Materiały źródłowe

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

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

  Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications. […] Treatment for moderate OHSS may involve: Increased fluid intake, Frequent physical exams and ultrasounds, Daily weigh-ins and waist measurements to check for drastic changes, Measurements of how much urine you produce each day, Blood tests to monitor for dehydration, electrolyte imbalance and other problems, Drainage of excess abdominal fluid using a needle inserted in your abdominal cavity, Medications to prevent blood clots (anticoagulants). […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) to help suppress ovarian activity. […] Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.

• #1 Ovarian hyperstimulation syndrome – UF Health

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

  Mild cases of OHSS usually don’t need to be treated. The condition may actually be associated with a greater chance of becoming pregnant. […] The following steps can help you ease your discomfort: Get plenty of rest with your legs raised. This helps your body release the fluid. However, light activity every now and then is better than complete bed rest, unless your provider tells you otherwise. Drink at least 10 to 12 glasses (about 1.5 to 2 liters) of fluid a day (especially drinks that contain electrolytes). Avoid alcohol or caffeinated beverages (such as colas or coffee). Avoid intense exercise and sexual intercourse. These activities can cause ovarian discomfort and may cause ovarian cysts to rupture or leak, or cause the ovaries to twist and cut off blood flow (ovarian torsion). Take an over-the-counter pain reliever such as acetaminophen (Tylenol).

• #1 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Treatment for OHSS is supportive. Mild ovarian hyperstimulation can develop into moderate or severe disease, especially if conception ensues. Therefore, women with mild disease should be observed for enlarging abdominal girth, acute weight gain, and abdominal discomfort on an ambulatory basis for at least 2 weeks or until menstrual bleeding occurs. […] The treatment of moderate OHSS consists of observation, bed rest, the provision of adequate fluids, and ultrasonographic monitoring of the size of cysts. Serum electrolyte concentrations, hematocrits, and creatinine levels should also be evaluated. […] Clinician experience with severe OHSS is mandatory for appropriate treatment. One should transfer the patient to a different center if no one who is experienced in managing severe OHSS is available at the present location.

• #1 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Surgical management further aggravates electrolyte imbalances and increases morbidity. Indeed, surgery is necessary only in extreme cases, such as in the case of ovarian torsion, a ruptured cyst, or an internal hemorrhage. Ascites can be tapped by means of paracentesis. Laparotomy during torsion and intraperitoneal hemorrhage is lifesaving and recommended. […] In severe cases of OHSS, consultation with a physician specializing in fluid and electrolyte imbalances is warranted. For some cases, aggressive treatment in the surgical intensive care unit may be required. […] Conservative management in the outpatient setting is appropriate for mild-to-moderate ovarian hyperstimulation syndrome (OHSS) until spontaneous resolution occurs. However, management in the inpatient setting should be considered if any of the following criteria are present: Inability to tolerate oral food or hydration, Severe abdominal pain, Unclear diagnosis, Hypotension, Shortness of breath, Tense ascites, Peritoneal signs, Hematocrit greater than 48%, Sodium less than 135 mEq/L, Potassium greater than 5 mEq/L, Creatinine greater than 1.2 mg/dL.

• #1 Prevention and Management of Ovarian Hyperstimulation Syndrome

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

  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. Cycle cancelation before trigger can prevent OHSS, but the emotional and financial burden it imposes on patients should be considered before the cycle is canceled. Coasting involves temporarily stopping gonadotropin administration and postponing the hCG trigger until the estradiol level is lower causing decreased luteinization with lower LH levels. Administration of intravenous albumin and HES: Colloid infusion at time of opu are useful. It binds to vasoactive mediators and prevent OHSS. […] Diagnosis of OHSS is clinical. Treatment of the acute phase merely relies on an empirical and symptomatic approach. Outpatient management is appropriate for mild, moderate, and few selected severe OHSS cases. Intravenous hydration should always be initiated with a crystalloid solution to prevent hemoconcentration and provide proper sufficient end-organ perfusion and strict charting to be done. Oliguria despite adequate fluid replacement responds to paracentesis in few cases. Indications for paracentesis include the following: severe abdominal distension, shortness of breath due to ascites, and increased intra-abdominal pressure and failed volume replacement causing oliguria.

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

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

  It is recommended to 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. (Strength of evidence: B; strength of recommendation: moderate) […] It is recommended to use a GnRH agonist to trigger oocyte maturation as a first-line strategy to reduce the risk of moderate-to-severe OHSS. (Strength of evidence: A; strength of recommendation: strong) […] 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. (Strength of evidence: A; strength of recommendation: strong) […] 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. (Strength of evidence: A; strength of recommendation: strong)

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

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

  It is not recommended to administer letrozole as an intervention to reduce rates of moderate-to-severe OHSS. (Strength of evidence: B; strength of recommendation: moderate) […] It is not recommended to administer a luteal GnRH antagonist alone to reduce rates of moderate-to-severe OHSS. Most studies report no reduction in rates of moderate-to-severe OHSS or signs or symptoms associated with OHSS. (Strength of evidence: C; strength of recommendation: weak) […] It is not recommended to administer medications such as mifepristone, myoinositol, D-chiro-inositol, or glucocorticoids to reduce rates of OHSS because studies have shown these interventions to be ineffective. (Strength of evidence: C; strength of recommendation: weak) […] It is not recommended to use volume expanders such as albumin, hydroxyethyl starch, or mannitol in patients who are at high risk of developing moderate or severe OHSS. (Strength of evidence: C; strength of recommendation: weak)

• #1 Ovarian hyperstimulation syndrome – UF Health

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

  If your provider diagnoses severe OHSS before transferring embryos in an IVF, they may decide to cancel the embryo transfer. The embryos are frozen and they wait for OHSS to resolve before scheduling a frozen embryo transfer cycle. […] In the rare case that you develop severe OHSS, you will probably need to go to a hospital. Your provider will give you fluids through a vein (intravenous fluids). They will also remove fluids that have collected in your body, and monitor your condition.

• #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/

  Coasting is generally not recommended as a primary strategy to reduce the risk of moderate-to-severe OHSS. However, when other more effective strategies are not available to reduce the risk of OHSS, coasting in combination with cabergoline and a freeze-only strategy may mitigate the risk. (Strength of evidence: C; strength of recommendation: weak) […] It is recommended to add adequate luteal support when using a GnRH agonist as a trigger and planning a fresh embryo transfer. (Strength of evidence: A; strength of recommendation: strong)

• #1 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Medical treatment of severe hyperstimulation is directed at maintaining intravascular blood volume. Simultaneous goals are correcting the disturbed fluid and electrolyte balance, relieving secondary complications of ascites and hydrothorax, and preventing thromboembolic phenomena. […] The main interventions are fluid management and correction of hypovolemia. These measures consist of initial intravenous (IV) administration of 1 L normal saline over 1 hour. Dextrose 5% in normal saline or normal saline is then infused at a rate of 125-150mL/h, with 4-hour tabulations of urine production. […] To prevent thrombosis, subcutaneous heparin 5000-7500 U daily is begun on the first day of admission. It is stopped after adequate ambulation is achieved. […] After several days, third-space fluid begins to reenter the intravascular space, hemoconcentration reverses, and natural diuresis ensues. IV fluids may be tapered as the patient’s oral intake increases. Complete resolution typically takes 10-14 days from the onset of initial symptoms.

