Ovarian Hyperstimulation

Meaning

Ovarian Hyperstimulation Syndrome (OHSS) is an iatrogenic complication of controlled ovarian stimulation, particularly in assisted reproductive technologies. It involves an excessive ovarian response to exogenous gonadotropins, leading to enlarged ovaries and systemic manifestations from increased vascular permeability. This condition ranges from mild discomfort to severe, potentially life-threatening physiological disturbances.

Context

OHSS is an adverse effect of fertility treatments designed to induce multifollicular development. Its physiological basis involves an exaggerated ovarian granulosa cell response to hormonal stimulation, common during IVF cycles. High circulating estrogens and subsequent human chorionic gonadotropin (hCG) administration are key precipitants.

Significance

Recognizing OHSS is critically important in clinical practice due impacting patient well-being and treatment safety. Its presence can necessitate hospitalization, disrupt fertility cycles, and in severe cases, lead to significant morbidity. Clinicians must balance optimal follicular recruitment with prevention, ensuring patient safety remains paramount.

Mechanism

The core mechanism involves a surge in vascular permeability, primarily mediated by vasoactive substances from stimulated ovaries, notably vascular endothelial growth factor (VEGF). This results in fluid shifts from the intravascular compartment into third spaces, like peritoneal and pleural cavities. Hemoconcentration, electrolyte imbalances, and reduced organ perfusion can develop.

Application

OHSS management focuses on prevention via individualized stimulation protocols, such as lower gonadotropin doses or GnRH agonist triggers. If OHSS develops, treatment is largely supportive, involving fluid and electrolyte balance, pain management, and thromboembolism prevention. Severe cases may require paracentesis to relieve abdominal distension or respiratory compromise.

Metric

Monitoring for OHSS involves clinical and laboratory metrics. Regular transvaginal ultrasound assesses ovarian size and follicular development. Serum estradiol levels are tracked during stimulation as a predictive marker. Post-trigger, hematocrit indicates hemoconcentration; serum electrolytes and renal function tests assess systemic impact. Daily weight and abdominal circumference provide practical indicators.

Risk

Primary OHSS risks include severe abdominal pain, nausea, vomiting, and respiratory distress from ascites. More serious complications involve thromboembolic events due to hemoconcentration, acute kidney injury, and acute respiratory distress syndrome. Ovarian torsion, though less common, represents a significant risk requiring immediate surgical intervention. Patient education on symptoms is vital.

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