Prevention and management of ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is considered as one of the significant complications of assisted conception. Its presentation may vary in severity with the mild form affecting about 33% and the more severe forms seen in around 3-8% of in-vitro fertilization (IVF) cycles. Exact aetiology of OHSS is unknown but it seems to be secondary to vasoactive products released by the ovaries after being exposed to human chorionic gonadotropin (HCG). This results in increased capillary permeability which in turn leads to leakage of fluid from the vascular compartment causing third space fluid accumulation and intravascular dehydration. Although mild and some moderate cases can be treated as outpatients, severe forms of OHSS need inpatient treatments which are mainly aimed at preventing complications like deep vein thrombosis, renal and liver dysfunction and acute respiratory distress syndrome (ARDS).