• #1 How is Ovarian Hyperstimulation Syndrome Treated? | IVF Treatment

  https://www.ivf1.com/blogs/how-is-ovarian-hyperstimulation-syndrome-treated-08d29

  Preventing future episodes of OHSS is a key goal of ovarian hyperstimulation syndrome treatment. Developing OHSS is a sign that the initial dose of fertility medication was too high for the patient to tolerate. If you choose to go through further fertility treatment cycles, the doctor will prescribe a lower, more gentle dose of medication. In addition, you will be carefully monitored for the recurrence of OHSS.

• #1 Preventing Ovarian Hyperstimulation Syndrome

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

  Advancements in understanding the causes of OHSS, the availability of techniques to modify the risk of its occurrence, and experienced practitioners trained in the proper management of patients undergoing ovarian stimulation procedures have thankfully made the likelihood of the severest forms of OHSS rare and have made fertility treatments very safe.

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

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

  Ovarian hyperstimulation syndrome (OHSS) may occur in women undergoing in vitro fertilization (IVF) or ovulation induction with injectable medications. […] Treatment depends on the severity of the condition. OHSS may improve on its own in mild cases, while severe cases may require hospitalization and additional treatment. […] 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. […] Strategies to help prevent OHSS include: Adjusting medication. Your provider uses the lowest possible dose of gonadotropins to stimulate your ovaries and trigger ovulation.

• #2 The Management of Ovarian Hyperstimulation Syndrome (Green-top Guideline No. 5) | RCOG

  https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/the-management-of-ovarian-hyperstimulation-syndrome-green-top-guideline-no-5/

  Ovarian hyperstimulation syndrome (OHSS) is a complication of fertility treatment, which uses pharmacological ovarian stimulation to increase the number of oocytes and therefore embryos available during assisted reproductive technology (ART). […] In a minority of women undergoing treatment, the ovarian response exceeds that aimed for and results in a clinical condition with a specific pathophysiology. OHSS is associated with significant physical and psychosocial morbidity and has been associated with maternal death. However, in most cases OHSS is self-limiting and requires supportive management and monitoring while awaiting resolution. […] Women with more severe OHSS may require inpatient treatment to manage the symptoms and reduce the risk of further complications.

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

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

  The treatment for OHSS varies depending on how severe the condition is. Treatment aims to manage symptoms and avoid complications. Mild cases tend to go away within a week or two. However, if you get pregnant that cycle, your symptoms could last much longer. […] For mild to moderate cases of OHSS, treatment usually involves: Avoiding vigorous physical activity. Drinking electrolyte-rich fluid like Gatorade or Propel. Using acetaminophen to relieve symptoms. Weighing yourself daily. Monitoring yourself for any severe symptoms. […] Severe cases of OHSS often require hospitalization. Treatment of severe OHSS may include: Receiving intravenous (directly into the vein) fluids. Undergoing paracentesis (a procedure to remove fluid from your belly). Taking medicines to ease symptoms or reduce activity in your ovaries. A blood thinner to help decrease the risk of a blood clot.

• #2 Treatment of ovarian hyperstimulation syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/21082512/

  Mild forms of ovarian hyperstimulation syndrome (OHSS) do not require treatment. Moderate OHSS should be followed up on an outpatient basis with no specific treatment. Severe OHSS requires proper evaluation. Investigations are done to evaluate hematocrit, electrolytes, and kidney and liver function. Conservative treatment with intravenous (i.v.) fluids and close monitoring is usually done. Intensive care admission is indicated in cases with severe respiratory distress or major electrolyte imbalance with elevated serum creatinine. Crystalloids in the form of i.v. saline and colloids as albumin or hydroxyethyl starch are commonly used to expand intravascular volume. Dopamine can be used to improve diuresis, and prophylactic heparin is administered to prevent venous thrombosis. Diuretics are generally contraindicated because they may further contract intravascular volume. Abdominal or vaginal aspiration of ascitic fluid results in marked improvement of symptoms, improved diuresis, and shortened hospital stay. The current trend to treat patients with i.v. fluids, albumin, and to perform aspiration of ascitic fluid on an outpatient basis has been found to be a more cost-effective protocol of treatment.

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

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

  Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications. […] Treatment for moderate OHSS may involve: Increased fluid intake, Frequent physical exams and ultrasounds, Daily weigh-ins and waist measurements to check for drastic changes, Measurements of how much urine you produce each day, Blood tests to monitor for dehydration, electrolyte imbalance and other problems, Drainage of excess abdominal fluid using a needle inserted in your abdominal cavity, Medications to prevent blood clots (anticoagulants). […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) to help suppress ovarian activity. […] Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.

• #2 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Surgical management further aggravates electrolyte imbalances and increases morbidity. Indeed, surgery is necessary only in extreme cases, such as in the case of ovarian torsion, a ruptured cyst, or an internal hemorrhage. Ascites can be tapped by means of paracentesis. Laparotomy during torsion and intraperitoneal hemorrhage is lifesaving and recommended. […] In severe cases of OHSS, consultation with a physician specializing in fluid and electrolyte imbalances is warranted. For some cases, aggressive treatment in the surgical intensive care unit may be required. […] Conservative management in the outpatient setting is appropriate for mild-to-moderate ovarian hyperstimulation syndrome (OHSS) until spontaneous resolution occurs. However, management in the inpatient setting should be considered if any of the following criteria are present: Inability to tolerate oral food or hydration, Severe abdominal pain, Unclear diagnosis, Hypotension, Shortness of breath, Tense ascites, Peritoneal signs, Hematocrit greater than 48%, Sodium less than 135 mEq/L, Potassium greater than 5 mEq/L, Creatinine greater than 1.2 mg/dL.

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

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

  Aggressive outpatient management of patients with moderate-to-severe OHSS using early paracentesis has been shown to effectively reduce the need for hospitalization. […] In patients with moderate OHSS, aggressive early paracentesis can prevent the progression of disease severity. […] A recent review of the clinical aspects of OHSS provides detailed recommendations for management according to patient diagnosis and risk.

• #2 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Ovarian hyperstimulation syndrome (OHSS) is a self-limiting disease of the luteal phase. Without luteinizing hormone (LH) or its imitator, human chorionic gonadotropin (hCG), ovulation or the luteal phase does not occur. Avoidance of hCG during ovarian stimulation offers an opportunity to prevent OHSS in high-risk patients. […] A Cochrane review that included 22 trials involving 3171 women at high risk for OHSS evaluated the safety and efficacy of three dopamine agonists (cabergoline, bromocriptine, and quinagolide) for prevention. The dopamine agonists seem to reduce the incidence of moderate or severe OHSS in women at risk, compared with placebo or no treatment, with no influence on pregnancy outcome. […] The best preventive method is to adapt the treatment and closely monitor patients at risk. Remember that women at risk are those with high levels of estrogen and many follicles at the assumed time of ovulation. Patients with polycystic ovarian syndrome should be closely monitored as well.

