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Abstract

Ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian stimulation as part of assisted reproductive technologies occuring during the luteal phase or during early pregnancy. HCG either applicated for ovulation induction or produced by the trophoblast is the most important trigger for developing OHSS. Fortunately, the reported prevalence of the severe form of OHSS is small, ranging from 0,5 to 5%. The most important factors which are involved in the development of OHSS on the cellular level are the tumor necrosis factor alfa (TNF-a), cytokines (IL-1, IL-2, IL-6, IL-8), the angiotensinrenin system and the vascular endothelial growth factor (VEGF), which is of central importance. The clinical course of OHSS may involve, according to its severity and the occurrence of pregnancy, electrolytic imbalance, hemodynamic changes, oliguria, pulmonary manifestations, liver dysfunction, thromboembolic phenomena and adnexal torsion. As there is no completely curative therapy for OHSS at present, the most effective treatment is prevention. Recognition of the risk factors leading to the development of OHSS makes prevention possible. Particular preventive strategies are: modifying the stimulation protocols, using a GnRH trigger (for those using a GnRH antagonist protocol), the use of plasma expanders at the time of oocyte retrieval, the freeze-all strategy, administration of dopamine agonists and metformin. These measures to prevent OHSS were successful in reducing the incidence of the syndrom.

Keywords
OHSS, Pathophysiologie, Therapie, Prävention, modifiziertes Stimulationsprotokoll

Ingrid Nickel
Kinderwunschzentrum Magdeburg
Reviewer: Sören von Otte, Kiel,
und Thilo Schill, Langenhagen

Nickel I. Ovarielles ... Gynakol Geburtsmed Gynakol Endokrinol 2017; 13(2): 116–131 publiziert 31.07.2017 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2017 ISSN 1614-8533