Ovarian hyperstimulation syndrome (OHSS)

a potentially life-threatening complication of ovulation induction with exogenous human chorionic gonadotropin (hCG)

• Exogenous hCG is thought to be responsible for the massive luteinization of the ovarian granulosa cells.

• Formation of multiple ovarian follicles and corpus luteum cysts with rapid ovarian enlargement

• ↑ Release of vasoactive mediators (e.g., VEGF) that induce an increase in capillary permeability and consequent third spacing into the abdominal cavity

onset between 3 days (early onset) and ≥ 9 days (late onset) after hCG administration

• Abdominal pain and distention

• Nausea and/or vomiting

• Weight gain

• Ascites

• Oliguria or anuria

• Dyspnea

• Syncope

• Venous thrombosis

• Pleural effusion

• Laboratory analysis

  • Leukocytosis, ↑ Hct

  • Serum electrolyte concentrations and renal function tests

  • Liver function tests

• Transvaginal ultrasound: ascites and ovarian enlargement

• Mild and moderate cases (usually early onset): manage on an outpatient basis

  • Limit physical activity

  • Pain management with acetaminophen

  • Daily monitoring of body weight (should not increase by > 1 kg/day) and urine output

  • Sufficient hydration (1–2 L/day)

  • Paracentesis to relieve symptoms of ascites

• Severe cases (usually late onset)

  • Hospitalization

  • Multidisciplinary management approach: supportive care, monitoring, and prevention of complications (e.g., prophylactic anticoagulation)

• Sepsis

• Thromboembolism

• Pericardial effusion

• Arrhythmias

• Acute respiratory distress syndrome

• Acute kidney injury