• #2 All About OHSS (Ovarian Hyperstimulation Syndrome)

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

  At the hospital, you may be given intravenous (IV) fluids to aid with hydration. In some cases, your doctor may want to alter your dose of fertility medication. You may be placed on a blood thinner to prevent blood clots. […] Your doctor may also recommend paracentesis, which is a procedure that can remove excess fluid buildup in your abdomen. And there are certain medications you can take to calm down all that activity going on in your ovaries. […] While frustrating, your doctor may additionally recommend delaying your scheduled embryo transfer essentially skipping your current treatment cycle. The good news is that you can freeze your embryos for transfer when you are symptom-free. […] There are a variety of ways you can work with your doctor to lower your odds of developing OHSS. […] Your doctor may adjust your dose of medication. Lower doses may still help stimulate egg production and maturation/release while not overstimulating your ovaries. […] Your doctor may also suggest that you freeze your follicles (both the mature and immature) so you can transfer the fertilized embryos in a future cycle. This involves retrieval of the eggs and then undergoing a frozen embryo transfer (FET) after letting your body rest.

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

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

  Ovarian hyperstimulation syndrome (OHSS) is an important iatrogenic complication caused by ovarian stimulation which is associated with increased luteinizing hormone (LH), follicle-stimulating hormone (FSH), human chorionic gonadotropin (hCG), and estradiol (E2) levels. […] OHSS has mild, moderate, severe, and critical forms, and the mild form is the most frequent. […] Prevention strategies for this condition include cessation of exogenous gonadotropins for several days (referred to as “coasting”), cancellation of the in vitro fertilization (IVF) cycle, and withholding hCG. […] The complexities inherent in OHSS require absolute compliance with guidelines and evidence-based recommendations, both for the sake of patient welfare and the medicolegal tenability of all procedures. […] Comparing the long protocol with GnRHa, the risk of a severe form of OHSS is reduced by 50% if we use GnRHant. However, a mild or moderate form of OHSS is also possible if the antagonist protocol is used, especially when hCG is used for the final maturation of oocytes in so-called “high responders” patients.

• #2 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Medical treatment of severe hyperstimulation is directed at maintaining intravascular blood volume. Simultaneous goals are correcting the disturbed fluid and electrolyte balance, relieving secondary complications of ascites and hydrothorax, and preventing thromboembolic phenomena. […] The main interventions are fluid management and correction of hypovolemia. These measures consist of initial intravenous (IV) administration of 1 L normal saline over 1 hour. Dextrose 5% in normal saline or normal saline is then infused at a rate of 125-150mL/h, with 4-hour tabulations of urine production. […] To prevent thrombosis, subcutaneous heparin 5000-7500 U daily is begun on the first day of admission. It is stopped after adequate ambulation is achieved. […] After several days, third-space fluid begins to reenter the intravascular space, hemoconcentration reverses, and natural diuresis ensues. IV fluids may be tapered as the patient’s oral intake increases. Complete resolution typically takes 10-14 days from the onset of initial symptoms.

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

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

  It is recommended to employ ovarian stimulation protocols using GnRH antagonists over protocols using GnRH agonists when there is concern for OHSS. (Strength of evidence: A; strength of recommendation: strong) […] It is recommended to dose gonadotropins on the basis of individualized ORT to decrease the risk of OHSS. (Strength of evidence: B; strength of recommendation: moderate) […] 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. (Strength of evidence: B; strength of recommendation: moderate) […] 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. (Strength of evidence: A; strength of recommendation: strong)

• #2 6 Tips to Avoid & Treat Ovarian Hyperstimulation Syndrome

  https://rmanetwork.com/blog/ovarian-hyperstimulation-syndrome-ohss/

  For patients with a heightened risk of OHSS, we offer alternative methods to trigger ovulation. Instead of the conventional hCG trigger, we may utilize a gonadotropin-releasing hormone (GnRH) agonist trigger, which has demonstrated a significantly lower risk of inducing OHSS without compromising outcomes. […] By implementing these preventive measures, RMA demonstrates a commitment to minimizing the risk of OHSS and providing comprehensive care for all patients undergoing fertility treatments.

• #3 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  In the ideal situation, the ovaries should be stimulated to the desired level when ovulation is induced. However, the unpredictable response of the ovaries to induction makes the prediction and prevention of OHSS difficult. Hence, heightened clinical suspicion and early intervention are paramount to the reduction of morbidity and mortality. […] Treatment should include the following: Maintenance of a high degree of clinical suspicion and a low threshold for admission, Early surgical intervention in cases of ovarian torsion or hemorrhage, Paracentesis to address ascites – This decreases pressure on the inferior vena cava and diaphragm, Placement of a transthoracic tube to manage pleural effusions. […] Ovarian hyperstimulation syndrome is a self-limiting disease. Therefore, treatment should be conservative and directed at symptoms, with medical therapy being sufficient for most patients. Women with severe symptoms often require intensive medical care.

• #3 Ovarian hyperstimulation syndrome – UF Health

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

  Mild cases of OHSS usually don’t need to be treated. The condition may actually be associated with a greater chance of becoming pregnant. […] The following steps can help you ease your discomfort: Get plenty of rest with your legs raised. This helps your body release the fluid. However, light activity every now and then is better than complete bed rest, unless your provider tells you otherwise. Drink at least 10 to 12 glasses (about 1.5 to 2 liters) of fluid a day (especially drinks that contain electrolytes). Avoid alcohol or caffeinated beverages (such as colas or coffee). Avoid intense exercise and sexual intercourse. These activities can cause ovarian discomfort and may cause ovarian cysts to rupture or leak, or cause the ovaries to twist and cut off blood flow (ovarian torsion). Take an over-the-counter pain reliever such as acetaminophen (Tylenol).

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

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

  Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications. […] Treatment for moderate OHSS may involve: Increased fluid intake, Frequent physical exams and ultrasounds, Daily weigh-ins and waist measurements to check for drastic changes, Measurements of how much urine you produce each day, Blood tests to monitor for dehydration, electrolyte imbalance and other problems, Drainage of excess abdominal fluid using a needle inserted in your abdominal cavity, Medications to prevent blood clots (anticoagulants). […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) to help suppress ovarian activity. […] Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.

• #3 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Treatment for OHSS is supportive. Mild ovarian hyperstimulation can develop into moderate or severe disease, especially if conception ensues. Therefore, women with mild disease should be observed for enlarging abdominal girth, acute weight gain, and abdominal discomfort on an ambulatory basis for at least 2 weeks or until menstrual bleeding occurs. […] The treatment of moderate OHSS consists of observation, bed rest, the provision of adequate fluids, and ultrasonographic monitoring of the size of cysts. Serum electrolyte concentrations, hematocrits, and creatinine levels should also be evaluated. […] Clinician experience with severe OHSS is mandatory for appropriate treatment. One should transfer the patient to a different center if no one who is experienced in managing severe OHSS is available at the present location.

• #3 Treatment of ovarian hyperstimulation syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/21082512/

  Mild forms of ovarian hyperstimulation syndrome (OHSS) do not require treatment. Moderate OHSS should be followed up on an outpatient basis with no specific treatment. Severe OHSS requires proper evaluation. Investigations are done to evaluate hematocrit, electrolytes, and kidney and liver function. Conservative treatment with intravenous (i.v.) fluids and close monitoring is usually done. Intensive care admission is indicated in cases with severe respiratory distress or major electrolyte imbalance with elevated serum creatinine. Crystalloids in the form of i.v. saline and colloids as albumin or hydroxyethyl starch are commonly used to expand intravascular volume. Dopamine can be used to improve diuresis, and prophylactic heparin is administered to prevent venous thrombosis. Diuretics are generally contraindicated because they may further contract intravascular volume. Abdominal or vaginal aspiration of ascitic fluid results in marked improvement of symptoms, improved diuresis, and shortened hospital stay. The current trend to treat patients with i.v. fluids, albumin, and to perform aspiration of ascitic fluid on an outpatient basis has been found to be a more cost-effective protocol of treatment.

