use the Lupron trigger as opposed to the HcG; this shortens the length of time patients are symptomatic post-retrieval and doesn’t have the same potentiated effects of HcG.

• #74 Ovarian hyperstimulation syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3205536/

  Low-dose gonadotrophin protocols have been implemented to reduce the risks of fertility treatment in polycystic ovary syndrome patients. […] Cabergoline inhibits partially the VEGF receptor 2 phosphorylation levels and associated vascular permeability without affecting luteal angiogenesis reduces the early (within the first 9 days after hCG) onset of OHSS. […] OHSS is significantly lower in an antagonist protocol than in an agonist protocol.

• #75 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/

  Ovulation disorders, including polycystic ovary syndrome (PCOS), have been consistently associated with a higher incidence of OHSS. Among women with PCOS, those with metabolic syndrome appear to be at lower OHSS risk than those without. […] An elevated AMH level has consistently predicted risk for OHSS. In one study, AMH levels in women who developed OHSS were sixfold higher than in age- and weight-matched controls. […] 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.

• #76 Ovarian hyperstimulation syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3205536/

  Low-dose gonadotrophin protocols have been implemented to reduce the risks of fertility treatment in polycystic ovary syndrome patients. […] Cabergoline inhibits partially the VEGF receptor 2 phosphorylation levels and associated vascular permeability without affecting luteal angiogenesis reduces the early (within the first 9 days after hCG) onset of OHSS. […] OHSS is significantly lower in an antagonist protocol than in an agonist protocol.

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

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

  In patients at risk for moderate-to-severe OHSS, it is recommended to start a dopamine agonist such as cabergoline on the day of the hCG trigger or soon thereafter and continue for several days. […] It is not recommended to administer letrozole as an intervention to reduce rates of moderate-to-severe OHSS. […] 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.

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

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

  In patients at risk for moderate-to-severe OHSS, it is recommended to start a dopamine agonist such as cabergoline on the day of the hCG trigger or soon thereafter and continue for several days. […] It is not recommended to administer letrozole as an intervention to reduce rates of moderate-to-severe OHSS. […] 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.

• #79 Understanding Ovarian Hyperstimulation Syndrome (OHSS): Symptoms, Risk Factors, and Prevention: OC Fertility® + OC Biogenix®: Fertility Clinic

  https://www.ocfertility.com/blog/understanding-ovarian-hyperstimulation-syndrome-ohss-symptoms-risk-factors-and-prevention

  Additionally, the introduction of „freeze all” cycles has helped reduce the incidence of OHSS. […] Aside from limiting fresh transfers and using Lupron triggers, careful monitoring and thoughtful IVF stimulation medication dosage are key to limiting the risks of OHSS. […] In some cases, despite considerations of the patient’s age, ovarian reserve, BMI, and medical history, the stimulation dosage might result in too many follicles growing. […] Understanding your risks for OHSS is an important part of the consultation prior to starting stimulation medications.

• #80 Ovarian hyperstimulation syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3205536/

  Low-dose gonadotrophin protocols have been implemented to reduce the risks of fertility treatment in polycystic ovary syndrome patients. […] Cabergoline inhibits partially the VEGF receptor 2 phosphorylation levels and associated vascular permeability without affecting luteal angiogenesis reduces the early (within the first 9 days after hCG) onset of OHSS. […] OHSS is significantly lower in an antagonist protocol than in an agonist protocol.

• #81

  https://journals.lww.com/jhrs/fulltext/2011/04020/ovarian_hyperstimulation_syndrome.2.aspx

  Low-dose gonadotrophin protocols have been implemented to reduce the risks of fertility treatment in polycystic ovary syndrome patients. […] Cabergoline inhibits partially the VEGF receptor 2 phosphorylation levels and associated vascular permeability without affecting luteal angiogenesis reduces the early (within the first 9 days after hCG) onset of OHSS. […] The use of hCG in luteal phase support (LPS) has been shown to confer significant benefits over placebo in agonist suppressed cycles; however, hCG is also known to increase the risk of OHSS. […] Insulin resistance with compensatory hyperinsulinemia is thought to play a pathophysiological role in the ovarian dysfunction and hyperandrogenism associated with PCOS. […] A 2006 meta-analysis of eight randomized controlled trials of metformin co-administration during gonadotrophin-stimulated OI or IVF in women with PCOS found little benefit of metformin treatment in terms of improved ovulation or clinical outcome in this population but did note a significant positive effect on the incidence of OHSS. […] Cabergoline reduces the early onset of ovarian hyperstimulation syndrome: A prospective randomized study. […] A large RCT demonstrated that low-dose aspirin was associated with reduction in the OHSS incidence in a high-risk group with similar pregnancy rates.

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

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

  Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian hyperstimulation (COH) for assisted reproduction technologies (ART). It occurs when the ovaries are hyperstimulated and enlarged due to fertility treatments (or rarely, mutations in the follicle-stimulating hormone [FSH] receptor), resulting in the shift of serum from the intravascular space to the third space, mainly to the abdominal cavity. In its severe form, OHSS is a life-threatening condition because it can cause venous or arterial thromboembolic events, including stroke and loss of perfusion of an extremity. […] The 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.

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