Journal of Assisted Reproduction and Genetics

, Volume 27, Issue 2–3, pp 121–128 | Cite as

Ovarian hyperstimulation syndrome: pathophysiology and prevention

  • Carolina O. Nastri
  • Rui A. Ferriani
  • Isa A. Rocha
  • Wellington P. Martins
Gonad Physiology and Disease



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.


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


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).


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.


Ovarian hyperstimulation syndrome Ovulation induction Assisted reproductive techniques 


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Carolina O. Nastri
    • 1
    • 2
  • Rui A. Ferriani
    • 1
  • Isa A. Rocha
    • 1
  • Wellington P. Martins
    • 1
    • 2
  1. 1.Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (DGO-HC-FMRP-USP)Ribeirão PretoBrazil
  2. 2.Escola de Ultra-Sonografia e Reciclagem Médica de Ribeirão Preto (EURP)Ribeirão PretoBrazil

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