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

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

  Adding medication. Some medications seem to reduce the risk of OHSS without affecting the odds of pregnancy. These include low-dose aspirin; dopamine agonists such as carbergoline or quinogloide; and calcium infusions. […] Avoiding use of an HCG trigger shot. Because OHSS often develops after an HCG trigger shot is given, alternatives to HCG for triggering have been developed using gonadotropin-releasing hormone (Gn-RH) agonists, such as leuprolide (Lupron), as a way to prevent or limit OHSS. […] Freezing embryos. If you’re undergoing in vitro fertilization (IVF), all the follicles (mature and immature) may be removed from your ovaries to reduce the chance of OHSS.

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

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

  It is not recommended to administer letrozole as an intervention to reduce rates of moderate-to-severe OHSS. (Strength of evidence: B; strength of recommendation: moderate) […] It is not recommended to administer a luteal GnRH antagonist alone to reduce rates of moderate-to-severe OHSS. Most studies report no reduction in rates of moderate-to-severe OHSS or signs or symptoms associated with OHSS. (Strength of evidence: C; strength of recommendation: weak) […] It is not recommended to administer medications such as mifepristone, myoinositol, D-chiro-inositol, or glucocorticoids to reduce rates of OHSS because studies have shown these interventions to be ineffective. (Strength of evidence: C; strength of recommendation: weak) […] It is not recommended to use volume expanders such as albumin, hydroxyethyl starch, or mannitol in patients who are at high risk of developing moderate or severe OHSS. (Strength of evidence: C; strength of recommendation: weak)

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

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

  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. (Strength of evidence: B; strength of recommendation: moderate) […] It is recommended to use a GnRH agonist to trigger oocyte maturation as a first-line strategy to reduce the risk of moderate-to-severe OHSS. (Strength of evidence: A; strength of recommendation: strong) […] 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. (Strength of evidence: A; strength of recommendation: strong) […] 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. (Strength of evidence: A; strength of recommendation: strong)

• #3 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Surgical management further aggravates electrolyte imbalances and increases morbidity. Indeed, surgery is necessary only in extreme cases, such as in the case of ovarian torsion, a ruptured cyst, or an internal hemorrhage. Ascites can be tapped by means of paracentesis. Laparotomy during torsion and intraperitoneal hemorrhage is lifesaving and recommended. […] In severe cases of OHSS, consultation with a physician specializing in fluid and electrolyte imbalances is warranted. For some cases, aggressive treatment in the surgical intensive care unit may be required. […] Conservative management in the outpatient setting is appropriate for mild-to-moderate ovarian hyperstimulation syndrome (OHSS) until spontaneous resolution occurs. However, management in the inpatient setting should be considered if any of the following criteria are present: Inability to tolerate oral food or hydration, Severe abdominal pain, Unclear diagnosis, Hypotension, Shortness of breath, Tense ascites, Peritoneal signs, Hematocrit greater than 48%, Sodium less than 135 mEq/L, Potassium greater than 5 mEq/L, Creatinine greater than 1.2 mg/dL.

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

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

  Sometimes hospitalization is required for supportive care and close monitoring until symptoms improve. […] Healing times for OHSS vary depending on the severity of the condition and if you become pregnant that cycle. Your healthcare provider will tell you when you can return to your usual activities and what you can expect. […] There isnt a way to get rid of OHSS fast. Your treatment depends on the severity of your symptoms. Your healthcare provider is the best person to discuss treatment options with. They can let you know what you can expect and how long your symptoms may persist.

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

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

  It is recommended to employ ovarian stimulation protocols using GnRH antagonists over protocols using GnRH agonists when there is concern for OHSS. (Strength of evidence: A; strength of recommendation: strong) […] It is recommended to dose gonadotropins on the basis of individualized ORT to decrease the risk of OHSS. (Strength of evidence: B; strength of recommendation: moderate) […] 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. (Strength of evidence: B; strength of recommendation: moderate) […] 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. (Strength of evidence: A; strength of recommendation: strong)

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

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

  Ovarian hyperstimulation syndrome (OHSS) may occur in women undergoing in vitro fertilization (IVF) or ovulation induction with injectable medications. […] Treatment depends on the severity of the condition. OHSS may improve on its own in mild cases, while severe cases may require hospitalization and additional treatment. […] 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. […] Strategies to help prevent OHSS include: Adjusting medication. Your provider uses the lowest possible dose of gonadotropins to stimulate your ovaries and trigger ovulation.

• #4 Ovarian hyperstimulation syndrome – UF Health

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

  Mild cases of OHSS usually don’t need to be treated. The condition may actually be associated with a greater chance of becoming pregnant. […] The following steps can help you ease your discomfort: Get plenty of rest with your legs raised. This helps your body release the fluid. However, light activity every now and then is better than complete bed rest, unless your provider tells you otherwise. Drink at least 10 to 12 glasses (about 1.5 to 2 liters) of fluid a day (especially drinks that contain electrolytes). Avoid alcohol or caffeinated beverages (such as colas or coffee). Avoid intense exercise and sexual intercourse. These activities can cause ovarian discomfort and may cause ovarian cysts to rupture or leak, or cause the ovaries to twist and cut off blood flow (ovarian torsion). Take an over-the-counter pain reliever such as acetaminophen (Tylenol).

• #4 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Treatment for OHSS is supportive. Mild ovarian hyperstimulation can develop into moderate or severe disease, especially if conception ensues. Therefore, women with mild disease should be observed for enlarging abdominal girth, acute weight gain, and abdominal discomfort on an ambulatory basis for at least 2 weeks or until menstrual bleeding occurs. […] The treatment of moderate OHSS consists of observation, bed rest, the provision of adequate fluids, and ultrasonographic monitoring of the size of cysts. Serum electrolyte concentrations, hematocrits, and creatinine levels should also be evaluated. […] Clinician experience with severe OHSS is mandatory for appropriate treatment. One should transfer the patient to a different center if no one who is experienced in managing severe OHSS is available at the present location.

• #4 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Medical treatment of severe hyperstimulation is directed at maintaining intravascular blood volume. Simultaneous goals are correcting the disturbed fluid and electrolyte balance, relieving secondary complications of ascites and hydrothorax, and preventing thromboembolic phenomena. […] The main interventions are fluid management and correction of hypovolemia. These measures consist of initial intravenous (IV) administration of 1 L normal saline over 1 hour. Dextrose 5% in normal saline or normal saline is then infused at a rate of 125-150mL/h, with 4-hour tabulations of urine production. […] To prevent thrombosis, subcutaneous heparin 5000-7500 U daily is begun on the first day of admission. It is stopped after adequate ambulation is achieved. […] After several days, third-space fluid begins to reenter the intravascular space, hemoconcentration reverses, and natural diuresis ensues. IV fluids may be tapered as the patient’s oral intake increases. Complete resolution typically takes 10-14 days from the onset of initial symptoms.

