- MEDICINE ATHENS MED4WOMAN ATHENS
- MEDICINE VOLOS MED4WOMAN VOLOS
- 2103390838
- 2421022988
Obstetrician Gynaecologist
Doctor of Medicine, University of Athens Medical School
Panagiotis Polyzos, Gynaecologist Obstetrician, is active at the Institute of Life - IVF Unit of Iaso Maternity Hospital.
Ovarian Hyperstimulation Syndrome is a serious systemic complication caused by the circulation of vasoactive substances released by the ovaries following ovarian stimulation protocols. Its pathophysiology is characterized by increased capillary permeability, leading to extensive fluid extravasation, loss of protein-rich fluid into the interstitial space, and widespread intravascular dehydration.
The majority of severe Ovarian Hyperstimulation Syndromes occur after IVF cycles, but ovarian hyperstimulation syndrome can also develop following any form of ovulation induction. The incidence of ovarian hyperstimulation syndrome is higher in young women as well as in in those with polycystic ovaries.
The diagnosis of Ovarian Hyperstimulation Syndrome is based on the patient’s history, typically reporting a stimulation protocol with either clomiphene or gonadotropins, and on the clinical presentation, which includes:
Moderate abdominal pain
Nausea Vomiting
Ultrasound evidence of ascites
Tense ascites or significant pleural effusion
Oliguria
Blood congestion (HT > 45%)
Hypoproteinemia
Ascites under tension or marked hydrothorax
Hematocrit > 55%
White blood cells > 25.000/ml
Oliguria - Anuria
Thromboembolic episode
Both the severity and the frequency of the syndrome require its prevention, as well as early intervention at an initial stage.
1. Personalized ovarian stimulation protocol (especially in women with PCOS or a history of OHSS)
2. Adjustment of gonadotropin dosage and stabilization of E2 (estradiol) levels
3. Prophylactic administration of albumin during oocyte retrieval
4. Embryo cryopreservation and embryo transfer in a subsequent cycle
The outpatient management of a patient with OHSS refers to the mild and moderate forms of the syndrome:
Please rest and take a few days off from work or physical activities.
For pain relief and pelvic discomfort, paracetamol or codeine is recommended. Fluid intake should be reasonable, with close monitoring of fluid balance. Excessive fluid intake should be discouraged. Strenuous exercise and sexual intercourse should be avoided due to the risk of ovarian torsion or trauma to hyperstimulated ovaries. Luteal support with progesterone is recommended, while the use of hCG is contraindicated.
Ultrasound monitoring is essential to assess ovarian size and the presence of ascites. Laboratory tests to determine the severity of the condition include:
Hematocrit / Hemoglobin, Serum Creatinine, Electrolytes, and liver function tests.
These values are used in serial measurements to evaluate the progression of the condition. Monitoring is repeated every 2–3 days.
Monitoring should be intensified if the patient develops:
Women with severe forms of the syndrome should be admitted and treated as inpatients. Additionally, women with moderate OHSS who cannot adequately control their symptoms with oral therapy should also be hospitalized, as well as women for whom continuous and systematic monitoring cannot be ensured for any reason.
Management of OHSS is entirely supportive until the condition resolves. Symptomatic treatment is important, especially for abdominal pain and nausea. Nausea is usually due to ascites, and therefore, measures aimed at reducing abdominal distension provide relief.
In cases of stage 4–5 OHSS, immediate admission to an Intensive Care Unit is required. Renal impairment is managed with dopamine and, if necessary, possible dialysis; respiratory distress with urgent thoracentesis and mechanical ventilation; and thromboembolic events with systemic anticoagulant therapy. Worsening of OHSS after embryo transfer always remains a possibility, and one should not be reassured by a temporarily improved clinical condition following ovarian stimulation. Finally, termination of early pregnancy in very severe cases of the syndrome remains the last therapeutic option.
