Ovarian Hyperstimulation Syndrome

(OHSS)

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Features

-  Syndrome which presents after stimulation of ovaries

-  Commonly during IVF cycles

-  Incidence

-  Mild form in 10-15% IVF cycles

-  Moderate 3-4% cycles

-  Severe 0.1-0.2 cycles

-  Mechanism

-  Increased capillary permeability from granulose cell secretions

-  Fluid shifts from intravascular to peritoneal & pleural cavities

 

Risks

-  Young age

-  Low BMI

-  PCOS

-  Pregnancy

-  hCG administration

 

Associated S/S

-  Decreased renal perfusion & excretion

-  Impaired liver function

-  Respiratory distress

-  Thromboembolism: DVT, PE

-  Haemoconcentration

 

Ix

-  U&E: renal function

-  LFTs

 

Mx

-  Prevention

-  Closley monitor IVF cycle

-  Cancel cycle if > 20 follicles develop or oestrogen levels too high

-  IV fluids

-  Paracentesis: drain ascities

-  Thoracentesis: drain pleural effusion

-  DVT prophylaxis: TEDS, Enoxaparin daily