• #4 Preventing ovarian hyperstimulation syndrome

  https://www.fcionline.com/article/preventing-ovarian-hyperstimulation-syndrome/

  Ovarian hyperstimulation syndrome (OHSS) is the most common complication following IVF and occurs in approximately 1-5% of cycles. […] We identify women at risk for OHSS to ensure that safety strategies are added to their treatment regimen. […] When OHSS does occur, most cases are mild and handled as outpatients. […] If patients develop uncomfortable ascites with more severe OHSS, a transvaginal culdocentesis can be performed in the office. […] Patients typically have significant symptom relief after this procedure. […] Since patients can present intravascularly deplete with hyponatremia, normal saline should be the fluid of choice. […] Treatment protocols are designed to reduce risk of severe symptoms in patients at risk. […] Outpatient management with culdocentesis is often the best approach for patients with uncomfortable ascites. […] As we learn more about the pathophysiology of OHSS, our ability to prevent it has increased.

• #4 Prevention and Management of Ovarian Hyperstimulation Syndrome

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

  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. Cycle cancelation before trigger can prevent OHSS, but the emotional and financial burden it imposes on patients should be considered before the cycle is canceled. Coasting involves temporarily stopping gonadotropin administration and postponing the hCG trigger until the estradiol level is lower causing decreased luteinization with lower LH levels. Administration of intravenous albumin and HES: Colloid infusion at time of opu are useful. It binds to vasoactive mediators and prevent OHSS. […] Diagnosis of OHSS is clinical. Treatment of the acute phase merely relies on an empirical and symptomatic approach. Outpatient management is appropriate for mild, moderate, and few selected severe OHSS cases. Intravenous hydration should always be initiated with a crystalloid solution to prevent hemoconcentration and provide proper sufficient end-organ perfusion and strict charting to be done. Oliguria despite adequate fluid replacement responds to paracentesis in few cases. Indications for paracentesis include the following: severe abdominal distension, shortness of breath due to ascites, and increased intra-abdominal pressure and failed volume replacement causing oliguria.

• #4 Ovarian hyperstimulation syndrome | VARTA

  https://www.varta.org.au/resources/news-and-blogs/ovarian-hyperstimulation-syndrome-0

  If you’re going through IVF, theres a small risk you will experience ovarian hyperstimulation syndrome (OHSS). […] While no treatment can reverse OHSS, it will usually get better with time. Treatments used to help symptoms and prevent complications include: pain relief medicines, anti-sickness medicines, intravenous drip to replace fluids, support stockings and heparin injections to prevent blood clots. […] Most of your symptoms should resolve in seven to 10 days. If your treatment does not result in a pregnancy, OHSS usually gets better by the time your next period starts. If you become pregnant, OHSS can get worse and last up to a few weeks or longer.

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

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

  It is recommended to employ ovarian stimulation protocols using GnRH antagonists over protocols using GnRH agonists when there is concern for OHSS. (Strength of evidence: A; strength of recommendation: strong) […] It is recommended to dose gonadotropins on the basis of individualized ORT to decrease the risk of OHSS. (Strength of evidence: B; strength of recommendation: moderate) […] 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. (Strength of evidence: B; strength of recommendation: moderate) […] 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. (Strength of evidence: A; strength of recommendation: strong)

• #5 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  In the ideal situation, the ovaries should be stimulated to the desired level when ovulation is induced. However, the unpredictable response of the ovaries to induction makes the prediction and prevention of OHSS difficult. Hence, heightened clinical suspicion and early intervention are paramount to the reduction of morbidity and mortality. […] Treatment should include the following: Maintenance of a high degree of clinical suspicion and a low threshold for admission, Early surgical intervention in cases of ovarian torsion or hemorrhage, Paracentesis to address ascites – This decreases pressure on the inferior vena cava and diaphragm, Placement of a transthoracic tube to manage pleural effusions. […] Ovarian hyperstimulation syndrome is a self-limiting disease. Therefore, treatment should be conservative and directed at symptoms, with medical therapy being sufficient for most patients. Women with severe symptoms often require intensive medical care.

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

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

  The treatment for OHSS varies depending on how severe the condition is. Treatment aims to manage symptoms and avoid complications. Mild cases tend to go away within a week or two. However, if you get pregnant that cycle, your symptoms could last much longer. […] For mild to moderate cases of OHSS, treatment usually involves: Avoiding vigorous physical activity. Drinking electrolyte-rich fluid like Gatorade or Propel. Using acetaminophen to relieve symptoms. Weighing yourself daily. Monitoring yourself for any severe symptoms. […] Severe cases of OHSS often require hospitalization. Treatment of severe OHSS may include: Receiving intravenous (directly into the vein) fluids. Undergoing paracentesis (a procedure to remove fluid from your belly). Taking medicines to ease symptoms or reduce activity in your ovaries. A blood thinner to help decrease the risk of a blood clot.

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

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

  Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications. […] Treatment for moderate OHSS may involve: Increased fluid intake, Frequent physical exams and ultrasounds, Daily weigh-ins and waist measurements to check for drastic changes, Measurements of how much urine you produce each day, Blood tests to monitor for dehydration, electrolyte imbalance and other problems, Drainage of excess abdominal fluid using a needle inserted in your abdominal cavity, Medications to prevent blood clots (anticoagulants). […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) to help suppress ovarian activity. […] Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.

• #5 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Medical treatment of severe hyperstimulation is directed at maintaining intravascular blood volume. Simultaneous goals are correcting the disturbed fluid and electrolyte balance, relieving secondary complications of ascites and hydrothorax, and preventing thromboembolic phenomena. […] The main interventions are fluid management and correction of hypovolemia. These measures consist of initial intravenous (IV) administration of 1 L normal saline over 1 hour. Dextrose 5% in normal saline or normal saline is then infused at a rate of 125-150mL/h, with 4-hour tabulations of urine production. […] To prevent thrombosis, subcutaneous heparin 5000-7500 U daily is begun on the first day of admission. It is stopped after adequate ambulation is achieved. […] After several days, third-space fluid begins to reenter the intravascular space, hemoconcentration reverses, and natural diuresis ensues. IV fluids may be tapered as the patient’s oral intake increases. Complete resolution typically takes 10-14 days from the onset of initial symptoms.

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

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

  It is not recommended to administer letrozole as an intervention to reduce rates of moderate-to-severe OHSS. (Strength of evidence: B; strength of recommendation: moderate) […] It is not recommended to administer a luteal GnRH antagonist alone to reduce rates of moderate-to-severe OHSS. Most studies report no reduction in rates of moderate-to-severe OHSS or signs or symptoms associated with OHSS. (Strength of evidence: C; strength of recommendation: weak) […] It is not recommended to administer medications such as mifepristone, myoinositol, D-chiro-inositol, or glucocorticoids to reduce rates of OHSS because studies have shown these interventions to be ineffective. (Strength of evidence: C; strength of recommendation: weak) […] It is not recommended to use volume expanders such as albumin, hydroxyethyl starch, or mannitol in patients who are at high risk of developing moderate or severe OHSS. (Strength of evidence: C; strength of recommendation: weak)

• #5 Ovarian Hyperstimulation Syndrome (OHSS) | LLU Fertility

  https://lomalindafertility.com/treatments/ivf/about-ovarian-hyperstimulation-syndrome-ohss/

  Since symptoms are usually resolved within two weeks, if you do not achieve pregnancy through fertility treatment, the doctor may advise that all embryos be frozen so they can be transferred after recovery. […] If severe OHSS occurs after conceiving, it can last up to the tenth week of pregnancy and then resolve.

