February 2002 · Vol. 14, No. 2Fostering Fertility:
despite ovarian hyperstimulation
Ob/Gyns are increasingly likely to find themselves managing ovarian hyperstimulation syndrome, a troubling and potentially life-threatening complication of ovulation induction. Here, an expert discusses predicting, preventing, and treating this challenging condition.
JEFFREY
M.
GOLDBERG,
MDDr. Goldberg is section head, reproductive endocrinology and infertility, department of OBG, at the Cleveland Clinic Foundation in Ohio. OHSS may be limited by reducing or eliminating exogenous hCG.
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Key points
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Ovarian hyperstimulation syndrome (OHSS) ranges from mild ovarian enlargement to severe multisystem failure, with death occurring in approximately 1 in 400,000 to 500,000 superovulation cycles.
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The basic features of OHSS are enlarged multicystic ovaries and increased vascular permeability, with intravascular fluid loss into the third space.
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Mild to moderate OHSS is treated expectantly on an outpatient basis, while women with severe OHSS should be hospitalized.
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Severe OHSS has been reported in 0.1% to 2% of superovulation and assisted reproductive technology (ART) cycles.
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Risk factors for severe OHSS include young age, lean habitus, high 17ß-estradiol (E2) levels, pregnancy, and a greater follicle number.
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Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of the medical treatment of infertile women. This potentially life-threatening iatrogenic condition has challenged physicians since the inception of ovulation induction more than 30 years ago. Despite a great deal of basic science and clinical research, its etiology eludes us. Thus, OHSS is difficult—though not necessarily impossible—to prevent and predict, and treatment remains supportive and symptom-directed.
OHSS ranges from mild ovarian enlargement to severe multisystem failure, with death occurring in approximately 1 in 400,000 to 500,000 superovulation cycles.1 Of the several staging systems that have been developed to help guide patient management, the one by Navot et al is most useful, as it introduces a fourth category of critical disease (Table 1).2 In general, mild to moderate OHSS is treated expectantly on an outpatient basis, while women with severe OHSS should be hospitalized. Critical patients are best managed in an intensive-care setting in consultation with other specialists. This article focuses primarily on OHSS requiring hospitalization.
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