Ovarian Hyperstimulation Syndrome

Question 1

What is ovarian hyper-stimulation syndrome?

Answer 1

Usually a complication of infertility treatment. Presence of a high number of luteinized cysts within the ovaries results in high levels of oestrogen, progesterone and vasoactive substances such as vascular endothelial growth factor. This results in increased permeability and loss of fluid from vascular compartments.

Question 2

What are the most common causes of ovarian hyper-stimulation syndrome?

Answer 2

Rarely seen with clomifine

Gonadotrophin or hCG treatment

Question 3

What are risk factors for ovarian hyper-stimulation syndrome?

Answer 3

Young
Low BMI
Polycystic ovaries
Previous OHSS

Question 4

What are the clinical features that classify ovarian hypersitmulation syndrome into mild, moderate, severe and critical?

Answer 4

Mild
• Abdominal pain
• Abdominal bloating

Moderate
• As for mild
• Nausea and vomiting
• Ultrasound evidence of ascites

Severe
•	As for moderate
•	Clinical evidence of ascites
•	Oliguria
•	Haematocrit > 45%
•	Hypoproteinaemia

Critical
•	As for severe
•	Thromboembolism
•	Acute respiratory distress syndrome
•	Anuria
•	Tense ascites

Question 5

How is mild-moderate ovarian hyperstimulation syndrome managed?

Answer 5

Mild-Moderate
Outpatient
Analgesia but avoid NSAIDs (CI in pregnancy and will worsen fluid shift and renal issues)
Drink to thirst not excess
Avoid strenuous activities and intercourse – risk of torsion
Continue progesterone luteal support
Review every 2-3 days

Question 6

How is severe ovarian hypersitmulation syndrome managed?

Answer 6

Admit
Analgesia and anti-emetics but avoid NSAIDs
Blood tests – FBC, Us and Es, LFTs and albumin
Strict fluid balance
Daily assessment for ascites and thrombosis in legs
Thromboprophylaxis
Catheter

Question 7

How is critical ovarian hyper-stimulation syndrome managed?

Answer 7

Admit to ITU

Thromboprophylaxis