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Semin Reprod Med 2021; 39(05/06): 170-179
DOI: 10.1055/s-0041-1736492
Review Article

Ovarian Hyperstimulation: Diagnosis, Prevention, and Management

Paolo Emanuele Levi-Setti
1   IRCCS Humanitas Research Hospital, Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Milan, Italy
,
Noemi Di Segni
1   IRCCS Humanitas Research Hospital, Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Milan, Italy
2   Humanitas University, Department of Biomedical Sciences, Milan, Italy
,
Clara Gargasole
1   IRCCS Humanitas Research Hospital, Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Milan, Italy
2   Humanitas University, Department of Biomedical Sciences, Milan, Italy
,
Camilla Ronchetti
1   IRCCS Humanitas Research Hospital, Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Milan, Italy
2   Humanitas University, Department of Biomedical Sciences, Milan, Italy
,
Federico Cirillo
1   IRCCS Humanitas Research Hospital, Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Milan, Italy
› Author Affiliations
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Abstract

Ovarian hyperstimulation syndrome (OHSS) is a severe complication of controlled ovarian stimulation (COS). Pathogenesis of the disease is based on massive transudation of protein-rich fluid from the vascular compartment into the peritoneal, pleural and pericardial spaces, with a variable picture of clinical manifestations depending on its severity. Nowadays OHSS can easily be avoided by several prevention methods, ranging from identification of high-risk patients, choice of a correct protocol stimulation, trigger with gonadotropin-releasing hormone (GnRH) agonists or, finally, the freeze-all strategy. When OHSS occurs, it can usually be managed as outpatient care. Only if severe/critical cases are diagnosed hospitalization is necessary for appropriate rehydration, monitoring of fluid balance and eventual drainage of ascitic fluid. One of the most dangerous complications of OHSS is venous thromboembolism (VTE). Thromboprophylaxis has shown to be cost effective and widely used, while there are controversies regarding the usage of low dose aspirin (LDA) as a preventive measure.

Keywords

ovarian hyperstimulation syndrome - assisted reproduction technologies - diagnosis - prevention - management


Publication History

Article published online:
13 October 2021

© 2021. Thieme. All rights reserved.

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