Ovarian hyperstimulation syndrome. Issue 8 (August 2020) - Sood, Akanksha
Abstract: Ovarian Hyperstimulation Syndrome (OHSS) is an iatrogenic condition arising from supraphysiological ovarian stimulation for fertility treatment. It is characterized by ovarian enlargement with fluid shift to the third space and intravascular dehydration. Ovarian reserve tests can identify patients at high risk of OHSS, allowing targeted preventative measures. Evidence supports the use of GnRH antagonist regimes in women with a high ovarian reserve. GnRH agonist trigger and elective cryopreservation of all embryos further reduce the risk of OHSS. All women at risk of OHSS should have adequate information and access to 24-hour care. Women presenting with possible OHSS should be assessed and investigated to confirm the diagnosis and classify severity. Mild to moderate cases can be managed on an out-patient basis, whilst more severe cases need admission and monitoring. Principles of management are maintaining intravascular hydration by encouraging "drink to thirst", close monitoring of fluid balance, prevention of thromboembolic complications, drainage of ascites in selected cases and symptom relief. If conception occurs in OHSS cycle, the recovery is protracted.