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

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

  It is recommended to 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. (Strength of evidence: B; strength of recommendation: moderate) […] It is recommended to use a GnRH agonist to trigger oocyte maturation as a first-line strategy to reduce the risk of moderate-to-severe OHSS. (Strength of evidence: A; strength of recommendation: strong) […] 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. (Strength of evidence: A; strength of recommendation: strong) […] 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. (Strength of evidence: A; strength of recommendation: strong)

• #6 Ovarian hyperstimulation syndrome – UF Health

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

  Mild cases of OHSS usually don’t need to be treated. The condition may actually be associated with a greater chance of becoming pregnant. […] The following steps can help you ease your discomfort: Get plenty of rest with your legs raised. This helps your body release the fluid. However, light activity every now and then is better than complete bed rest, unless your provider tells you otherwise. Drink at least 10 to 12 glasses (about 1.5 to 2 liters) of fluid a day (especially drinks that contain electrolytes). Avoid alcohol or caffeinated beverages (such as colas or coffee). Avoid intense exercise and sexual intercourse. These activities can cause ovarian discomfort and may cause ovarian cysts to rupture or leak, or cause the ovaries to twist and cut off blood flow (ovarian torsion). Take an over-the-counter pain reliever such as acetaminophen (Tylenol).

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

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

  Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications. […] Treatment for moderate OHSS may involve: Increased fluid intake, Frequent physical exams and ultrasounds, Daily weigh-ins and waist measurements to check for drastic changes, Measurements of how much urine you produce each day, Blood tests to monitor for dehydration, electrolyte imbalance and other problems, Drainage of excess abdominal fluid using a needle inserted in your abdominal cavity, Medications to prevent blood clots (anticoagulants). […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) to help suppress ovarian activity. […] Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.

• #6 Prevention and Management of Ovarian Hyperstimulation Syndrome

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

  Women with severe OHSS should receive thromboprophylaxis with LMWH anti-embolism stockings. Individualized duration is suggested. C-reactive protein levels may correlate with severity of OHSS. Observational studies suggest that GnRH antagonist administration may also help in severe early cases although there is insufficient evidence.

• #6 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Medical treatment of severe hyperstimulation is directed at maintaining intravascular blood volume. Simultaneous goals are correcting the disturbed fluid and electrolyte balance, relieving secondary complications of ascites and hydrothorax, and preventing thromboembolic phenomena. […] The main interventions are fluid management and correction of hypovolemia. These measures consist of initial intravenous (IV) administration of 1 L normal saline over 1 hour. Dextrose 5% in normal saline or normal saline is then infused at a rate of 125-150mL/h, with 4-hour tabulations of urine production. […] To prevent thrombosis, subcutaneous heparin 5000-7500 U daily is begun on the first day of admission. It is stopped after adequate ambulation is achieved. […] After several days, third-space fluid begins to reenter the intravascular space, hemoconcentration reverses, and natural diuresis ensues. IV fluids may be tapered as the patient’s oral intake increases. Complete resolution typically takes 10-14 days from the onset of initial symptoms.

• #6 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). […] Treatment is to help symptoms and prevent complications. […] Although there is no treatment that can reverse OHSS, it will usually get better with time. […] This includes: pain relief such as paracetamol or codeine, anti-sickness drugs to help reduce nausea and vomiting, an intravenous drip to replace fluids, support stockings and heparin injections to prevent thrombosis (a blood clot in the leg or lungs). […] If your abdomen is tense and swollen because of fluid build-up, you may be offered a procedure known as a paracentesis. […] This treatment helps relieve discomfort and improve kidney function and your breathing. […] To lower the risk of developing a blood clot in your legs or lungs, you will be advised to continue wearing support stockings and taking heparin (blood-thinning) injections until 12 weeks of your pregnancy. […] You may be at increased risk of developing pre-eclampsia or giving birth to your baby prematurely. However, there are no known risks to your baby’s development as a result of OHSS.

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

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

  After gaining experience and knowledge over the years, it has been found that using the GnRHa trigger with modified luteal phase support yields reproductive outcomes comparable to those achieved with the hCG trigger in fresh cycles. […] One significant advantage of using GnRHa trigger is the significant reduction in or complete elimination of OHSS in high responders. […] The GnRHa trigger is considered an optimal tool for this purpose, as it allows clinicians to consider the ovarian response to stimulation when deciding whether to proceed with a fresh transfer or carry out a segmented cycle. […] The dopamine agonist cabergoline has been hypothesized to potentially cause a reduction in VEGF production, with ensuing OHSS mitigation. […] In order to stave off the harmful effects on follicular growth, final oocyte maturation, fertilization rate, or subsequent clinical outcome due to the untimely blockage of the VEGF system, cabergoline administration should occur immediately after oocyte retrieval.

• #7 Ovarian hyperstimulation syndrome – UF Health

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

  Mild cases of OHSS usually don’t need to be treated. The condition may actually be associated with a greater chance of becoming pregnant. […] The following steps can help you ease your discomfort: Get plenty of rest with your legs raised. This helps your body release the fluid. However, light activity every now and then is better than complete bed rest, unless your provider tells you otherwise. Drink at least 10 to 12 glasses (about 1.5 to 2 liters) of fluid a day (especially drinks that contain electrolytes). Avoid alcohol or caffeinated beverages (such as colas or coffee). Avoid intense exercise and sexual intercourse. These activities can cause ovarian discomfort and may cause ovarian cysts to rupture or leak, or cause the ovaries to twist and cut off blood flow (ovarian torsion). Take an over-the-counter pain reliever such as acetaminophen (Tylenol).

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

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

  Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications. […] Treatment for moderate OHSS may involve: Increased fluid intake, Frequent physical exams and ultrasounds, Daily weigh-ins and waist measurements to check for drastic changes, Measurements of how much urine you produce each day, Blood tests to monitor for dehydration, electrolyte imbalance and other problems, Drainage of excess abdominal fluid using a needle inserted in your abdominal cavity, Medications to prevent blood clots (anticoagulants). […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) to help suppress ovarian activity. […] Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.

• #7 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). […] Treatment is to help symptoms and prevent complications. […] Although there is no treatment that can reverse OHSS, it will usually get better with time. […] This includes: pain relief such as paracetamol or codeine, anti-sickness drugs to help reduce nausea and vomiting, an intravenous drip to replace fluids, support stockings and heparin injections to prevent thrombosis (a blood clot in the leg or lungs). […] If your abdomen is tense and swollen because of fluid build-up, you may be offered a procedure known as a paracentesis. […] This treatment helps relieve discomfort and improve kidney function and your breathing. […] To lower the risk of developing a blood clot in your legs or lungs, you will be advised to continue wearing support stockings and taking heparin (blood-thinning) injections until 12 weeks of your pregnancy. […] You may be at increased risk of developing pre-eclampsia or giving birth to your baby prematurely. However, there are no known risks to your baby’s development as a result of OHSS.

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

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

  It is recommended to employ ovarian stimulation protocols using GnRH antagonists over protocols using GnRH agonists when there is concern for OHSS. (Strength of evidence: A; strength of recommendation: strong) […] It is recommended to dose gonadotropins on the basis of individualized ORT to decrease the risk of OHSS. (Strength of evidence: B; strength of recommendation: moderate) […] 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. (Strength of evidence: B; strength of recommendation: moderate) […] 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. (Strength of evidence: A; strength of recommendation: strong)

• #8 Ovarian hyperstimulation syndrome – UF Health

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

  Mild cases of OHSS usually don’t need to be treated. The condition may actually be associated with a greater chance of becoming pregnant. […] The following steps can help you ease your discomfort: Get plenty of rest with your legs raised. This helps your body release the fluid. However, light activity every now and then is better than complete bed rest, unless your provider tells you otherwise. Drink at least 10 to 12 glasses (about 1.5 to 2 liters) of fluid a day (especially drinks that contain electrolytes). Avoid alcohol or caffeinated beverages (such as colas or coffee). Avoid intense exercise and sexual intercourse. These activities can cause ovarian discomfort and may cause ovarian cysts to rupture or leak, or cause the ovaries to twist and cut off blood flow (ovarian torsion). Take an over-the-counter pain reliever such as acetaminophen (Tylenol).

