Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment

Objective: To overview the world literature on ovarian hyperstimulation syndrome (OHSS) and modes of prevention and treatment of OHSS. Study Selection: All the pertinent literature on OHSS, its prevention, and strategies for treatment were reviewed. Prevention: Key to prevention is proper identification of the population at risk, which includes women with either the hormonal or the morphological signs of polycystic ovarian disease, high serum estradiol (E-2) before human chorionic gonadotropin (heG) administration (E-2 > 4,000 pg/mL), multiple follicular response (>35), younger age, and lean habitus. When a high risk situation is recognized; ovulatory dose of heG may be reduced, avoided (with cycle cancellation), or substituted by gonadotropin-releasing hormone or its agonist. Luteal support with heG is to be bypassed. To minimize risk of OHSS, endogenous pregnancy-drived heG may be eluded by judicious cryopres-ervation of all embryos. Last, follicular aspiration will allow higher levels of E-2 and larger number of follicles to be matured with lesser risk of OHSS than conventional ovulation induction without follicular aspiration. Treatment: In-house for the severe and intensive care for the critical form. Meticulous fluid and electrolyte balance using both crystalloids and colloids (albumin) until hemoconcentration abates. Paracentesis is indicated for tight ascites, deteriorating kidney functions, and symptomatic relief. Diuretics may be prudently used once hemodilution is achieved. Dopamine drip may be used as a renal rescue, whereas heparin is indicated for thromboembolic phenomena and surgery reserved for abdominal catastrophies. Therapeutic interruption of an early gestation may be lifesaving when all other measures have failed. Conclusions: Although severe and critical OHSS may not be completely avoided, early recognition of high-risk factors, judicious prevention schemes, and treatment strategies should reduce the com-plications and long-term sequelae of this iatrogenic syndrome.