, Volume 27, Issue 2-3, pp 121-128
Date: 06 Feb 2010

Ovarian hyperstimulation syndrome: pathophysiology and prevention

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Abstract

Purpose

To review and discuss the pathophysiology and prevention strategies for ovarian hyperstimulation syndrome (OHSS), which is a condition that may occur in up to 20% of the high risk women submitted to assisted reproductive technology cycles.

Methods

The English language literature on these topics were reviewed through PubMed and discussed with emphasis on recent data.

Results

The role of estradiol, luteinizing hormone, human chorionic gonadotropin (hCG), inflammatory mediators, the renin-angiotensin system and vascular endothelial growth factor is discussed in the pathophysiology of OHSS. In addition we consider the prevention strategies, including coasting, administration of albumin, renin-angiotensin system blockage, dopamine agonist administration, non-steroidal anti-inflammatory administration, GnRH antagonist protocols, reducing hCG dosage, replacement of hCG and in vitro maturation of oocytes (IVM).

Conclusions

Among the many prevention strategies that have been discussed, the current evidence points to the replacement of hCG by GnRH agonists in antagonist cycles and the performance of IVM procedures as the safest approaches.

Capsule

Many strategies have been suggested to prevent OHSS. Based on current evidence, replacement of hCG by GnRH agonists in antagonist cycles and IVM are the safest approaches.