Ovarian hyperstimulation syndrome

Authors

  • Alka Prakash MRCOG MD,

    Consultant
    1. Gynaecology and Reproductive Medicine and Surgery, Cambridge IVF and Addenbrooke's Hospital, Cambridge, UK
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  • Raj Mathur FRCOG MD

    Consultant, Corresponding author
    1. Reproductive Medicine and Surgery, Cambridge IVF and Addenbrooke's Hospital, UK
    • Gynaecology and Reproductive Medicine and Surgery, Cambridge IVF and Addenbrooke's Hospital, Cambridge, UK
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Correspondence: Raj Mathur. Email: r.mathur@addenbrookes.nhs.uk

Abstract

Key content

  • Ovarian hyperstimulation syndrome (OHSS) is characterised by ovarian enlargement, increased vascular permeability and fluid shift.
  • Patients with polycystic ovary syndrome (PCOS) or previous history of OHSS are at increased risk.
  • A reduced risk of OHSS is seen with use of gonadotrophin-releasing hormone antagonist instead of agonist, coasting of overstimulated cycles, metformin in women with PCOS and dopamine agonists.
  • OHSS is likely to be more severe and prolonged in cycles where conception occurs.
  • Patients of severe OHSS require close monitoring of fluid balance, thromboprophylaxis and attention to effusions.

Learning objectives

  • To identify patients and cycles at high risk of OHSS and apply preventative measures.
  • To assess and classify the severity of OHSS.
  • To manage cases of severe OHSS.

Ethical issues

  • How do we counsel patients about the risk of an uncommon serious complication of fertility treatment in the face of an overwhelming desire to have a family?
  • Should the risk of OHSS be considered a reason to restrict funding for assisted conception treatment?

Ancillary