• #8 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Treatment for OHSS is supportive. Mild ovarian hyperstimulation can develop into moderate or severe disease, especially if conception ensues. Therefore, women with mild disease should be observed for enlarging abdominal girth, acute weight gain, and abdominal discomfort on an ambulatory basis for at least 2 weeks or until menstrual bleeding occurs. […] The treatment of moderate OHSS consists of observation, bed rest, the provision of adequate fluids, and ultrasonographic monitoring of the size of cysts. Serum electrolyte concentrations, hematocrits, and creatinine levels should also be evaluated. […] Clinician experience with severe OHSS is mandatory for appropriate treatment. One should transfer the patient to a different center if no one who is experienced in managing severe OHSS is available at the present location.

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

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

  It is recommended to 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. (Strength of evidence: B; strength of recommendation: moderate) […] It is recommended to use a GnRH agonist to trigger oocyte maturation as a first-line strategy to reduce the risk of moderate-to-severe OHSS. (Strength of evidence: A; strength of recommendation: strong) […] 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. (Strength of evidence: A; strength of recommendation: strong) […] 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. (Strength of evidence: A; strength of recommendation: strong)

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

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

  Adding medication. Some medications seem to reduce the risk of OHSS without affecting the odds of pregnancy. These include low-dose aspirin; dopamine agonists such as carbergoline or quinogloide; and calcium infusions. […] Avoiding use of an HCG trigger shot. Because OHSS often develops after an HCG trigger shot is given, alternatives to HCG for triggering have been developed using gonadotropin-releasing hormone (Gn-RH) agonists, such as leuprolide (Lupron), as a way to prevent or limit OHSS. […] Freezing embryos. If you’re undergoing in vitro fertilization (IVF), all the follicles (mature and immature) may be removed from your ovaries to reduce the chance of OHSS.

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

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

  The treatment for OHSS varies depending on how severe the condition is. Treatment aims to manage symptoms and avoid complications. Mild cases tend to go away within a week or two. However, if you get pregnant that cycle, your symptoms could last much longer. […] For mild to moderate cases of OHSS, treatment usually involves: Avoiding vigorous physical activity. Drinking electrolyte-rich fluid like Gatorade or Propel. Using acetaminophen to relieve symptoms. Weighing yourself daily. Monitoring yourself for any severe symptoms. […] Severe cases of OHSS often require hospitalization. Treatment of severe OHSS may include: Receiving intravenous (directly into the vein) fluids. Undergoing paracentesis (a procedure to remove fluid from your belly). Taking medicines to ease symptoms or reduce activity in your ovaries. A blood thinner to help decrease the risk of a blood clot.

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

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

  Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications. […] Treatment for moderate OHSS may involve: Increased fluid intake, Frequent physical exams and ultrasounds, Daily weigh-ins and waist measurements to check for drastic changes, Measurements of how much urine you produce each day, Blood tests to monitor for dehydration, electrolyte imbalance and other problems, Drainage of excess abdominal fluid using a needle inserted in your abdominal cavity, Medications to prevent blood clots (anticoagulants). […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) to help suppress ovarian activity. […] Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.

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

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

  Pharmacologic interventions, which are relatively easily achievable and cost-effective, have been studied to decrease the incidence of OHSS. […] A Cochrane meta-analysis of RCTs claimed that metformin is effective in preventing OHSS. […] Network meta-analysis (NMA), which is a statistical method, enables a comparison among multiple interventions by synthesizing direct and indirect evidence from RCTs. […] In this article, we performed Bayesian NMA to determine the combined effectiveness of commonly used pharmacologic interventions (cabergoline, IV albumin, IV calcium infusion, IV HES infusion, aspirin, glucocorticoid, metformin) in preventing COS-related OHSS and to determine a treatments influence on pregnancy outcome. […] Compared with P/N, 5 pharmacologic interventions were superior in decreasing OHSS incidence: aspirin (RR 0.07, 95% CrI 0.010.30, p0.05), IV calcium (RR 0.11, 95% CrI 0.020.54, p0.05), cabergoline (RR 0.17, 95% CrI 0.060.43, p0.05), metformin (RR 0.20, 95% CrI 0.070.59, p0.05) and IV HES (RR 0.26, 95% CrI 0.050.99, p0.05).

• #10 Treating Ovarian Hyperstimulation Syndrome | Progyny

  https://progyny.com/education/fertility-medication/treating-ovarian-hyperstimulation-syndrome/

  Mild OHSS symptoms, such as fluid retention and ovarian discomfort, can be managed by: […] If you gain more than 2 pounds per day, your urinary frequency is decreasing, or you have severe pain, you should contact your fertility doctor.

• #10 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/

  OHSS can be serious, so careful monitoring and managing the symptoms are important whenever it occurs. Office visits for ultrasound exams to measure the ovaries and fluid in the abdomen and blood tests are routinely done. Decreased activity and drinking lots of electrolyte-rich fluids are recommended. Medicines for nausea are available. If fluid is in the abdomen, drainage of fluid (paracentesis) can provide significant relief in most cases. […] If OHSS does not improve with outpatient care, the woman may be treated in the hospital with close monitoring. The doctor may order intravenous (IV) fluids and medicines for nausea and may remove fluid from the abdomen. Other supportive therapy may be given as needed. […] OHSS often can be managed with decreased activity, drinking electrolyte-rich fluids, draining fluid that accumulates in the abdomen, medication for nausea and pain, careful monitoring, and frequent doctor visits.

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

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

  It is recommended to 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. (Strength of evidence: B; strength of recommendation: moderate) […] It is recommended to use a GnRH agonist to trigger oocyte maturation as a first-line strategy to reduce the risk of moderate-to-severe OHSS. (Strength of evidence: A; strength of recommendation: strong) […] 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. (Strength of evidence: A; strength of recommendation: strong) […] 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. (Strength of evidence: A; strength of recommendation: strong)

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

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

  Pharmacologic interventions, which are relatively easily achievable and cost-effective, have been studied to decrease the incidence of OHSS. […] A Cochrane meta-analysis of RCTs claimed that metformin is effective in preventing OHSS. […] Network meta-analysis (NMA), which is a statistical method, enables a comparison among multiple interventions by synthesizing direct and indirect evidence from RCTs. […] In this article, we performed Bayesian NMA to determine the combined effectiveness of commonly used pharmacologic interventions (cabergoline, IV albumin, IV calcium infusion, IV HES infusion, aspirin, glucocorticoid, metformin) in preventing COS-related OHSS and to determine a treatments influence on pregnancy outcome. […] Compared with P/N, 5 pharmacologic interventions were superior in decreasing OHSS incidence: aspirin (RR 0.07, 95% CrI 0.010.30, p0.05), IV calcium (RR 0.11, 95% CrI 0.020.54, p0.05), cabergoline (RR 0.17, 95% CrI 0.060.43, p0.05), metformin (RR 0.20, 95% CrI 0.070.59, p0.05) and IV HES (RR 0.26, 95% CrI 0.050.99, p0.05).

