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Ovarian hyperstimulation syndrome: pathophysiology and prevention

  • Gonad Physiology and Disease
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (DGO-HC-FMRP-USP), Avenida dos Bandeirantes 3900, 8º andar, Ribeirão Preto, São Paulo, Brazil, CEP 14049-900

    Carolina O. Nastri, Rui A. Ferriani, Isa A. Rocha & Wellington P. Martins

  2. Escola de Ultra-Sonografia e Reciclagem Médica de Ribeirão Preto (EURP), Ribeirão Preto, São Paulo, Brazil

    Carolina O. Nastri & Wellington P. Martins

Authors
  1. Carolina O. Nastri
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  2. Rui A. Ferriani
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  3. Isa A. Rocha
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  4. Wellington P. Martins
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Corresponding author

Correspondence to Wellington P. Martins.

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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.

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Nastri, C.O., Ferriani, R.A., Rocha, I.A. et al. Ovarian hyperstimulation syndrome: pathophysiology and prevention. J Assist Reprod Genet 27, 121–128 (2010). https://doi.org/10.1007/s10815-010-9387-6

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  • DOI: https://doi.org/10.1007/s10815-010-9387-6

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