Review Article
Volume 9 Issue 4 - 2020
Ovarian Hyper Stimulation Syndrome - Challenges, Updates and Review of Current Management
Oluseyi Adeniji*
LAS Specialty Registrar Obstetrics and Gynaecology, Dorset County Hospital, Dorchester, Dorset, United Kingdom
*Corresponding Author: Oluseyi Adeniji, LAS Specialty Registrar Obstetrics and Gynaecology, Dorset County Hospital, Dorchester, Dorset, United Kingdom.
Received: October 14, 2019; Published: March 10, 2020




Abstract

Ovarian hyper stimulation syndrome is an important iatrogenic complication of ovulation induction in assisted reproduction technology based on the subsequent enlarged ovarian and other endothelial surfaces, fluid shift from the intravascular space to the extravascular space (abdomen, pleura, pericardium), hemoconcentration, decreased renal clearance, oliguria/anuria, hyper viscosity of blood, modification in coagulation factors and thrombo-embolic risks. The incidence of Ovarian hyperstimulation syndrome is unknown globally based on multiple factors. It varies between units, treatments, patient groups and in countries due to the non-uniform systematic registrations. Ovarian hyperstimulation syndrome is classified from mild, moderate and severe depending on the presentation. Majority of cases of severe OHSS are sequel to In-vitro fertilization treatment though it can also occur after any form of supraphysiological ovarian stimulation such as gonadotrophin ovulation induction and clomiphene administration. Occurrence of OHSS is dependent on administration of human chorionic gonadotrophin (hCG). Other analogs of β-hCG, sex hormones (estrogen, estradiol), prostaglandins, prolactins, histamines, molecules of the renin- angiotensin system and vascular endothelial growth factor have been implicated to play an important role in pathophysiology of OHSS. Other factors of reference in OHSS pathology are inflammatory mediators such as cytokines and interleukins. Interleukin 6 has been noted to be associated with elevated estradiol concentration, hemoconcentration, increased vascular permeability and hepatic albumin inhibition production. The diagnosis of OHSS hinge on clinical history, examination, and investigation. It is mindful to note that unusual presentation OHSS can occur cases of respiratory disorder was noted with shortness of breath as the primary symptom. The management care plan of OHSS is important and need be known not only by medical personnel in the Reproductive medicine and infertility units but also front-line medical personnel in accident and emergency, Obstetrics and Gynecological units, general medical practice units to mention but a few. 

Prevention of OHSS is an important component of management of Infertility which the clinician must be aware of and take into consideration. OHSS can be prevented by identifying the risk factors and institute management accordingly. Prevention are categorized into primary and secondary. 

Treatment modalities involve maintaining diuresis, plasma expanders, fluid managements, albumin administration, ascites drainage, and use of anticoagulant. 

Keywords: Ovarian Hyperstimulation Syndrome; Assisted Reproductive Technology; Risk Factors; Diagnosis; Prevention; Management

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Citation: Oluseyi Adeniji. “Ovarian Hyper Stimulation Syndrome - Challenges, Updates and Review of Current Management”. EC Gynaecology 9.4 (2020): 17-37.

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