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.
OHSS, Pathophysiologie, Therapie, Prävention, modifiziertes
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