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Ovarielles Überstimulationssyndrom

Ovarian hyperstimulation syndrome

  • Leitthema
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Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Das ovarielle Überstimulationssyndrom (OHSS) ist eine potenziell lebensbedrohliche Komplikation, die in der Regel nach ovarieller Stimulation und Ovulationsinduktion mittels hCG auftritt. Viele pathophysiologische Mechanismen wurden diskutiert. Der stärkste Mediator scheint aber der „vascular epithelial growth factor“ (VEGF) zu sein. Patientinnen mit PCOS, hyperandrogenämischen Zyklusstörungen und hypothalamisch-hypophysärer Ovarialinsuffizienz haben zudem ein erhöhtes OHSS-Risiko prädisponiert. Durch eine Abschätzung des individuellen Risikos und Maßnahmen der Prävention wie einer niedrig dosierten Stimulation, einer Minimierung der hCG-Dosen bei der Ovulationsinduktion und dem Verzicht auf einen Embryotransfer kann das Auftreten des Krankheitsbildes deutlich vermindert werden. Bei der Behandlung muss – je nach Schweregrad – für eine ausreichende Hydratation mit Bilanzierung, Thromboseprophylaxe, ggf. Aszitesableitung, engmaschige, u. U. intensivmedizinische Überwachung gesorgt werden. Das Rational in der Reproduktionsmedizin sollte eine hohe Schwangerschaftsrate möglichst ohne Nebenwirkungen sein.

Abstract

Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication during hormonal stimulation and ovulation induction with human chorionic gonadotropin (hCG) in the course of fertility treatment. Many pathophysiologic mechanisms are involved. A key mediator seems to be vascular epithelial growth factor (VEGF). In addition, patients with polycystic ovarian syndrome (PCOS), hyperandrogenemia or hypothalamic ovarian disorder seem to have an increased risk to develop the syndrome. Individual risk assessment and precautionary measures, such as low-dose stimulation, minimizing hCG doses for ovulation induction and even cancellation of embryo transfer, may help to reduce the incidence of the condition. Treatment of the more severe forms should include in-patient treatment, intravenous (IV) infusion therapy, fluid balancing, anticoagulation, and drainage of ascites. The rationale in reproductive medicine should be implicate a high baby-take home rate in combination with a low incidence of adverse effects.

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Authors and Affiliations

  1. Frauenklinik, Universitätsklinikum Erlangen, Universitätsstraße 21–23, 91054, Erlangen, Deutschland

    H. Binder

  2. Klinikum für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    G. Griesinger

  3. Universitätsfrauenklinik Münster, Münster, Deutschland

    L. Kiesel

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  1. H. Binder
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Binder, H., Griesinger, G. & Kiesel, L. Ovarielles Überstimulationssyndrom. Gynäkologische Endokrinologie 5, 203–211 (2007). https://doi.org/10.1007/s10304-007-0208-7

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