Ovarian Hyperstimulation Syndrome Flashcards by Mollie O

What is the most serious consequence of ovulation due to assisted conception techniques?

Ovarian hyperstimulation syndrome

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What drugs more commonly cause ovarian hyperstimulation syndrome?

- Human menopausal gonadotrophin

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When is ovarian hyperstimulation syndrome more common with clomiphene?

In PCOS

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What happens in ovarian hyperstimulation syndrome?

The ovary may form 20 follicles or more and swell due to increased levels of hCG

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What is released from the hyperstimulated ovaries?

Vasoactive mediators

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What happens as a result of the vasoactive mediators released by the hyperstimulated ovaries?

Increase in capillary permeability leading to a fluid shift from the intravascular compartment to the third space compartment such as the peritoneal or thoracic cavities

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What can cause morbidity/mortality in ovarian hyperstimulation syndrome?

Effusions
Haemoconcentration
Liver or kidney dysfunction

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What effusions can cause problems in ovarian hyperstimulation syndrome?

Pericardial
Pleural
Ascites

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What is the risk of haemoconcentration in ovarian hyperstimulation syndrome?

Risk of thrombosis and coagulopathy

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What proportion of IVF cycles have a mild degree of ovarian hyperstimulation syndrome?

1/3

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What % of IVF cycles have a moderate degree of ovarian hyperstimulation syndrome?

3-6%

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What % of IVF cycles have a severe ovarian hyperstimulation syndrome?

0.1-2%

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What are the risk factors for ovarian hyperstimulation syndrome?

PCOS
Under 30
Rapidly rising oestrogen levels and large number of follicles
Use of hCG for luteal phase support
Low body weight

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When may symptoms of ovarian hyperstimulation syndrome first start?

Within 24 hours of hCG administration

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When do symptoms of ovarian hyperstimulation syndrome tend to become severe?

After 7-10 days

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What are the symptoms for mild to moderate ovarian hyperstimulation syndrome?

Mild to moderate abdo pain
Abdominal bloating and increased waist size
Nausea and vomiting
Diarrhoea
Tenderness in area of ovaries
Sudden weight increase of more than 3kg

What are the symptoms of severe ovarian hyperstimulation syndrome?

Rapid weight gain e.g. 15-20kg in 10 days
Severe abdominal pain
Severe persistent nausea and vomiting
Blood clots in legs
Decreased urination
Shortness of breath
Tight or enlarged abdomen

What is classified as mild ovarian hyperstimulation syndrome?

Abdominal bloating
Mild abdo pain
Ovarian size <8cm

What is classified as moderate ovarian hyperstimulation syndrome?

Moderate abdo pain
Nausea and vomiting
USS evidence of ascites
Ovarian size 8-12cm

What is classified as severe ovarian hyperstimulation syndrome?

Clinical ascites
Oliguria
Haemoconcetration haematocrit >45%
Hypoproteinaemia
Ovarian size usually >12cm

What is classified as critical ovarian hyperstimulation syndrome?

Tense ascites or large hydrothorax
Haematocrit >55%
WCC > 25x10^/L
Thromboembolism
ARDS

What monitoring is mandatory during drug treatment for IVF?

USS of ovaries

What is measured in the ovaries during IVF treatment?

Rate of follicle growth

What is done if rate of follicle growth in IVF treatment is excessive?

Treatment is cut back

What are the investigations in severe ovarian hyperstimulation syndrome?

- USS ovaries and abdomen - FBC - U&E's and creatinine - Coagulation screen - LFTs - CXR - Measurement of abdominal girth

How is ovarian hyperstimulation syndrome managed?

Conservatively until resolves spontaneously

What happens if the patient is at risk of developing severe ovarian hyperstimulation syndrome?

hCG is withheld

What happens to IVF cycle if ovarian hyperstimulation syndrome occurs?

Egg collection and insemination can occur but embryo should be frozen and not implanted in that cycle

What are the key components to managing mild-to-moderate ovarian hyperstimulation syndrome?

- Analgesia - Anti-emetics - Increase oral fluids and drink according to thirst

What analgesics should be avoided in ovarian hyperstimulation syndrome?

NSAIDs

How often should women with ovarian hyperstimulation syndrome be monitored if managed in the community?

Every 1-2 days

Why may hospital admission be needed in moderate cases of ovarian hyperstimulation syndrome?

For prevention of thromboemoblism

What care setting may be required in severe ovarian hyperstimulation syndrome?

Intensive care

What monitoring is needed in severe ovarian hyperstimulation syndrome?

Fluid balance and electrolytes

What electrolyte imbalance is common in severe ovarian hyperstimulation syndrome?

Hyponatraemia

What immediate intervention can relieve symptoms of severe ovarian hyperstimulation syndrome?

Aspiration of ascites or pleural effusion

What are the potential complicatiqons of ovarian hyperstimulation syndrome?

- Thromboembolism - ARDS - AKI - Ovarian torsion - Death (rare)

How can the risk of ovarian hyperstimulation syndrome be reduced?

- Individualised stimulation regimes based on risk - Use of GnRH analogues rather than hCG - Freeze embryos and implanting in another cycle - Use metformin in women with PCOS

What is the other significant risk of IVF?

Multiple pregnancy