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

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

  The treatment for OHSS varies depending on how severe the condition is. Treatment aims to manage symptoms and avoid complications. Mild cases tend to go away within a week or two. However, if you get pregnant that cycle, your symptoms could last much longer. […] For mild to moderate cases of OHSS, treatment usually involves: Avoiding vigorous physical activity. Drinking electrolyte-rich fluid like Gatorade or Propel. Using acetaminophen to relieve symptoms. Weighing yourself daily. Monitoring yourself for any severe symptoms. […] Severe cases of OHSS often require hospitalization. Treatment of severe OHSS may include: Receiving intravenous (directly into the vein) fluids. Undergoing paracentesis (a procedure to remove fluid from your belly). Taking medicines to ease symptoms or reduce activity in your ovaries. A blood thinner to help decrease the risk of a blood clot.

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

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

  Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications. […] Treatment for moderate OHSS may involve: Increased fluid intake, Frequent physical exams and ultrasounds, Daily weigh-ins and waist measurements to check for drastic changes, Measurements of how much urine you produce each day, Blood tests to monitor for dehydration, electrolyte imbalance and other problems, Drainage of excess abdominal fluid using a needle inserted in your abdominal cavity, Medications to prevent blood clots (anticoagulants). […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) to help suppress ovarian activity. […] Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.

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

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

  It is not recommended to administer letrozole as an intervention to reduce rates of moderate-to-severe OHSS. (Strength of evidence: B; strength of recommendation: moderate) […] It is not recommended to administer a luteal GnRH antagonist alone to reduce rates of moderate-to-severe OHSS. Most studies report no reduction in rates of moderate-to-severe OHSS or signs or symptoms associated with OHSS. (Strength of evidence: C; strength of recommendation: weak) […] It is not recommended to administer medications such as mifepristone, myoinositol, D-chiro-inositol, or glucocorticoids to reduce rates of OHSS because studies have shown these interventions to be ineffective. (Strength of evidence: C; strength of recommendation: weak) […] It is not recommended to use volume expanders such as albumin, hydroxyethyl starch, or mannitol in patients who are at high risk of developing moderate or severe OHSS. (Strength of evidence: C; strength of recommendation: weak)

• #12 Treating Ovarian Hyperstimulation Syndrome | Progyny

  https://progyny.com/education/fertility-medication/treating-ovarian-hyperstimulation-syndrome/

  Mild OHSS symptoms, such as fluid retention and ovarian discomfort, can be managed by: […] If you gain more than 2 pounds per day, your urinary frequency is decreasing, or you have severe pain, you should contact your fertility doctor.

• #12 Ovarian Hyperstimulation Syndrome | Doctor

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

  In moderate cases admission to hospital for thromboprophylaxis with low molecular weight heparin and monitoring may be judicious. […] An intensive care setting may be required. […] Careful monitoring of fluid balance is needed. Intravenous (IV) fluids should be used if hydration cannot be maintained orally. A colloid such as albumin is given if, despite intensive IV fluid input, a woman remains fluid-depleted. […] Aspiration of ascites or pleural effusion can relieve symptoms. […] Intense monitoring (as per the 'Investigations’ section, above) is needed so that complications such as acute kidney injury (AKI), thromboembolism, pericardial effusion and Adult Respiratory Distress Syndrome (ARDS) are diagnosed early and managed appropriately.

• #12 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  In the ideal situation, the ovaries should be stimulated to the desired level when ovulation is induced. However, the unpredictable response of the ovaries to induction makes the prediction and prevention of OHSS difficult. Hence, heightened clinical suspicion and early intervention are paramount to the reduction of morbidity and mortality. […] Treatment should include the following: Maintenance of a high degree of clinical suspicion and a low threshold for admission, Early surgical intervention in cases of ovarian torsion or hemorrhage, Paracentesis to address ascites – This decreases pressure on the inferior vena cava and diaphragm, Placement of a transthoracic tube to manage pleural effusions. […] Ovarian hyperstimulation syndrome is a self-limiting disease. Therefore, treatment should be conservative and directed at symptoms, with medical therapy being sufficient for most patients. Women with severe symptoms often require intensive medical care.

• #13 Treatment of ovarian hyperstimulation syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/21082512/

  Mild forms of ovarian hyperstimulation syndrome (OHSS) do not require treatment. Moderate OHSS should be followed up on an outpatient basis with no specific treatment. Severe OHSS requires proper evaluation. Investigations are done to evaluate hematocrit, electrolytes, and kidney and liver function. Conservative treatment with intravenous (i.v.) fluids and close monitoring is usually done. Intensive care admission is indicated in cases with severe respiratory distress or major electrolyte imbalance with elevated serum creatinine. Crystalloids in the form of i.v. saline and colloids as albumin or hydroxyethyl starch are commonly used to expand intravascular volume. Dopamine can be used to improve diuresis, and prophylactic heparin is administered to prevent venous thrombosis. Diuretics are generally contraindicated because they may further contract intravascular volume. Abdominal or vaginal aspiration of ascitic fluid results in marked improvement of symptoms, improved diuresis, and shortened hospital stay. The current trend to treat patients with i.v. fluids, albumin, and to perform aspiration of ascitic fluid on an outpatient basis has been found to be a more cost-effective protocol of treatment.

• #14 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  In the ideal situation, the ovaries should be stimulated to the desired level when ovulation is induced. However, the unpredictable response of the ovaries to induction makes the prediction and prevention of OHSS difficult. Hence, heightened clinical suspicion and early intervention are paramount to the reduction of morbidity and mortality. […] Treatment should include the following: Maintenance of a high degree of clinical suspicion and a low threshold for admission, Early surgical intervention in cases of ovarian torsion or hemorrhage, Paracentesis to address ascites – This decreases pressure on the inferior vena cava and diaphragm, Placement of a transthoracic tube to manage pleural effusions. […] Ovarian hyperstimulation syndrome is a self-limiting disease. Therefore, treatment should be conservative and directed at symptoms, with medical therapy being sufficient for most patients. Women with severe symptoms often require intensive medical care.

• #15 Ovarian Hyperstimulation Syndrome Treatment & Management: Approach Considerations, Treatment Based on Degree of Hyperstimulation, Resolution

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

  Surgical management further aggravates electrolyte imbalances and increases morbidity. Indeed, surgery is necessary only in extreme cases, such as in the case of ovarian torsion, a ruptured cyst, or an internal hemorrhage. Ascites can be tapped by means of paracentesis. Laparotomy during torsion and intraperitoneal hemorrhage is lifesaving and recommended. […] In severe cases of OHSS, consultation with a physician specializing in fluid and electrolyte imbalances is warranted. For some cases, aggressive treatment in the surgical intensive care unit may be required. […] Conservative management in the outpatient setting is appropriate for mild-to-moderate ovarian hyperstimulation syndrome (OHSS) until spontaneous resolution occurs. However, management in the inpatient setting should be considered if any of the following criteria are present: Inability to tolerate oral food or hydration, Severe abdominal pain, Unclear diagnosis, Hypotension, Shortness of breath, Tense ascites, Peritoneal signs, Hematocrit greater than 48%, Sodium less than 135 mEq/L, Potassium greater than 5 mEq/L, Creatinine greater than 1.2 mg/dL.

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